What is the pelvic floor?
It seems that nowadays everyone is talking about the pelvic floor muscles and how important they are. But do you actually know what the pelvic floor is and why it is so important? Put simply, the pelvic floor is the group of muscles that join the front of the pubic bone to the coccyx (tailbone) at the base of the spine (fig.1).
These muscles are very important because they help to:
- maintain continence by closing the sphincters of the bladder and bowels
- give support to the pelvic organs
- give support to the pelvis to create stability while we move, walk or stand
- enhancing sexual activities
Fig. 1 – Lateral view of the pelvic floor muscles supporting the bladder, uterus, and rectum.
* Yes, that’s right they are the ones working to prevent us from peeing when sneezing, coughing, laughing or when doing sports, helps us to hold when we need to have a bowel movement or release wind, keeping the bladder and womb in the right place and enjoying pain free and satisfactory sex.
The pelvic floor muscles don’t act alone, they work closely with the abdominal muscles, the muscles on the lower back, and the diaphragm – that topic in itself deserves a whole new post but I’ll keep it simple today – The work of all these muscles help to give good stability to the core and keep all the functions mentioned above working well.
On this post, I will teach you how to find your pelvic floor muscles and how to activate them.
However, I want you to keep in mind that these muscles are part of the team of muscles I mentioned above, so working only on these muscles may not be enough to completely resolve some of your problems. Therefore, the first “DON’T” is – DON’T give up on pelvic floor exercises (commonly known Kegels) if you have tried everything already and haven’t seen any changes. Perhaps you weren’t using the right technique or you weren’t doing exercises addressing the whole team of muscles (diaphragm, abdominal, and lower back muscles).
Going back to the pelvic floor muscles, as I mentioned before, like any other muscle in our body they can become tight, weakened, shortened or overstretched and painful. This can happen in any stage of a woman’s life and can be due to a number of different reasons including painful periods, repetitive straining because of constipation or high impact exercises, pelvic pain, pregnancy or childbirth, pelvic surgery or menopause, which can all affect the way these muscles work.
Are pelvic floor exercises safe to do?
The answer to this question is yes, BUT there are some things you should have in mind when doing the exercises. It’s not a matter of just doing them, it is more about how you do them because if they are not done well, they cause more problems or will not help you at all. This was the reason why I decided to write this (long!) article about it, so please keep reading it until the end 🙂
Having said that, the pelvic floor exercises are safe to do in any stage of a woman’s life unless your doctor or women’s health physiotherapist has advised you otherwise.
After childbirth or pelvic/gynecological surgery, you can start exercising your pelvic floor as soon as the catheter is removed (if you had one) or as soon as you start having control over your muscles. It is also safe to start your pelvic floor muscle exercises if you have stitches as the exercises will help to reduce swelling, discomfort and will encourage healing.
How to exercise your pelvic floor?
The best way to activate your pelvic floor muscles is to tighten around the front and back passage at the same time as if you were trying not to pass wind and urine. To help you understand better if you are using the correct muscles, you can press gently with one finger on the back passage while you activate your pelvic floor muscles. You should then be able to feel a gentle contraction.
It is normal to have a decreased sensation on your pelvic floor muscles after childbirth, pelvic/gynecological surgery or if it’s the first time you are trying to do them. Time and training will improve your sensations and improve your ability to activate your pelvic floor muscles.
DON’T hold your breath when doing pelvic floor exercises
It is very important that when you squeeze your pelvic floor you continue to breathe and avoid holding your breath – ideally, you should squeeze on an out breath. You should also avoid tightening your buttocks or inner thighs. You may feel a light contraction of your tummy muscles when you are squeezing your pelvic floor muscles, and that’s okay as long as you squeeze your pelvic floor muscles first, keep breathing throughout the contractions and don’t pull them too hard.
DO relax your pelvic floor muscles fully between each contraction
It is also very important that after a pelvic floor muscle contraction you allow a full relaxation to happen. The pelvic floor muscles need to be able to squeeze and relax and to move up and down to respond to the changes in the pressure inside the tummy when we breathe, cough or laugh. A lot of women think they have to squeeze the pelvic floor muscles all the time as they are so worried about muscle weakness and are afraid of leakages. Please remember that only tightening the muscles and not letting go or fully relaxing them between each contraction or during your daily activities can lead to dysfunction and pain!
DON’T continue to do your exercises if you have pain
If you have pain when squeezing the pelvic floor muscles this means that you need to see a women’s health physio for an assessment. Activating the pelvic floor muscles shouldn’t be painful.
