Most women aren’t aware of their pelvic floor muscles until something goes wrong or when they get pregnant and feel the strain placed on it. However, maintaining a healthy pelvic floor is essential as it supports a range of important bodily functions, including urination, bowel movements, sex, pregnancy and childbirth.
Before we look at how to keep your pelvic floor strong and healthy, it’s helpful to understand its anatomy.
Your pelvic floor refers to a sling or hammock of muscles that run from the end of your spine (tailbone or coccyx) to your pubic bone at the front of your body. These muscles wrap around three openings at the bottom of your pelvis: your back passage (rectum), vagina and urethra (where urine passes out of your body).
In women, there are two main factors that can weaken the pelvic floor: pregnancy and menopause.
During pregnancy your pelvic floor muscles are put under considerable strain due to the growing weight of the baby and they can stretch by up to 300 times their original length.
During menopause, hormonal changes can soften and therefore weaken your pelvic floor muscles.
A weakened pelvic floor can cause urinary incontinence where you can’t control the flow of urine out of your body, problems with bowel movements and pelvic organ prolapse where organs inside your pelvis (eg womb or bladder) shift out of place and bulge into your vagina.
Around one in three women will experience urinary incontinence after childbirth, while up to half of all women will experience pelvic organ prolapse.
These conditions can be prevented by strengthening your pelvic floor muscles — this is important for all women, not just women who are recovering from pregnancy and childbirth.
There are six steps to performing pelvic floor exercises, also known as pelvic floor squeezes:
When you squeeze your pelvic floor muscles, it is important to start the squeeze at the back by your spine and move the squeeze forward to the front by your pubic bone. This more fully engages all of your pelvic floor muscles.
Each pelvic squeeze can either be short ie you lift your pelvic floor for just one second, or long ie you lift your pelvic floor and hold it for five to 10 seconds before gradually relaxing it over another five to 10 seconds. If you can’t lift your pelvic floor muscles for five to 10 seconds, start with just a few seconds and gradually work your way up as your muscles strengthen.
If you have a weakened pelvic floor, complete a set of 10 short pelvic squeezes six times a day and a set of 10 long pelvic squeezes six times a day, every day for three to six months. This should gradually strengthen your pelvic floor. To maintain this strength, you will need to complete two sets of short pelvic squeezes and two sets of long pelvic squeezes every day for the rest of your life.
Getting in position
When first starting to do pelvic floor exercises you may need to lie down on your back with your knees bent, feet flat on the floor and with a cushion under your hips. This will tilt your pelvis back and may help ease any back pain or the sensation of a prolapse, making it easier to squeeze your pelvic floor muscles.
Once you’re more comfortable performing pelvic floor exercises, you can progress to a sitting position and finally a standing position. Remember, don’t over exert your muscles. If, when you move from a lying down position to a sitting position, or a sitting position to a standing position, your pelvic floor muscles feel shaky, stop and relax your muscles.
The great thing about pelvic floor exercises is once you are confident in performing them, you can do them anywhere and no one will notice. This is because when you contract and relax your pelvic floor muscles correctly, there is no outward sign that you’re doing this.
It can be challenging to activate your pelvic floor muscles but using mental imagery can help you perform your pelvic floor exercises correctly. Try these examples:
If you’re struggling with incontinence, you may be tempted to squeeze every muscle in your pelvic area when trying to stop a leak and consequently, out of habit, may do the same when performing your pelvic floor exercises. This isn’t the correct way to exercise your pelvic floor and you may end up engaging other muscles instead of your pelvic floor.
To avoid exercising the wrong muscles, make sure you:
It is also important to relax your pelvic floor muscles, so between each long pelvic squeeze, rest your pelvic floor for five seconds. If your muscles feel tense, you can also try some relaxing breathing techniques eg take a gentle breath in through your nose and imagine a balloon inflating inside your tummy and pelvic floor, then breathe out through your mouth and imagine the balloon deflating.
If you’re not sure whether you’re performing your pelvic floor exercises correctly, see a women’s health physiotherapist.
Mrs Diane Daly is a Specialist Women's Health Physiotherapist at Spire London East Hospital, providing a wide range of services including exercise prescription and manual therapy for pregnant women with pelvic girdle pain or lower back pain, post-operative rehabilitation after gynaecology and breast surgery, and recovery therapy from bladder pain syndrome and pelvic floor dysfunction.