Today was one of the many days where I truly appreciated specialising in women’s health physiotherapy. I had an amazing, confident woman confide in me about a bladder problem she has been battling for years. It began as an annoying problem which with time became a big enough problem that she declined a promotion due to the anxiety of being unable to hold her bladder for the length of a meeting.

After a 60 minute appointment where we discussed all things private, she is extremely relieved to find that there are many strategies we can implement to help resolve her bladder problems. What I found that is also quite common, is that despite her doing her pelvic floor exercises for years, her technique has been incorrect. So today I want to give you some tips to help you know your pelvic floor better.

Where is your pelvic floor?

The pelvic floor muscles help to form the base of the pelvis. You can imagine them as a sling of muscles in your private area, running between your legs from your pubic bone to your tail bone.

There are superficial and deep pelvic floor muscles, and they have three openings in women, which are the anus, vagina and the urethra.

What do the pelvic floor muscles do?

The pelvic floor muscles have several important roles:

1. Supporting all the internal organs inside of you.
2. Controlling your bladder and bowel (wees and poos)
3. Sexual pleasure
4. Relaxing to let urine, faeces or a baby come out.
5. Contributing to core stability and thus helping prevent back and pelvic pain.

Why do women need to exercise these muscles?

There are many factors that can contribute to pelvic floor muscle weakness. The most common causes are:

• Pregnancy and childbirth. Especially if the baby was large and/or required an assisted delivery with forceps or vacuum.
• Increasing Age
• Menopause
• Overweight or obesity
• Straining to empty bowels regularly, especially with chronic constipation.
• Chronic coughing or sneezing related to chest problems or hayfever
• Heavy lifting at work, in the garden or with home life.
• High impact exercise with or without heavy lifting.

Pelvic floor muscles are like any other muscle because they need to be used regularly to maintain their strength and function. A pelvic floor exercise program can be designed to regain their strength, endurance and timing.

What symptoms might tell me that my pelvic floor muscles are weak?

The most common symptoms of pelvic floor muscle weakness are:

• Bladder problems such as urine leakage, urgency and frequency.
• Bowel problems such as faecal incontinence, difficulty controlling wind and haemorrhoids.
• Pelvic Organ Prolapse – feelings of heaviness, dragging or lumps and bulges in the vagina or perineal area.
• Persistent pain in the low back, pelvis or coccyx area.
• Decreased sensation and pleasure during sexual intercourse.

How do I exercise my pelvic floor muscles?

1. Find a comfortable position, which could be lying, sitting or standing. Take 2-3 deep breaths in and out and relax your tummy muscles.
2. Imagine you are tightening around the anus, vagina and urethra. You should feel a closing / squeezing sensation around the urethra, vagina and anus and a lift up internally. It can help to imagine you are stopping the flow of urine, holding in wind, or squeezing around the vagina.
3. Check that your buttocks, upper abdomen and legs stay relaxed.
4. Let go and release the muscles. Take 2-3 more deep breaths in out.
5. Repeat step 2 to 4, and then try to hold it 5-10 seconds. Aim for 5-10 repetitions.

Everyone’s starting point with pelvic floor exercises will vary. Some people will find they can only hold for 2 seconds, others may be able to hold for 10 seconds.

I can’t feel mine working. How do I know if I am doing them right?

The pelvic floor muscles only move a small amount and can be difficult to feel if they are weak. It is also quite common for women to be doing them incorrectly. If you are not certain about your technique, then we recommend that you seek the advice of a women’s health physiotherapist.

To check if you are doing pelvic floor muscle contractions properly try the following:

• Try to stop the flow of urine when you are emptying your bladder. If you can stop the flow, in most people, it means you are using the correct muscles.
• Look at the perineal area by using a hand mirror and see if you can see the anus and vagina move internally, away from the mirror.
• Place your hands on your perineum near the tailbone or pubic bone and feel for the muscles tightening and moving away from your hand.

What position should I be in to practice my pelvic floor muscle exercises?

The easiest position to practice tightening your pelvic floor muscles is normally a lying down position. When the muscles are stronger, you should practice doing your pelvic floor exercises in sitting or standing. Then when you are considering returning to exercise you should be able to tighten the muscles during different exercises, such as squats or lunges.

It is important to be able to do the pelvic floor muscle functionally and we sometimes call this “The Knack”. This means that you should be able to tighten and lift your pelvic floor muscles before coughing, sneezing, laughing and lifting activities.

Who can help me improve my pelvic floor muscle isolation and strength?

A physiotherapist specialising in women’s health can help you learn to do the exercises correctly. The physiotherapist may do an assessment with a real time ultrasound machine through your lower tummy, look at the perineum from the outside and/or do an internal vaginal examination. For more information on how women’s health physiotherapy can help you, click here.