DO short and long squeezes
There are two types of contractions you can do when you squeeze the pelvic floor muscles; fast or short squeezes and long or slow squeezes. These two types of contractions reflect two different abilities of these important muscles. The short or fast squeezes are necessary when the intra-abdominal pressure is raised suddenly in activities such as laughing, coughing, sneezing or lifting weights and the pelvic floor muscles need to contract rapidly to close the sphincters and avoid leakage of urine or stools/wind. The long or slow squeezes reflect the endurance capacity of these muscles. It means that the pelvic floor muscles need to be able to keep an underlying tension and bounce gently up and down to give good stability to the pelvic organs and to the pelvis while we move, walk, run or stand. This type of contraction is also useful in situations where you feel the urge to go the toilet but you need to hold it for a little while.
If you have a healthy and functional pelvic floor you should be able to do 10 short squeezes, and 10 long squeezes holding for 10 seconds each, keeping the same strength throughout and good coordination and ability to relax. These are some of the things a women’s health physiotherapist would be looking for when assessing your pelvic floor.
On this note, DON’T PANIC if you find it very hard and tiring to activate the pelvic floor muscles and keep the contractions for as long as 10 seconds!!
It’s the same as going to the gym, we don’t start by doing all the exercises correctly on the first try, nor do our muscles become strong with only one go. You may also find that you need the help of a women’s health physiotherapist to help you to understand where the muscles are, teach you the correct technique, and give you a specific and individualized exercise program.
DON’T be too hard on yourself.
You should start your exercises by doing only what you find easy to do and pain free – this is very important!
Start by DOING your exercises once a day. You may find that initially you can only do 5 short squeezes plus 5 long squeezes holding for 5 seconds each, and that’s okay. As soon as you find it easier you can start gradually increasing the number of repetitions up to 10 of each.
DO squeeze the pelvic floor muscles before and during sneezing, coughing, laughing or lifting weights and then relax.
This exercise is called “the Knack” which is a voluntary and timed contraction of your pelvic floor muscles before and during any increase in downward pressure on the pelvic floor. This is an amazing technique and if you are struggling with urinary incontinence or pelvic organ prolapse you can start feeling improvements as soon as you try it!
Being a mum, a grandmother, a wife, and/or a working woman with a million things to do every day besides caring for yourself can make life very tiring, busy and overwhelming so you may find it easier to link your pelvic floor exercises with your daily routine. The exercises can be done in any position so you can DO them while you are driving or on the train to work.
DON’T do your pelvic floor exercises when you are passing urine as this may lead to poor bladder emptying and result in urinary infections!
Even if you do your pelvic floor exercises as explained above, it can take between 3 to 6 months for your pelvic floor muscles to improve strength, coordination and endurance especially if you had a baby or pelvic/gynecological surgery. So please, DON’T lose hope and you will see that sooner rather than later the effort will lead to good results!
If you had a baby recently, hormones will keep your muscles more flexible and stretchy up to 3 months after you finish breastfeeding. So again, DON’T be too hard on your body and allow time for things to get back to normal.
After the 6 months and after achieving your goal it is recommended that you continue to DO your exercise program as this will help to keep the muscles strong and will avoid problems later in life.
What is the best way to start doing pelvic floor exercises?
The posture that I recommend to all my patients initially, is to start doing the pelvic floor exercises lying on your back as shown in figure 2.
Fig 2 – How to start doing your pelvic floor exercises
Pelvic floor muscle training lying on back:
- Lying on your back breathe in through your tummy.
- Then slowly breathe out and squeeze the pelvic floor muscles by tensing the muscles around the front and back passage and pulling your belly button gently in.
- You can then let go while you breathe in.
- Make sure you have your shoulders relaxed throughout the exercises.
- Give yourself a moment to fully relax and then restart when you are ready. You can use this posture to do the short and long squeezes and once you find it easy to do them in this posture you can start doing the exercises sitting or standing.
Ideally, every woman (with problems or not) should have an initial assessment with a women’s health physiotherapist to be assessed for pelvic floor dysfunction and to be taught the correct technique on how to squeeze and completely relax the pelvic floor muscles.
If you are experiencing any symptoms you should book an appointment to see a women’s health physiotherapist to help you improve your symptoms and guide you through an individualized exercise program.
Please DON’T think that because you had a baby (or more than one)… or you’re menopausal…or you feel “old”…, that having these symptoms is normal because it’s not! Symptoms are just a way of the body telling us that something is not right and needs help. And lucky for you, science and medicine are evolving so much that there is a solution for each and every one of the symptoms listed and they don’t always require medication or surgery!
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