Have you done your pelvic floor exercises today? For most the answer will be no. Although we all know we should be doing our pelvic floor exercises regularly there still appears to be a lack of information about what exactly the pelvic floor muscles are, how often we should be doing them and how this will benefit us. This enigma surrounding the pelvic floor may prevent us regularly completing these exercises.

Why Things Go Wrong

As a women’s health physiotherapist, the main pelvic floor dysfunctions I see include: stress incontinence, urgency/urge incontinence, nocturia, prolapse, perineal tears and vaginal/pelvic floor pain.

Pelvic floor dysfunction arises because of injuries, deterioration of the muscles, nerves, and/or connective tissue that support and control normal pelvic function. Some symptoms can be due to the bladder and not be any pelvic floor dysfunction which is where a thorough assessment is needed. Researchers DeLancey and Wei report that there is no hour during a woman’s life when these pelvic floor structures are more vulnerable than during childbirth. If the ligaments and fasciae within the pelvis were subjected to a continuous stress by a great force of abdominal pressure, they would stretch and pelvic floor dysfunction could occur, examples include: pushing during labour, repeated heavy lifting and heavy pulling (weeding). Changes in hormonal levels can also cause issues, pregnancy and menopause are examples as fluctuating hormone levels cause changes to our collagen and muscle fibres that provide support to our pelvic floor. It is at this stage that an increase in pelvic floor exercises would be appropriate.

A little bit of anatomy  

This was adapted from “Functional Anatomy of the Pelvic Floor and Lower Urinary Tract” (The Journal of Clinical Obstetrics and Gynaecology Volume 47, Number 1, 3–17). The pelvic floor consists of several components including the peritoneum, pelvic viscera, endopelvic fascia, levator ani muscles, perineal membrane, and superficial genital muscles. Phew! Looking mainly at the muscles there are two basic regions of the levator ani muscle, the main muscle that makes up the pelvic floor, the iliococcygeal and coccygeal portions form a relatively flat, horizontal shelf that spans the potential gap from one pelvic sidewall to the other. The second portion of the levator ani muscle is the pubococcygeus, the pubovisceral component that arises from the pubic bone on either side, forming a sling around and behind the pelvic organs providing support for the bladder, uterus and bowel.

How To Do a Pelvic Floor Contraction

Knowing our pelvic floor starts round by our back passage, and actually this is where the largest bulk of the pelvic floor is, this is a good starting point to perform a pelvic floor contraction. Squeeze your back passage as if trying to hold in wind, then imagine you are trying to pull your perineum upwards before finally pulling up the urethra (where you pee) as if you are trying to hold in urine. Never actually try this technique on the toilet though as it can be confusing to your bladder.

There are 2 types of pelvic floor contraction: Short, strong quick exercises – try pulling up as strongly as you can with your pelvic floor but don’t hold at the top, immediately release.

The second type is slow, endurance exercises; try pulling up between 50-100% of your maximum contraction and hold for up to 10 seconds.

Some people are taught to ‘ladder’ up and down with the pelvic floor, i.e. lifting up and down in sections. Although this is a good exercise and allows some good awareness of pelvic floor contraction, it is not particularly functional i.e. in day to day activities your pelvic floor would not often need to ‘ladder up’. However if you find it useful then feel free to incorporate it into your exercise programme.

When To Do A Pelvic Floor Contraction

Aim to complete about 10 quick and 10 slow pelvic floor exercises several times a day. Try and give yourself triggers to remember that you do several times a day like brushing your teeth, putting the kettle on, talking on the phone, washing your hands, traffic lights, feeding baby etc. Remember that lying is the easiest position to complete a pelvic floor exercises, then increasing in difficulty, sitting, standing, squat standing, so try and vary these positions to perform your exercises.

Any questions about this then please do not hesitate to contact me.