The Pelvic Floor and Physiotherapy

What is the pelvic floor?

The pelvic floor is the collection of muscles and connective tissue that make up the floor of the pelvis.
The muscular component stretches like a sling from the pubic bone at the front to the tailbone at the back, and consists of a deep layer and a superficial layer.



What do the pelvic floor muscles do?

1. Upwards support for the pelvic organs i.e. bladder, uterus, and bowel
2. Maintain bladder and bowel control
3. Play a role in sexual sensation and function
4. Work with the deep abdominal, back muscles, and diaphragm to support your spine. All these muscles together make up the ‘core’.


Why should we do pelvic floor exercises?

Like any muscle, these muscles need strengthening and endurance training for optimal function, especially:

– During pregnancy, where the pelvic floor muscles are loaded much more than usual due to the extra weight of growing baby, uterus, and extra fluid. Pregnancy is also a time where, due to hormone changes, our connective tissues are softer and more extendable, which can stretch the pelvic floor fascia around our pelvic organs.

– After a vaginal delivery, where the pelvic floor muscles and connective tissue are hyper stretched and potentially torn as the baby passes through the vagina during birth

– In the presence of prolapse, to help support the pelvic organs against gravity from below. A prolapse usually occurs when the connective tissues holding firm the pelvic organs have loosened or stretched.

– With stress incontinence symptoms, to prevent urine leakage by closing the urethra during activities of high abdominal pressure e.g. coughing, sneezing, and lifting.

– With urge incontinence symptoms, to help close the urethra during overactivity of the bladder or irritation of the bladder to prevent urine leakage.


How do I do pelvic floor exercises?

For most people, pelvic floor exercises are hard simply because they don’t know enough about the pelvic floor and how to exercise it best.
This is understandable as pelvic floor muscles are essentially internal and do not perform visible bodily movement. Therefore, using mental imagery is a good way to help understand how to do perform a correct pelvic floor lifting technique.

Some common examples are:

• Imagining lifting up and in to prevent a tampon from falling out

• Drawing the vagina up and away from the chair you are sitting on

• Squeezing and lifting up around the urethra (front passage) as if to stop the flow of urine.

• Squeezing and lifting up around the anal sphincter (back passage) as if to stop the passing of wind.

• Imagining a droplet of water hitting water and creating ripples outwards on the surface of the water. A pelvic floor muscle contraction is the opposite action: a gentle drawing inward of the ripples followed by the lifting back up of the droplet.



As well as being able to contract and lift, it is equally important to also be able to fully relax your muscle between repetitions.

Start by holding your contraction for as long as you feel it is able to. Initially, this may only be 1-2 seconds. As your strength and endurance improves, aim to gradually increase this hold to 10 seconds.

Start by only doing 3-5 holds each time you practise – stopping when your muscles feel fatigued. Gradually building up to 10 holds.


What is the best dosage for pelvic floor exercise?

Doing any pelvic floor exercise is certainly better than none at all!

Especially during pregnancy, post-natally and post menopausal, ideally all women should be doing pelvic floor exercises at least once a day.

You can do your pelvic floor exercises in lying, sitting or standing. If you are having difficulty feeling the contraction, it is easiest to start in lying.

If you are learning how to do pelvic floor exercises for the first time, it is beneficial to do less more often during the day. For example 10 lift holds, 3 times a day.

Usually the maintenance dosage is only once a day; performing 3 sets of 10 holds or for a total of two minutes.

Finding the time to do these exercises may seem tricky but consider this:
We spend 2 minutes every morning and night looking after our oral health, two minutes a day for pelvic health should not be less of a priority!

If you are regularly forgetting to do your pelvic floor exercises, try and link the exercises with a task that you daily. Or put a reminder on your phone or even put a dot on your mirror in the bathroom or on you clock next to bed to help remind you.



What NOT to do during pelvic floor exercises.

• Stopping and starting the flow of urine every time you go do the toilet.
Certainly for some women this can help us work out how to contract the right muscle but this is not the safe way to exercise the pelvic floor every time.

• Over doing it with hundreds of repetitions every day.
This may do you harm by making your pelvic floor stiff, sore, and overactive, thereby negatively affecting its normal function.

• Holding your breath or bracing your abdominals whilst doing a pelvic floor lift.
This increases your internal abdominal pressure, which put more downward pressure against your pelvic floor lift.

• Squeezing and contracting your gluteal (buttock) and adductor (inner thigh) muscles at the same time.
It is important to learn to isolate the pelvic floor muscle to activate without other muscles co-contracting.

See your doctor or women’s health physiotherapist if:

• You are not certain how to contract your pelvic floor muscles
• You cannot feel a lift and squeeze of your pelvic floor when performing the exercise
• You have no improvement after a few weeks or worsening of any bladder and bowel symptoms
• You feel a heaviness or bulge in your vagina
• You feel downward pressure during the exercise

Empower yourself by understanding your pelvic floor better for better pelvic health now and in the future.

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