The Pelvic Floor
What is the Pelvic Floor and why should I exercise them?
The pelvic floor a set of sling like muscles that run form the coccyx at the base of the spine, to the back of the pubic bones and spread out into the bottom of the pelvis. Their job is to help provide good function and support of the bladder, uterus and bowels, with the openings at the urethra, vagina (in women), penis (in men) and anus. They also have a link with the transversus abdominals (deep abdominal muscles) forming part of your core along with the multifidus and diaphragm. It has also been suggested that good pelvic floor function can help to prevent against stress incontinence and erectile dysfunction.
The muscles within the pelvic floor attach to the pelvis at different levels and angles meaning that they can work at different positions. Like most muscles they can vary in strength and tone depending on their attachment to the pelvis.
Reasons why these muscles may become weak include the weight of a growing baby, hormone changes or a prolonged labour during pregnancy. The perineum (the soft skin between the vagina or testicles and the anus) can also become weak due to multiple or large babies. This can lead to stress incontinence post birth as these muscles can become over-stretched and damaged due to tearing or cutting (episiotomy) during labour.
Other factors that could weaken these muscles include things that place excessive, repetitive strain on the pelvic floor. Some factors include, being overweight, chronic coughing or sneezing, very high impact exercise including horse riding and trampoline, very heavy repetitive lifting and even strenuous abdominal exercises.
How do I locate the Pelvic Floor?
The muscles of the pelvic floor can be hard to find feel at first, possibly because we cannot ‘see’ them like your leg muscles or feel a very strong contraction for example squeezing your bum. At first there might not be much in the way of feedback, the contractions might feel very small or weak. In time as you start to exercises them they will begin to feel stronger and you should feel the muscles more.
To locate the pelvic muscles, you can imagine you are trying to stop yourself from peeing and/or passing wind. You should feel these muscles gently pull upwards. You could also imagine standing in a pool of very cold water or lifting an elevator inside you.
To help locate these muscles you can also sit on a soft chair with the legs slightly open. You should feel the muscles between your legs move against the chair. However, if you feel your glutes, legs or tummy squeezing this indicates that you’re not working the pelvic floor correctly. Remember it is a very gentle sensation to start with.
Other things you might try could be to insert your fingers into your vagina and try lifting the pelvic floor, you should feel them tighten around the fingers.
For men they can imagine trying to draw the testicals up into the abdomen, again without the bum, legs or tummy squeezing.
It is normal to feel your deep abdominals gently pulling in at the same time, this is due to the neurological connection they share. After having a baby the co-contraction may be disrupted and so they may not work together at first.
How do I exercise the Pelvic Floor?
Like all muscles the pelvic floor consists of both fast and slow twitch muscle fibres. When we bend down or in standing the slow twitch fibres are working, whereas the fast twist will activate a quick response such as stopping an ‘accident’. When working the pelvic floor, both sets of fibres should be worked.
- Start by finding you ‘starting point’. Pull up your pelvic floor muscles and using a timer, see how long you can hold your pelvic floor before you lose the contraction. This will be your starting point from which to work
- Once you have found your starting time, try and repeat this 10 times. So if you can hold for 2 seconds, you lift the pelvic floor and hold it for 2 seconds, 10 times. Try and repeat this from 3 up to 10 times a day. Have around 30 seconds rest in between each lift.
- Aim to increase the hold by 1 second each week. Continue to do this until you are able to hold the pelvic floor for 10 seconds and repeating 10 times a day.
- The optimum pelvic floor health is to be able to hold for 10 seconds, 10 times, 10 times throughout the day.
- Once you can do this start by adding 10 very quick, little contractions with a few seconds rest in between. This exercise helps to exercise the fast twist fibres.
- You can also start to lift up in stages. Start with a small contraction and hold for 1 second, then pull up a little stronger and continue up to your highest point or stage. You could aim for 3 or 4 depending on your muscle strength. Relax and repeat again. This exercise helps to work the slow twitch fibres.
When starting to exercise the pelvic floor remember with the contractions may not feel very strong try to persevere as the more you practice, the stronger these feelings will get. Think of like strength training, you have to keep lifting to get stronger!
If at all whilst doing the exercises they start to feel tiered or you lose the sensation, stop and try again later, give them chance to rest! And most of all breathe! Never hold your breath, always try and breathe normally.
One important note is to never actually practice the exercises when you are weeing. The holding in of urine can lead to infections and in some cases can cause functional problems. By all means try once to get an idea of the muscles, but not when your bladder is full.
You can also think of the pelvic floor muscles like your legs; they contain many different muscles that all work together but also work separately depending on what you’re doing and what position your in. For example, a deadlift will work more of the hamstrings, whereas a squat is more quad dominant, the pelvic floor is the same. As your lifts become stronger, you can then start to do them in different positions such as sitting, laying on either side (always try both sides!), laying on your front, laying on your back, kneeling, standing, and finally walking. If you can do this then chances are your pelvic floor will have sufficient strength to support you whilst you exercise, laugh, sneeze, cough etc.
What happens if I don’t exercise my pelvic floor?
Well your bladder is unlikely to fallout! However, in cases like pregnancy where they muscles are become stretched and weak it could lead to incontinence because the bladder and bowel isn’t support efficiently and can also cause prolapse. Many people will however unconsciously work their pelvic floor and not have any problems, but rather to have a wonderfully toned, strong pelvic floor?
There are many benefits to working these muscles, they may be slow to start with but in the long run, they may help to stop embarrassing moments after having a baby or later in life and can even improve your sex life!
Sian Fletcher is a personal trainer and Pilates instructor with a keen interest in postnatal health. For more information about Sian please visit www.feelgoodfitness.org
The information is intended as general guide only and may not be suitable for everyone. Please check with your health care professional before starting any new exercise regime.
Rafiefar. R, The Thoughtful Body