Pelvic Floor Muscles Explained
All muscles need to be exercised to keep them strong. This advice page will enable you to become familiar with your pelvic floor muscles, and provides a guide to exercises. These exercises may be used by women who already have strong pelvic floor muscles and want to keep them toned, and women who have weakened muscles and want to improve their strength.
Pelvic floor exercises can assist with
- Better bladder and bowel control
- Improved muscle tone during pregnancy and childbirth
- Increased vaginal tone
- Prevention/correction of prolapse
What is the pelvic floor?
The pelvic floor is made of layers of muscles stretching like a tight hammock from the pubic bone in the front, to the base of the spine. There are three openings through the pelvic floor for the urethra, vagina and bowel.
Surrounding the openings to the urethra and the bowel are tight circular bands of muscle called sphincters. These act like valves and are normally closed. When urine is passed through the urethra or faeces through the anal sphincter, the muscle floor relaxes and the sphincter opens. The muscles tighten again and the sphincter closes.
When the pelvic floor muscles are strong the bladder, uterus and bowel are well supported in the pelvis and the sphincters will control the flow of urine and faeces reliably. The muscles surrounding the vagina are also part of the pelvic floor and can he tightened or relaxed voluntarily. They can also contract involuntarily as they do during orgasm.
Benefits of stronger pelvic floor muscles
- Helps prevent the bladder from leaking under pressure (eg when you cough, sneeze or jump).
- Enables you to hold on longer when you get the urge to go to the toilet in a hurry.
- Will better support the uterus during pregnancy. This may reduce pressure on the bladder and lessen the likelihood of back or pelvic aches.
- Will help you to recover more quickly after the birth and to resume activities such as lifting and sport.
- Your vagina becomes firmer as the muscles increase in strength and this may increase your sensation during sexual activity.
- With stronger muscles the bladder, uterus and bowel will be better supported from below which can prevent prolapse.
- The exercises can assist with the management of mild prolapse in some women.
What are the effects of weakened pelvic floor muscles?
If the pelvic floor muscles are weakened the sphincters may not close as tightly allowing leakage from the bladder or bowel. The weakening may also result in the bladder, uterus or bowel slipping down from their usual position This may mean that the bladder, uterus or bowel bulges into the vagina (called a prolapse) which can cause one or more of the following:
- Leakage of urine, which may occur when coughing, sneezing, laughing or during exercise (often called 'stress incontinence').
- Needing to pass urine or use your bowels urgently.
- Difficulty having a bowel movement.
- Less sensation when the vaginal muscles are tightened.
- Feeling of something pushing down into the vagina.
- A deep vaginal ache, particularly late in the day.
- Referred pain to the back.
Pregnancy and childbirth are the most common causes of weakened pelvic floor muscles. During pregnancy there is increased pressure on the pelvic floor and childbirth can stretch or damage the muscles. The effects of this may only become apparent years later. There are several other factors that may contribute to a weakened pelvic floor:
- Chronic coughing.
- Straining or bearing down when using bowels or passing urine.
- Constipation which can cause pressure on the pelvic floor and bladder.
- Pressure due to obesity.
- Lack of use of pelvic floor muscles.
- Some types of pelvic surgery which may involve the muscles.
- Decreased oestrogen particularly after menopause. This reduces the elasticity of the muscles.
Becoming familiar with your pelvic floor muscles
Before beginning your exercises it is useful to become familiar with the muscles in the pelvic floor and test their strength. There are three different parts of your pelvic floor muscles to identify and you need to become familiar with them separately to be able to do the exercises effectively. This can be done by finding out which muscles control your urine flow, control your anal sphincter and surround your vagina.
While you are passing urine try to slop your urine flow midway. Try to hold for 3 seconds and then relax. If your pelvic floor is weakened you may find it difficult to slow down or stop your urine flow. Even so, this will help you to identify the muscles you will be exercising later. This test can also be used intermittently to check your progress once you are doing your exercises regularly.
