Pelvic floor muscles and exercise

Rebecca our Director wrote this piece for a local fitness company as part of Women’s Health Week!

My name is Rebecca Liberatore. I am senior Pelvic Floor Physiotherapist and Co-Director of Melbourne Pregnancy and Pelvic Floor Physiotherapy (East Keilor) and a Mum of two beautiful boys. Today, I wanted to combine my love of Pelvic Floor Muscles and Exercise to give you information on how best to combine the two in a safe way.  

Firstly, what are the Pelvic Floor Muscles and what do they do?

The Pelvic Floor Muscle are a large sling like  group of muscles that line the bottom of your pelvis. The pelvic floor is quite literally the floor to your pelvis and like any floor, in a building or a house, its aim is to support everything that sits above it and prevent things falling through it.

Specifically, the Pelvic Floor Muscles help to support the pelvic organs including the bladder, bowel and uterus and prevent them from falling down into the vagina and beyond (a condition that is known as prolapse). It also has a very important role in making sure you don’t wet yourself when you need to go to the toilet or when you cough, sneeze or jump and enables you to hold in wind and poo.  And if that wasn’t enough reason to get you doing your exercises already, here is the clincher…. it also has a role to play in increasing sensation with sex!

How do I know if I have a weak pelvic floor?

Signs of a weak pelvic floor include:

  • Leakage of wee with cough/ sneeze/ laugh/ jumping/ running/ sex

  • Unable to hold on to wee

  • Sudden urgency to wee

  • Unable to hold in wind

  • Unable to hold in poo

  • Sudden urgency to poo

  • Heaviness/ dragging/ pressure in vagina

  • Feeling like something is falling out of your vagina

  • Feeling a lump coming out of your vagina

  • Decreased sensation with sex

How common are pelvic floor problems?

  • 1 in 3 women who have had a baby will leak urine (Therefore this is COMMON but by no means NORMAL)

  • 1 in 4 women will have a prolapse

What causes the weakness?

  • Pregnancy and child birth (regardless of the type of birth)

  • Menopause (unfortunately that’s going to be every one of us women!)

  • Constipation

  • Heavy lifting

  • Post Hysterectomy

  • High impact exercise

Do these exercises really work?

Yes!! We have very high levels of evidence to show that a supervised, individualised program for a minimum of 3 months can significantly reduce symptoms if not cure your symptoms.

Ok, how do I do them?

A correct pelvic floor contraction should feel like a gentle 'squeeze' and 'lift' at the base of the pelvis where the muscles are located. You definitely should NOT feel a sense of straining or 'bearing down'.

When we teach a correct pelvic floor action, we often provide visual 'cues'. You might like to try the following 'cues' to help to identify your pelvic floor muscles correctly:

1. Imagine you are trying to stop the flow of urine (Don't actually do this when emptying) 

2. Imagine you are trying to stop passing wind

3. Imagine you are sitting on a silk scarf and you are trying to lift this upwards through your vagina (for women) OR

4. Imagine you are trying to shorten your penis (for men)

When complete, don't forget to release and relax the pelvic floor muscles again. 

If you're still in doubt, book an appointment with one of our experienced pelvic floor physiotherapists to have your pelvic floor assessed and technique confirmed. 

I find it hard to know if I am doing them right, do most people know how to do them?

About 50% of people are doing their exercises incorrectly, 30% are doing something that may cause harm. Individual assessment by a Pelvic Floor Physiotherapist is so important so that you know you are doing you exercises correctly and that your program is at a level that is best for you. If your program is too easy or too hard it won’t work and you could be doing yourself more harm than good

I leak with exercises but it doesn’t bother me that much, I just wear a liner

By doing this you are unfortunately, putting yourself at risk of further damage. Signs like this are an indication that your pelvic floor is not coping with the load you are putting through it. However, general exercise is so important to your health and wellbeing, we don’t want you to stop exercising just modify your program until your muscles are strong enough to cope.

I have a strong “core” therefore I must have a strong pelvic floor.

Unfortunately, this is not necessarily the case. The “core” is like a cylinder made up for the abdominal and back muscles (the sides), the diaphragm (breathing muscle) (the lid) and the pelvic floor muscles (the base). If all these muscles work together at once then when someone uses force such as lifting a weight they will direct force internally and there will be no pressure placed on the pelvic floor muscle. However, if the abdominal muscles are strong and the pelvic floor muscles are weak the pressure is directed downwards weakening the pelvic floor muscles further. Therefore, just because you are pulling in your stomach or you can plank for 60 seconds or you have done pilates in the past doesn’t mean you pelvic floor is necessarily strong.

What exercises are the worst for leakage?

Anything where you land on two feet together generally puts the most amount of pressure through your pelvic floor.

Box jumps, skipping (landing on two feet) and star jumps seem to be the worst.

Others find running especially sprinting can be an issue as well as heavy abdominal exercises such as sit ups.

What general exercises do you recommend?

As a general rule, any exercise where you don’t leak or feel pressure in your vagina during or after is ok for you.

Pelvic Floor First is a website I highly recommend you look at. It has ways to modify certain exercises to still achieve your outcome without risking your pelvic floor

My best tips for modifying program are to:

  • Sit down to do weights

  • Do greater numbers of repetitions, and lower weights

  • Avoid jumping or land on one foot rather than two (for skipping and jumping)

  • Modify planks/ push ups so you are on your knees

  • Marching on the spot can be a good alternative to running as well as swimming and cycling.

However, it is important to speak to your personal trainer and inform them when an exercise is not appropriate for you. They will be able to assist you to modify the activity.

Get squeezing!