Pelvic Floor, Exercise and Pregnancy

What are the Pelvic Floor Muscles?

The floor of the pelvis is made up of layers of muscle and other tissues. These layers stretch like a hammock from the tailbone at the back, to the pubic bone in front. A woman’s pelvic floor muscles support her bladder, womb (uterus) and bowel (colon). The urine tube (front passage), the vagina and the back passage all pass through the pelvic floor muscles. Your pelvic floor muscles help you to control your bladder and bowel. They also help sexual function. 

What Weakens the Pelvic Floor?

Pelvic floor muscles weaken for similar reasons to other muscles in our bodies: natural ageing and inactivity. But pelvic floor muscles are also often weakened through hormonal changes, pregnancy, heavy lifting and childbirth. Factors such as being overweight, ongoing constipation and a chronic cough can put extra pressure on the pelvic floor.

What is Stress Incontinence?

Women with stress incontinence – that is, women who wet themselves when they cough, sneeze or are active – will find pelvic floor muscle training can help in getting over this problem. This is VERY common. 

How do I know I’m contracting my pelvic floor muscles?

When sitting on the toilet to empty your bladder, try to stop the stream of urine, then start it again. Do this to learn which muscles are the right ones to use –but only once a week. Your bladder may not empty the way it should if you stop and start your stream more often than that.

How do I do my pelvic floor muscle training?

  1. Sit or lie down with the muscles of your thighs, buttocks and stomach relaxed.
  2. Squeeze and draw in the muscles around your back passage and your vagina at the same time as if you are trying to stop passing wind. Lift them UP inside. You should have a sense of “lift” each time you squeeze your pelvic floor muscles.
  3. Try to hold them gently then let them go and relax. You should have a distinct feeling of “letting go”.
  4. Squeeze and let go a couple of times until you are sure you have found the right muscles.

If you don’t feel a distinct “squeeze and lift” of your pelvic floor muscles, or if you can’t slow your stream of urine – book in for a Women’s Health consult and I can help you find them! 

Do your pelvic floor muscle training well

Fewer good squeezes are better than a lot of half hearted ones! It is useful to practice some quick contractions but the muscles need to contract to their maximum and fully relax each time. Not relaxing the muscle completelty after each contract can cause your pelvic floor to become stiff and painful. It also refuced the blood flow to the muscles and can cause your pelvic floor to fatigue.

When to seek help

  • If you cannot feel your muscle hold or relax
  • If you cannot feel a definite lift and squeeze
  • Feel any downward pressure on your pelvic floor during or after the exercises
  • Feel you have made no progress or improvements in your bladder or bowel control within 3 weeks of doing regular pelvic floor exercises
  • Remember – exercise is not the answer for everyone, if you have pain, or pain with intercourse or any other symptoms you are best to check in with your health professional for individualised advice. 

How long will it take and what do I do?

Lets think about the job of your pelvic floor and why it is important to train the muscles differently just like any other muscle!

  1. To prevent leakage with cough and sneeze – the pelvic floor needs to turn on quickly and with sufficient strength. Meaning we must incorporate strength and speed work. 
  2. To prevent leakage when urgent/busting to go to the toilet – the pelvic floor is required to hold on or contract over longer periods. The pelvic floor needs to be ‘specifically’ trained to improve its endurance

To fully rehabilitate a weak pelvic floor the literature suggests 3-5 months of regular and progressive PFMT is required (1).

Standardised Exercise Prescription for your Pelvic Floor

Body Position: While lying down, sitting or standing

  • Keep breathing
  • Don’t tighten your buttocks
  • Keep your thighs relaxed

Frequency: On average 3 – 4 x per week.

How often: Repeat 3 sets x per training day, Aim for 10 quality contractions in total with each set

One set will have 10 reps total: 7 endurance and 3 speed/power

Rest in between each contraction and make sure your pelvic floor switch off/fully relax this might take 10 -15 seconds!

 

Exercise 1 endurance muscle

REPEAT 7 reps – aim to gently hold and lift working up towards 8 seconds If you can’t hold for 8 seconds, just hold for as long as you can. 

 

Exercise 2 speed/power muscle

REPEAT 3 reps– aim to gently contract and then relax within 0.5 of a second

I have included a fabulous link to audio by Jaclyn Thurley who is a Pelvic Physiotherapist at Sydney Pelvic Clinic.

https://www.sydneypelvicclinic.com.au/three-basic-principles-to-improve-your-pelvic-floor/

It is never to late to change your pelvic floor health and function! Call us on 9756 7424 to book in with Loulou Negoescu – one of our Physiotherapists. 

Reference List

  1. Bø, K. (2006). Can pelvic floor muscle training prevent and treat pelvic organ prolapse? Acta Obstetricia et Gynecologica Scandinavica, 85(3), 263-268. doi:10.1080/00016340500486800
    Thompson, J., & O’Sullivan, P. (2003). Levator plate movement during voluntary pelvic floor muscle contraction in subjective with incontinence and prolapse; a cross-sectional study and review. Int Urogynecol J Pelvic Floor Dysfunct, 14(2), 84-88.

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