What is the pelvic floor?
The pelvic floor is the name used to refer to the layer of muscles that support the pelvic organs (bladder, bowel and uterus). It is essentially a supportive hammock that stretches from the pubic bone at the front to the tailbone (coccyx) at the back, and from one sitting bone to the other (side to side). Imagine it as a trampoline made of firm muscle that the organs sit on top of. The urethra, vagina and anus pass through the pelvic floor, and the pelvic floor helps to keep these passages closed. There are also circular muscles within the urethra and anus known as sphincters, keeping them closed until you need to pass urine or open your bowels.
Why is it important for these muscles to stay strong?
Keeping these muscles strong will help to reduce your risk of urinary incontinence later in life. This is the unintentional leaking of urine due to weakening of the muscles. A common type is called ‘stress incontinence’ where you leak urine at times when your bladder is under pressure, for example when you cough, sneeze or laugh. The pelvic floor muscles also support the vaginal wall and can prevent pelvic organ prolapse (POP). This is where the bladder, rectum or uterus protrudes/bulges into the vagina as the muscles holding them in place are weakened. As you can imagine this can be very uncomfortable and effect your sexual functioning.
Doing these exercises in pregnancy combined with perineal massage has been found to significantly lower the rate of episiotomies and severe perineal trauma; with a higher rate of women having an intact perineum (no tears at all) in comparison to women who didn’t perform the exercises (study here for the geeks).
These exercises are important for everyone, not just in pregnancy and after having a baby. There is some evidence to suggest that these exercises can improve sexual sensation.
How do I exercise these muscles?
It’s important to make sure you do these exercises in the right way, so make sure that you concentrate whilst doing them. First tighten (squeeze) the muscles around the back passage, as if you are trying to stop yourself passing wind. Whilst you hold this squeeze, tighten around the vagina and urethra, as if you’re trying to stop yourself from passing urine. It should feel like a ‘squeeze and lift’ inside. After each ‘squeeze and lift’ make sure you fully relax your muscles by letting them rest back to their starting level. (From the ‘Squeezy’ NHS app)
Try to breathe normally when you perform these exercises. You may feel your tummy muscles gently working, but the muscles in your thighs and buttocks should be relaxed.
Practice ‘slow’ exercises by holding the squeeze for a few seconds, gradually building in length as your pelvic floor muscles get stronger. I like to visualise I am going up in a lift: starting on the ground floor you engage the pelvic floor muscles. Imagine that with every floor that you go up in the lift you squeeze the muscles slightly more until you reach the ‘top floor’, then when you have reached your limit gently release the muscles as you return to the ‘ground floor’.
Don’t practice your exercises when actually passing urine as this can effect the flow of the urine and may increase the likelihood of getting a urinary tract infection.
Useful contacts relating to pelvic floor, bladder and bowel problems:
pogp.csp.org.uk (Pelvic Obstetric and Gynaecological Physiotherapy)
www.bladderandbowel.org (Bladder and Bowel Community)
www.cobfoundation.org (for cystitis and overactive bladder)
V is for Vulva 