As women, most of us know we HAVE a pelvic floor (men do too by the way ;-)). Some of us even know vaguely where it is. But most women I meet aren’t 100% sure how to activate the muscles or how to best look after them. So let me shed some light on it!

What is the pelvic floor?

Your pelvic floor is a group of muscles and ligaments that attach to your pubic bone at the front and your tailbone at the back. It is similar to a ‘hammock’, forming the base of your pelvis and providing support to the bladder, uterus and bowel.

What does it do?

When it functions properly, your pelvic floor helps to ensure proper bladder and bowel function, prevent prolapse of your organs, work with other ‘core stability’ muscles to support your lower back and can also increase sexual pleasure.

What causes weakness in the pelvic floor?

  • Childbirth, especially having a large baby or a prolonged pushing stage.
  • Constipation
  • Repetitive heavy lifting
  • Being overweight
  • Repetitive coughing
  • Menopause
  • Ageing

How can I prevent damage?

To prevent damage to your pelvic floor, try to minimise your risk factors. You can:

  • Ensure adequate fibre intake to avoid constipation and minimise straining with a bowel motion
  • Avoid or minimise heavy, repetitive lifting
  • Maintain a healthy weight
  • Do regular, low impact exercise (such as walking, and swimming)
  • See a good physio for assessment and guidance before returning to any high impact exercise (such as running, jumping) or lifting heavy weights.
  • Exercise your pelvic floor regularly and practice it in different positions.

What are the symptoms of Pelvic Floor Dysfunction?

Sometimes, you won’t have any symptoms of pelvic floor dysfunction at all. But usually, you will have one or more of the following:

  • Incontinence (leakage of urine or faeces) or poor control of wind
  • Symptoms of prolapse – a feeling of a bulge in the vagina, or a feeling of heaviness, dragging or pulling in the pelvis/vagina
  • Pain in the pelvis, lower abdominals or rectum
  • Difficulty starting a bladder or bowel motion
  • A feeling of incomplete emptying of the bladder or bowel
  • Urgency in needing to make it to the toilet, or not making it in time
  • Frequent need to urinate

Did you know your Pelvic Floor can also be too ‘tight’ or ‘hypertonic’?

When we think about pelvic floor dysfunction, we usually think of it being weak and needing to be strengthened. However, the pelvic floor can also be ‘hypertonic’ or too ‘switched on’. This means it has a hard time relaxing and lengthening, and pelvic floor strengthening can sometimes make matters worse. The symptoms of a hyper tonic pelvic floor can include:

  • Tailbone pain when sitting
  • Haemorrhoids
  • Straining to empty bladder or bowels
  • Trouble initiating a bladder or bowel motion
  • Pain on sex or insertion of tampon

How can I strengthen my pelvic floor?

It is recommended that you exercise your pelvic floor every day to maintain or improve strength. Remember though that for some women, they need to learn to lengthen before they can strengthen (i.e in the case of a hypertonic pelvic floor). So make sure you have a clear understanding of what your needs are before you start a program.

Exercises
Basic pelvic floor activation

1. Sit or stand up tall, lie on your back with your knees bent up or kneel on your hands and knees.
2. Imagine what muscles you would use to ‘hold on’ or stop yourself from passing urine and slowly tighten them.
You should: 
– feel a squeeze and a ‘lift up’ inside you
– continue breathing
You should not:
– feel a downward movement
– feel a tightening of your thighs or buttocks
– hold your breath

Exercise 1 – Long holds for strength

1. Tighten your pelvic floor muscles around your front passage, vagina and back passage as strongly as possible and hold for three to five seconds.
2. As you relax the muscles, you should feel a definite ‘let go’. Build up to 10 sec holds and do 5-10 repetitions. Try to fit in 3 sets of these every day. Vary the position you practice this exercise in.

Exercise 2 – Quick holds for power

1. Squeeze and lift your pelvic floor muscles as strongly and as quickly as possible. Do not try to hold on to the contraction; just squeeze and let go.
2. Rest for a few seconds in between each squeeze. Repeat this 10 times or until you feel your pelvic floor muscles fatigue. Try to fit in 1-3 sets per day.

Don’t forget to use it when you really need it!

Exercise 3 – Functional bracing

Try to activate your pelvic floor BEFORE any activities that place strain on it, such as lifting, coughing, sneezing, laughing. To encourage a recoil contraction of your pelvic floor, breathe out just before and during the action.

If you suspect you have a hypertonic pelvic floor, chat to your physio to ensure you are doing the most appropriate exercises for you

* Even with good cues, some women find it difficult to know if their pelvic floor is activating properly. There are a couple of ways to test this, including the use of real-time ultrasound, an internal examination by a women’s health physio, or a self examination. For more info, get in touch with me and we can have a chat about your options!