Train the pelvic floor well and often enough so that it responds to the demand at hand.

Do I Need Pelvic Floor Exercises?


The pelvic floor muscles support the pelvic organs, bladder and bowel as well as sexual function in both men and women.

These muscles develop strength in response to the demands placed on them. If the pelvic floor muscles are weak or functioning poorly, you need some form of pelvic floor exercise.

How do I know if I have weak pelvic floor muscles?

Pelvic floor problems can occur when the pelvic floor muscles are weakened, stretched or too tight. You may experience one or more of the following signs or symptoms:

  • leaking urine when you exercise, laugh, cough or sneeze
  • having to hurry to the toilet or not making it there in time
  • frequently needing to go to the toilet
  • difficulty to emptying the bladder or bowel
  • unintentional loss of faeces or wind
  • pelvic pain
  • a prolapse
    – in women, a sensation of bulging into the vagina, discomfort or heaviness, or a feeling of pulling, dragging or dropping down
    – in men, a noticeable bulging coming out of the rectum, a feeling of needing to use your bowels but not needing to go
  • pain during sexual intercourse
  • poor sensation or loss of bladder control during sexual intercourse

 

You need pelvic floor exercise if your pelvic floor is weak or functioning poorly

 

Where is the pelvic floor?

The pelvic floor is an integral part the core. The core can be pictured as a simple canister with four components:

Pelvic floor muscle – the base

Diaphragm, the breathing muscle at the top

Deep transverse abdominis, to the front

Deep back muscles multifidi, to the back
Continence Foundation of Australia 2011

 

All components need to work in harmony in order to provide a well-functioning base for the rest of the body. This team of muscles works together to balance muscular forces and pressures to achieve dynamic central stability.

Probably the most important aspect of the core is a person’s ability to maintain and regulate intra-abdominal pressure. For example, when you lift something, cough, sneeze or laugh or when you exercise, the pressure needs to be managed. It’s important that the pressure remains stable so that:

there is no bearing down on the pelvic floor

there is good pelvic control of the bowl and bladder

there is support for holding the pelvic organs in place

back health is promoted

Essentially you need to be as strong on the inside as you are on the outside

How do I find my pelvic floor muscles?

The pelvic floor muscles are located in the pelvic cavity. They attach at the front to the pubic bone to the back at the tailbone as well as to each side at the sit bones. It slings like a hammock from front to back and from side to side.

See exactly with this 3D-animation of the female pelvic floor muscles where it’s located and why it’s important to train with pelvic floor exercise.

How to contract your pelvic floor muscles

Pelvic floor exercise involves a gradual increase in the load, just as you would train any other muscle group. Try this exercise below to identify the correct muscles to contract and lift as you exhale. It is important to not activate or contract any other muscles like the inner thighs or glutes whilst specifically training the pelvic floor:

  1. Find good posture seated: sitting with tall posture on a chair or Swiss stability ball. Keep the shoulders, butt, legs and toes relaxed. Maintain an elongated spine with a natural curve in the lower back.
  2. Allow the breath to flow evenly in and out.
  3. Intentionally relax all muscles on the outside of the body and also internally – these are the abdominal and pelvic floor muscles, as though you would release the flow of urine.
  4. Take a breath in, as you exhale activate the pelvic floor muscles by lifting and squeezing the back passage as if you would stop wind. Then bring that same effort to the front as though you would stop the flow of urine. Keep lifting and squeezing inside whilst you keep breathing.
  5. Relax all muscles and rest a few seconds.
  6. Repeat the effort – on your next available exhalation, lift and squeeze at the back then at the front, keep lifting and breathing comfortably as your legs and buttocks stay relaxed.
  7. Gently let everything go by relaxing on the inside.
  8. One set is 8-10x repetitions, holding the contractions for 2-3 seconds at a time and slowly building up to 10 seconds. This can be repeated 3 times a day

The pelvic floor should relax after it contracts in order to work properly

 

These are general guidelines for finding and recruiting the pelvic floor muscles. Please consult your women’s health physiotherapist for more specific advice on execution, technique correction, the length of repetitions etc. and to see which pelvic floor exercises are most appropriate for you.

More on Pelvic Floor Exercises

If you have pelvic floor issues you will need to start with safe pelvic floor exercises. Safe exercises for the pelvic floor are those that provide a good level of support whilst exercising. These exercises are relevant for the time when you are learning to manage your pelvic floor so that you can later do more vigorous or high intensity exercise.

The goal is to train the pelvic floor well enough and often enough so that you maintain good muscle integrity and function. Ultimately you want to be able to exercise so that it responds to the activity and intensity required of it.

Some examples of safe pelvic floor exercises are:

Low Impact Cardio Exercise:

Walking uphill or on soft terrain like grass/sand

Seated cycling or cross-trainer (low resistance)

Swimming

Water aerobics

Resistance Exercises with the following precautions:

Reduce the weight initially so that you don’t feel pressure down on the pelvic floor

Select supported positions (eg seated machines or sitting on a Swiss ball) using dumbbells

Reduce squat and lunge depth

Modify overhead exercises

Limit strong abdominal exercises, hold “core” exercises no longer than 10 seconds

Think about lifting the pelvic floor during simple exercises

Do contract the pelvic floor on the exhalation

 

Remember that what works well for one person may not necessarily work well for another. An individualised assessment is always the best option to determine the most appropriate exercise program for yourself.