Female pelvic floor exercises

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Why are the pelvic floor muscles important?

The pelvic floor muscles form a broad muscular sling across the base of the pelvis. These muscles support the position of the pelvic organs and help the closure and control mechanisms of the bladder and bowel.

Incontinence and prolapse (symptoms of pelvic laxity and vaginal tissue bulging) are all too common problems for women of all ages, with many factors contributing to symptoms:

• Pregnancy and childbirth.
• Sustained coughing.
• Chronic constipation.
• Hormonal changes.
• Occupational heavy lifting.
• Collagen deficiency.
• Being overweight.
• The process of ageing.

Some of these factors are difficult to address but clinical evidence shows that these symptoms can be improved by strengthening the pelvic floor muscles with a simple but dedicated programme of daily, varied exercises.

How do I identify and work the pelvic floor muscles?

Close the muscles of the back passage, as if you are trying to stop yourself from passing wind. Once you feel the back passage drawing in, try and work this feeling forward into the vagina, as if closing the urinary passage too. This feeling of ‘squeezing and lifting’ internally is the basic pelvic floor contraction.

Always work with easy effort and easy breathing: No jaw clenching or tension in your face. Try not to tighten your buttocks or inner thigh muscles, or hold your breath as you work. Try also to feel how the muscles ‘let go’ when you stop working them.

Should my stomach muscles be working too?

The abdominal muscles can help the muscles of the pelvic floor to work well. As you get the idea of ‘lifting internally’, you will feel the stomach wall draw in. You can practice this.

• Relax your stomach. Gently draw in the lower part of your stomach wall towards your spine. Hold this with easy effort and with easy breathing for a few seconds before letting go.

Try working these two muscle groups at the same time. Feel how these muscles support your pelvic tissues. If you are unsure about the exercises, a specialist Chartered Physiotherapist will be able to advise you.

An internal examination may be helpful to assess the strength in these muscles. When you are confident with these basic instructions, you are ready to start a more varied exercise programme.

Your pelvic floor exercise programme

Work in any comfortable position: sitting, standing, lying on your side or on your back.
There are 4 exercises:
The basic instruction is the same with each exercise: Start by tightening the muscles around the back passage, squeeze and lift, forwards and up. Your stomach muscles will work too but try to
keep the focus on the pelvic floor muscles.

1. Maximum hold
   Slowly tighten the pelvic floor muscles. Aiming to hold for up to 10 seconds.
2. Fast speed:10 in a row
   Pull up and release the pelvic floor muscles quickly.
3. Controlled stages: 3 little lifts
   Draw up the pelvic floor muscles in 3 stages. Tighten a little around the back passage, the middle and then the front. Try to also let go in stages, front, middle, back.
4. Sustained work
   Pull up the pelvic floor muscles a little and maintain this strength for up to 20 seconds.

How many exercises and repetitions should I do?

• Try x 2 or 3 repetitions of each exercise, 2 or 3 times a day.
• These muscles do tire quickly in the early days so don’t forget to rest for a short time between contractions.
• Try to work out a daily varied exercise programme to suit you, maybe linking your exercises to something you do regularly.

Your physiotherapist will advise you on your personal programme. It will take 3 to 6 months of regular practice to make a difference to weak muscles.

Why is functional work important?

Always try to tighten the pelvic floor muscles and draw in the muscles of the lower abdominal wall in advance of any exertion, especially when coughing, sneezing, laughing or lifting. If urinary urgency is a problem, try to anticipate the times when your bladder is tricky and vulnerable to leaking. Tighten these muscles just a little, aiming to hold for a full 20 seconds. This should help calm the activity of the bladder and block sensations of urgency.

Remember

• It is also very important to avoid constipation and straining when opening your bowels.
• Try to minimise the amount of lifting you do by sharing the task or reducing the load.
• Be aware that if you are overweight, the extra pounds will be contributing to the downward load onto the pelvic floor.

Further information

Bladder and Bowel Foundation