Pelvic Floor Exercise, Why Do Them?

Written By Victoria Caulfield

I wanted to write this post as I get asked this question a lot;

“Do I really need to do pelvic floor exercises?”

Spoiler alert- YES. Yes you do! Don’t stop reading there’s a little more to it than just the odd squeeze now and then. I’d like to explain why they are so important at every stage of a woman life. To be clear, in this post I will be talking about exercises to help strengthen the pelvic floor. Like any musculature there can be weakness but also tightness. Some women who have an overactive pelvic floor will have difficulty for very different reasons to another lady who has an underactive pelvic floor. Hypertonic is the clinical term meaning the resting state of tension is tighter than we would normally expect. Different exercises and or manual therapy will be used to treat a woman who is having difficulty with a hypertonic pelvic floor. Some signs and symptoms of a hypertonic pelvic floor include;

  • Incomplete emptying of bladder or bowel

  • Painful sex

  • Constipation

  • Pain in any of the flowing areas; pelvis, lower back, hip.

  • Pain when inserting a tampon

  • Incontinence

Men also have a pelvic floor. Again exercises described in this post are not appropriate for men necessarily as the cues and mental imagery will not be the same, due to men being anatomically different to women in the uterus/ vagina area, obviously. More information can be found on the male pelvic floor in the Pelvic Obstetric and Gynaecological Physiotherapy (POGP) booklet Pelvic Floor Muscle Exercises and Advice for Men (2015), the website is cited in the reference list.

First things first, What is the pelvic floor and what does it do? Well the pelvic floor is a term used to describe a collection of muscles, tendon, ligaments, blood vessels and fascia. This network sits in the bottom of your pelvis and has several functions;

  • Helps to support the pelvic organs (bladder, uterus and bowel)

  • Maintains continence for both bladder and bowel

  • Protects the spine

  • Contributes to sexual sensation

Try to visualise the pelvic floor as a hammock with the ability to recoil think trampoline, it can lift and effectively hold the pelvic organs. It works for the most part involuntary and coordinates small co-contractions to close sphincters and prevent the loss of fluid wind and solid as you go about your daily life. It also moves as a part of that core cylinder I keep taking about, forming the bottom part of the muscular system. Below is an image of the core musculature from Stacey Dockins Posture Lab Blog, it’s a great resource and well worth a look.

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When we breath out our diaphragm moves upwards to push air out of the lungs and the pelvic floor moves up too (please note this as a eureka moment and very important!) When we breath in the diaphragm pulls the lungs downwards to fill the lungs with air and the pelvic floor also moves down a little. We will be coming back to breathing, I can not stress to you the importance of breathing and the vital role it plays in pelvic health as well as rather obviously keeping you alive. So you can familiarise yourself, below is a cross-section of the pelvic floor aka the bottom of the core cylinder. It’s from Pelvic Guru their website is a brilliant resource for all things pelvic health. I have put a link in the references.

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I think we can all agree looking at the many roles the pelvic floor plays it’s important we look after it as best we can. Which brings me on to my next point, we obviously can’t see our pelvic floor so I will make reference to the bicep muscle throughout this post just to draw comparison. Case and point if there was something wrong with our bicep muscle and it wasn’t working properly (bending our arm) we would seek help. So why do we treat our pelvic floor differently? Just because we can’t see it does not mean we should ignore it when it becomes symptomatic. It’s trying to tell us it needs help!


So why do we need to complete Pelvic floor Muscle Exercises (PFME’s)? The NHS, Exercise in pregnancy (2020) recommends completing pelvic floor exercises even if you’re not suffering with symptoms. I’m talking to you, ladies who haven’t had children but avoid trampolines like the plague or the CrossFitter who always puts a pad in before doing double unders. If you are leaking it isn’t normal, it is common yes, but not normal and we need to do something about it. Everybody loves a legs bums and tums class don’t they! Peachy bottoms are all over Instagram with booty workouts galore online. Why do we not treat our pelvic floor muscles in the same way? We can potentially over exert certain areas of our core cylinder without even knowing it. Taking into consideration the images above and the musculature involved in the core cylinder and the pelvic floor would it surprise you that muscular imbalances are quite common? Working on that booty or those washboard abs is great but what about those other synergistic muscles? The spine and pelvic floor and even the diaphragm (back to those breathing muscles again.) Overworking certain muscle groups can sometimes lead to becoming symptomatic with pain or leakage. Think about doing daily multiple bicep curls and completely neglecting your triceps, pectoral muscles, shoulder stability (I could go on.) If you just did that one exercise you will promote an imbalance. Nobody needs to end up looking like Poppey, enormous biceps zero triceps. Lord only knows what he’s been doing to his forearms!

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I think we’ve established why we need to do our PFME’s. So now we move onto the important matter of how to do them. I’ve had so many conversations about this with so many women. I know it’s confusing. Squeeze this, lift that so I’m going to try and make this as concise as possible. Please read this right to the end, I’ll try not to bang on too much!

Longer Holds

  • I want you to focus on just this one cue “squeeze from your bottom,” more specifically the anal sphincter muscle.

  • Begin the squeeze on breathing out

  • try to hold this for 10 seconds whilst breathing normally. If you can only do 5 great, work towards getting to 10.

  • once you have finished the squeeze make sure you breath in and out again before repeating the squeeze. Relaxing the PF is as important as the squeeze itself.

  • complete repetitions with the 10 second hold or whatever you managed for as many reps as you can feel a good squeeze and lift.

  • This might be 3 times or it could be 8 times. Do what you can but stop after 10 reps.

Short Squeezes

  • Inhale to prepare, exhale to squeeze your anal sphincter muscle.

  • Hold for approximately 1 second and let go finish the breath

  • make sure you relax between each quick squeeze, try taking an in-breath to relax

  • complete however many of these squeezes you can feel the successful squeeze and lift for but no more than 10.

Try completing these exercises three times a day if you are experiencing symptoms.

Now to run through some finer points. By bottom I mean your anus or the anal sphincter muscle, not the bottom cheeks. Like you’re trying to stop yourself fro passing wind. This is very important. We shouldn’t be working any other muscles accept for the pelvic floor muscles and the breath. I found this easiest to focus on in crook lying on my side with a pillow between my knees. I could feel if I was trying to use my bottom cheek muscles or tummy muscles in this position rather than lying on my back. If you’re new to PFME’s start in crook side lying and really concentrate on the squeeze. Positions to try and move on to once you are confident you are feeling the contraction.

  • crook lying (start here.)

  • sitting

  • standing

If you’re unsure about whether or not you’re completing the squeeze correctly you can insert a finger into the vagina. When you squeeze you should feel a tightening and lifting sensation around your finger. When you let the squeeze go you should feel the tightening relax and a lower.

Rehabilitation of the PF muscles is a long game and there are no short cuts. I should know. It can be up to 3-6 months before you start to see any changes. It’s an investment in your health, symptomatic or not and as we have previously discussed, it’s so very important and often over looked. It’s never too late to start, in fact as we age it’s just as important to complete pelvic floor exercises to maintain strength and flexibility through out the menopause and beyond. The biggest issue with PFE’s is compliance. I know they aren’t the most fun and they don’t grow you a booty or biceps. BUT ladies we simply can not ignore our pelvic floor. Set those phone reminders, put a post it note on the inside on the cupboard where you keep the tea and coffee. Ask your girlfriends if they do them, your sister and your mum. Let’s normalise these exercises, the benefits are well documented. Come on ladies get squeezing (and releasing!) Big love V x

 

References

Victoria Caulfield
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