If you have read the previous blog on “The female pelvic floor - what is it and why is it important” you will have an idea of where your pelvic floor muscles are. Now you need to work out how to use them!
As you contract the pelvic floor muscles, they draw inwards and lift up. This is the same feeling you get when you stop your urine mid-flow or stop wind escaping when in public.
A good visualisation to assist you with a pelvic floor contraction is to picture a pebble dropping into water and watch as the ripples spread outwards. Now imagine you are drawing those ripples back in and lifting the pebble up internally. Draw them in as close together as you can and lift the “pebble” as high as you can.
Foundation Level Pelvic Floor Exercises:
As you get used to feeling the muscles work, and if they are working well, you will be able to feel both left and right sides of the pelvic floor muscles, and feel a squeeze and lift through all of the pelvic floor area – from anus to pubis. You should also be able to do this contraction whilst keeping all your other muscles relaxed (buttocks, thighs, abdominals – although you may feel some tightening of the low abdominals occurring naturally) and breathe normally.
Breathing is VERY important!
You cannot function through the day, let alone exercise without breathing. This may be the hardest part of obtaining a basic pelvic floor contraction but it is vital that you achieve this level of coordination before progressing further.
To self-test whether you are contracting your pelvic floor muscles, there are a couple of quick checks you can do:
1. Try to stop your urine mid-flow - if you can stop it or slow it, your pelvic floor muscles are working. When you’ve finished on the toilet, continue to sit there for a few minutes and try to actively contract those same muscles again. This is a great easy test to identify the correct muscles, but it must not be performed regularly. Once a week is a good basic guideline.
2. Roll up a towel and sit astride it. Now bear down as if you were emptying your bowels. Feel the pressure that is exerted onto the towel. This is your pelvic floor bearing down. Now try to do the opposite and lift those muscles away from the towel. This is a correct contraction.
3. Sit or lie in a comfy position and insert you index and middle fingers into your vagina. As you perform a correct pelvic floor contraction you should feel your fingers being squeezed together and lifted, up and forwards, internally.
If you can’t feel your pelvic floor muscles working, you can only feel one side working, or you’re just not sure if you’re doing them correctly, book in to see a women’s health physiotherapist trained in internal examination of the pelvis.
Some clinics will offer you a real-time ultrasound (RTUS) assessment by a non-women’s health physio to assess your pelvic floor. Whilst this gives some idea of pelvic floor function, it is very basic and won’t be able to identify any specific dysfunctions such as pelvic organ prolapse, one side or layer of the pelvic floor muscles not coordinating/contracting properly or a tight pelvic floor.
If the idea of an internal examination is daunting then RTUS is a good second best but as I said above, it only gives a fraction of the information and therefore treatment will not be as specific.
If you have succeeded in gaining the basics of the foundation level of pelvic floor exercise, you are ready to progress to Stage 1.
Stage 1 Pelvic Floor Muscle Training (PFMT):
The muscles of the pelvic floor are like most other muscles in your body – they respond to exercise by getting stronger and more coordinated. The following exercises will build a foundation for general activity, continence and pelvic organ support.
1. Strength/Endurance Challenge: maximally squeeze and lift your pelvic floor muscles (PFM). Keep your buttocks, abdominals and thighs relaxed and BREATHE. Feel both sides of the pelvic floor working and all areas from back to front. Hold this contraction, continuing to breathe for 10 seconds. Relax fully. Repeat the contraction and hold 10 times. To begin with you may find that you can only hold it for 2 seconds and that after 3 repetitions you have no idea if it is working or not. Stop here. Leave it for the day then repeat tomorrow. As you increase your endurance you will find that you can gradually build up to holding it for the full 10 seconds x 10 repetitions. Do this once/day to fatigue.
Try different positions to do your PFMT in – lying, side lying, on all 4’s, sitting, standing – and work in the position that is easiest for you.
2. Speed Coordination Challenge: Perform quick contractions squeezing maximally and relaxing fully with each one. Build up to doing x20, x3/day.
3. The Knack: Perform a pelvic floor contraction prior to coughing/sneezing/lifting to pre-empt the increase in IAP (see above).
How long will it take to feel a difference?
Every skeletal muscle in the body requires repeated load training to fatigue over a period of 8-10 weeks in order to see a significant improvement in strength. The pelvic floor muscles are exactly the same. You will therefore need to perform these exercises repeatedly over 2-3 months to know for sure if they are making a difference.
If you are not seeing a significant improvement in this time then it is advisable to get a formal pelvic floor assessment done by a Pelvic Health Physio. This will determine if there is a specific problem that needs addressing or if your programme just needs a tweak to tailor it more specifically to you.
If you are seeing an improvement but the exercises feel too easy, also get a formal assessment of your pelvic floor muscles done to determine an objective measure of your PFM function so that your exercises can be tailored specifically to your needs. As with any muscle training, there are many ways of doing exercises. The more specifically these are targeted to your goals, the faster you will see improvement.