Tighten the muscles around your anus as if stopping wind. Hold for 3 seconds and then relax.
Concentrate on tightening the muscles around your vagina. It may help to put one or two fingers in your vagina so you can feel the muscles tighten. You should feel a squeezing, lifting movement. If your pelvic floor muscles are weak this sensation may be difficult to feel.
How to do your pelvic floor exercises
Once you have been able to identify the three different parts of your pelvic floor muscles, you need to practice using them all together. You can do this sitting, standing or lying down. The following technique will help:
Focus your attention on your pelvic floor muscles. Ensure that your thighs and buttocks remain relaxed. You may notice that your tummy muscles tighten but try to relax them as much as you can.
Concentrating on using all three different parts together, try to squeeze and lift the muscles slowly, gradually increasing. It may be useful to imagine they are travelling up floor by floor like an elevator. When you have tightened your muscles to your limit, don't just let go, release them again gradually floor by floor. When you reach the 'basement' be aware of letting go of all the tension. Come back up to the 'first floor' so the pelvic floor is slightly tense. This will maintain support of your bladder, uterus and bowel.
- Slow and sustained: squeeze and lift slowly, holding for about 5 to 10 seconds as firmly as possible, then release. Repeat this up to 10 times.
- Quick and short: squeeze and lift quickly, holding for 1 to 2 seconds as firmly as possible, then release. Repeat this up to 10 times.
- Holding under pressure: squeeze and lift quickly and while holding do a small cough, then release. This will help you to get used to using your pelvic floor muscles when there is increased pressure on them, e.g. when coughing, sneezing or getting up out of a chair. Repeat this two to three times. Once you are familiar with this exercise it is important to practice it standing up as this is when the pressure is greatest on the pelvic floor.
During these exercises it is important not to bear down. If you feel any downward movement or are holding your breath you are not doing them effectively. It is best to seek advice if you are having difficulty as it is possible to make a problem worse if these exercises are not done correctly. Overworking the muscles when you first begin may result in discomfort. If this happens, reduce the number of exercises you are doing, or stop for a day or two until the soreness disappears.
How often and when to do the exercises
It is worthwhile doing these exercises two to three times a day. By attaching them to a regular activity you can make the exercises part of your daily routine e.g. each time after passing urine stay on the toilet and do your exercises. It will take time for you to notice the effects of the exercises. It can be useful to test your progress by repeating the steps in the 'Becoming familiar with your pelvic floor muscles' section.
Putting the exercises into action
The exercises outlined above need to be practiced regularly to build and maintain the strength of your pelvic floor muscles. It is also important to use the 'holding under pressure' exercise when there is added pressure on your pelvic floor. For example, when you are about to cough, sneeze or get up out of a chair, squeeze and lift quickly, holding the muscles. This gives support which can prevent or reduce leakage of urine at these times.
Other steps you can take
If you are prone to constipation you may need to take steps to alleviate this as well as strengthening your pelvic floor muscles. You may consider whether you can adjust the foods you eat, your exercise levels and your fluid intake.
Cutting down on fluids does not stop stress incontinence and restricting fluids can sometimes lead to other bladder problems. Two litres of fluid each day is adequate to maintain a healthy bladder and this may include water, juice, tea, coffee etc. It is advisable to keep to a minimise drinks containing caffeine and alcohol as they can irritate the bladder.
Weight loss may reduce the pressure on pelvic floor muscles caused by obesity but any muscle weakness needs to be improved through pelvic floor exercises.
Surgery should always be the last thing you consider. Always try physiotherapy, osteopathy and rehabilitation first. Lose weight, exercise, improve your diet and get active.
But sometimes surgery may be suggested to correct incontinence and other problems that can result from prolapses. It is important to explore all your options and this may include finding out whether a supervised exercise program can be a suitable alternative. If you are considering surgery you should be offered information about the procedure, any risks involved and what effects you can expect.
If you would like to speak to one of our amazing physiotherapists and osteopaths, call us on 0208 685 6930 and ask for Kay, Niamh or Lucy.