“Chances are, you may not be that well acquainted
with something you were born with – your Pelvic Floor.”
First of all, where is my ‘Pelvic Floor’?
Your pelvic floor muscles are located between your legs and form the base of your pelvis.
The muscles attach to your pubic bone at the front and to the base of your spine (coccyx) at the back.
The muscles are shaped like a sling and attach at the sides of your pelvis to the bones that you sit on.
Your back passage (anus), vagina and urethra (tube from the bladder) all pass through the pelvic floor muscles.
What does it do exactly?
Your pelvic floor basically holds your pelvic organs in place – your uterus, bowel and bladder. It supports and gives you control over your bladder and bowel.
It also affects the function of your vaginal muscles, which are involved in sexual intercourse.
What factors can affect my pelvic floor?
Pregnancy, age, the onset of the menopause, and gynaecological or pelvic surgery, e.g. a hysterectomy.
What can go wrong?
Any of the above factors can weaken your pelvic floor muscles. This means your pelvic organs are
not fully supported and you may have less control of the release of urine, faeces (poo) or wind.
Weakened pelvic floor muscles can also cause reduced sensitivity and pleasure during sex.
In the most severe cases, there is a risk of pelvic organ prolapse, where one or more of
the pelvic organs bulges into the vagina.
Are the pelvic floor muscles involved in exercise?
Yes, the pelvic floor muscles form the base of your ‘Core’ muscles.
These muscles work with the deep abdominal (tummy) and back muscles and the
diaphragm (breathing muscle) to support the spine and control the pressure inside the abdomen.
During exercise, the internal pressure in your abdomen changes.
For example, when you lift a weight the internal pressure increases, and when you put the
weight down the internal pressure returns to normal. Ideally, the regulation of pressure within the
abdomen happens automatically. When lifting a weight, the muscles of the core should work together well – the pelvic floor muscles lift, the abdominal and back muscles draw in to support the spine,
and breathing is easy. In this ‘normal’ scenario, the pelvic floor muscles
will respond appropriately to the increase in abdominal pressure.
This means that the full functioning of your pelvic floor is also reliant on the other muscle groups
within the torso (the Transversus abdominis, Multifidi and the diaphragm) working in good co-ordination. If there is any imbalance between the working of all these muscles, problems
including the loss of urine when sneezing, may occur.
Therefore, all of the muscles of your core need to be strong for your pelvic floor to work at its optimum.
OK, so how do I strengthen my pelvic floor?
First, you need to locate it!
Sit on the arm of a chair or the edge of a table and imagine that you are trying to
stop yourself from passing wind at the same time as stopping your flow of wee, mid-stream. The feeling is one of squeezing and lifting, or pulling up and in, around your front and back passages.
You should squeeze hard enough to feel a little trembling in your vagina. If you pull hard enough,
you may feel your lower tummy muscles tightening, but you shouldn’t feel anything above
your belly button (Morkved et al, 2013). Try to hold this contraction for 6-10 seconds and then relax. Try to focus on feeling the difference between when the muscles are relaxed
and when they are tight.
You may feel more happening at the front, or you may feel it more around your bottom.
As long as you can feel a tightening in at least one of these areas, you will be exercising your pelvic floor.
You need to squeeze and lift without pulling in your upper tummy (above your belly button),
or squeezing your legs together, or tightening your buttocks, and without holding your breath.
These exercises can be done in any position, but try to practise doing them standing up,
as control of urine leakage is usually most necessary when upright.
Don’t actually stop your flow of urine more than once a week!
Do it once in a while to see if you can contract your pelvic floor fully.
Once you have got the basic pelvic floor exercise down to fine art, you can try fast pull-ups.
Begin by making sure you are breathing in a relaxed way.
As you breathe out, pull up your pelvic floor muscles and let go quickly.
Then try to pull up and let go quickly up to 10 times in a row, without holding your breath.
This exercise helps your pelvic floor muscles to react quickly when you cough, sneeze or
laugh. It only works if your pelvic floor muscles are already strong enough to support your pelvic
floor, which is why it is important to master slow contractions first.
As well as helping to improve symptoms of urinary incontinence, strong pelvic floor
muscles can also mean increased sensitivity during sex,
making orgasms stronger and more likely (Roughan and Kunst, 1981).
How often do I need to exercise my pelvic floor muscles?
Pelvic floor exercises should be done in sets of 8-12 repetitions, 3 times a day (2006),
or more often if you sometimes leak wee.
Try to do as many as you can as you go about your daily routine, so they
become a regular part of your life. To significantly strengthen your pelvic floor will take at least
8 weeks and if you stop exercising them after this time, your
muscles could lose their strength again (Fleck & Kraemer 2004).
What was that about making sex better?
Yes, your pelvic floor muscles play an essential role in sexual function and enjoyment!
There are a few different layers of muscles in the pelvic floor.
The most superficial layer (closest to the skin) has a couple of muscles which
are responsible for pumping the clitoris, so that it becomes full during arousal.
Therefore, women can improve their level of arousal by contracting
the pelvic floor muscles (stronger muscles = higher arousal).
One of the deepest pelvic floor muscles (furthest away from the skin) is directly
responsible for the amount of sensation that women feel during intercourse.
Vaginal sensations come mostly from this muscle that loops around behind the vagina.
It also affects the amount of sexual sensation that male partners feel during intercourse (also important!).
The lining of the vagina does not have many sensory nerve endings,
which it does not have a lot of sensation. However, all muscles have special nerve endings
within them that respond to stretch. The stronger and firmer a muscle, the more of these nerve endings it has.
Therefore, stronger and firmer pelvic floor muscles will be stretched more
by the erect penis, which in turn will increase a woman’s vaginal sensation and boost her ability to achieve orgasm.
I’ve heard that sit ups are bad for your pelvic floor, is this true?
When you undertake a sit up or crunch, the pressure in your abdomen rises.
Your pelvic floor should contract strongly and automatically at the same
time to match the increasing pressure. If you have a weakness in your pelvic floor,
the increased pressure will hone in on that weak area and could potentially worsen any pre-existing weakness. Therefore, if you are at high risk of having a weakened pelvic
floor, you should remain cautious or seek advice when doing a large number of sit ups.
You may prefer alternative core exercises (of which there are many!) until your pelvic floor is stronger.
Am I too old for pelvic floor muscle exercises to be of benefit?
Age is no barrier to the benefits of pelvic floor muscle exercises!
More mature ladies are just as likely to benefit from pelvic floor muscle exercises
for incontinence as younger ladies. The natural muscle mass loss associated with
ageing includes the muscles of the pelvic floor. However, there is plenty of evidence to show
that muscle mass loss can be delayed and sometimes reversed with a specific exercise programme.
Any other advice?
Practice good bathroom habits!
- You should only go to the toilet once a night, if at all (unless you are pregnant, of course!)
- You should not wee more than once every 2-3 hours when awake, ideally
- 7 times a day maximum (start counting!) If you go more frequently,
- you will train your bladder to have to go more frequently. You have waited long enough if you wee for 8 seconds or longer.
- Never push urine out (or push too hard to poo), this may weaken your pelvic floor.
Is it just a ladies’ problem?
No. Men have pelvic floors too!
For men, the pelvic floor muscles not only help to control the bladder and bowel,
but they also assist in achieving and maintaining an erection during sex.
* If you are unsure about how strong your pelvic floor muscles are or how to
exercise them to their fullest potential, please seek professional advice from your doctor. *