What is the Pelvic Floor and why is it important?

The benefits of pelvic floor muscle exercises are well documented but are we doing enough to challenge our pelvic floor muscles in our exercise programs?

Many people suffer from weakness of their pelvic floor muscles. This can lead to:

· Leaking with activity, for example running and jumping

· A sudden and urgent need to pass urine

· Leakage of stool from the back passage

· Decreased satisfaction during sexual intercourse

So, what are the Pelvic Floor muscles?

Most women at some point in their lives will be told about the importance of the pelvic floor and to do ‘exercises’ to make it stronger but do we really know what the pelvic floor is and does?

Pelvic floor muscles are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. The pelvic organs are the bladder and bowel in men, and bladder, bowel and uterus in women.

The pelvic floor muscles stretch like a muscular trampoline from the tailbone (coccyx) to the pubic bone (front to back) and from one sitting bone to the other sitting bone (side to side). These muscles are normally firm and thick.

Imagine the pelvic floor muscles as a round mini-trampoline made of firm muscle. Just like a trampoline, the pelvic floor can move down and up. The bladder, uterus (for women) and bowel lie on the pelvic floor muscle layer. The pelvic floor muscle layer has hole for passages to pass through. There are two passages in men (the urethra and anus) and three passages in women (the urethra, vagina and anus). The pelvic floor muscles normally wrap quite firmly around these holes to help keep the passages shut. There is also an extra circular muscle around the anus (the anal sphincter) and around the urethra (the urethral sphincter).

Although the pelvic floor is hidden from view, it can be consciously controlled and therefore trained, much like our arm, leg or abdominal muscles.

Why does the pelvic floor become ‘weak’?

There are several factors that can result in the pelvic floor functioning at a lower level causing some of the problems mentioned above. These factors include:

· Pregnancy and childbirth

· Long term cough

· Constipation

· Being overweight

· Menopausal changes

· Pelvic surgery/trauma

· Repeated heavy lifting

How to ‘exercise’ your pelvic floor?

As stated we are regularly told to ‘exercise’ our pelvic floor muscles but rarely are we shown how to do this correctly and at a level that will cause positive change. In the first instance, I would always recommend an appointment with a pelvic health physiotherapist who can complete a full examination and give instruction to ensure the pelvic floor muscles are activating correctly. Done incorrectly pelvic floor exercises can do more harm than good!

As a rough guide try the following:

· Lie comfortably with your knees slightly apart

· Imagine you are trying to stop yourself from passing wind at the same time as if you are trying to stop passing urine and slowly lift and squeeze the muscles

· A feeling of gentle tightening in your lower abdomen is normal. Try to avoid pulling in your stomach, tensing your buttocks, holding your breath or squeezing your legs together.

How long to exercise?

First you need to find your starting point. No two people are the same and everyone’s pelvic floor will have a different level of endurance. For example, if you have never been a runner you don’t start by running a marathon – you start slowly and build up. This is the same for your pelvic floor.

To find your level follow the steps mentioned above and see how long you can hold the contraction for (up to 10 seconds’ max). Next how many times can you repeat the contraction for this length of time i.e. 5 second hold x 3.

This gives you a guide for your exercise program, so if you can do a 5 second contraction 3 time start with this and repeat 3 times a day then gradually increase this by holding the contraction longer and repeating more repetitions.

These types of exercises will increase your endurance, but you also need to train your muscles to work quickly for example when you cough and sneeze. So it is important to add some quick contract and relax exercises to your program where you tighten and relax the pelvic floor muscles quickly. Repeat as above (minus the long hold) to find your baseline and then build up gradually.

So, is this enough to make your pelvic floor muscles function at a sufficent level?

The short answer is NO. While this is a great starting point to ensure your pelvic floor muscles are functioning, it is not enough to do these exercises alone. Just like the other muscles in your body your pelvic floor does not work in isolation. To fully rehabilitate the pelvic floor, we need to train it to work in different positions that mimic real life situations. If you go to pick up your child, move a heavy object, go for a run this is when our pelvic floor will be challenged so these are the situations we need to train it to work in. Pilates can be a great way to start to trian your pelvic floor and gain a good foundation before then progressing into higher level exercises. As with all good exercise programs there should be a gradual build up of load to cause muscle adaptation and a strengthening effect. Below is a short video with some examples of how to progress to functional pelvic floor exercises.

What about breathing?

Breathing control is another important consideration when performing pelvic floor exercises and many people don’t realise the importance of this connection. Our main breathing muscle is the diaphragm, a dome shaped muscle under the rib cage. When we breathe in, the diaphragm flattens out and pushes on our abdominal contents (stomach, intestines, bladder, etc.), sending them down toward our pelvis. At the same time, the abdominal muscles tighten a little bit and the muscles of the pelvic floor, located between your pubic bone and tailbone, lengthen a little bit. This allows us to manage the increase in pressure in our abdomen that occurs when the diaphragm flattens out. When we breathe out, essentially the opposite happens: the diaphragm relaxes and goes back up toward the heart, the organs move up as well and the pelvic floor muscles contract. Therefore, co-ordinating your muscle contractions on an outward breath can increase pelvic floor contraction.

In summary, a fully comprehensive rehabilitation program which focuses on correct muscle activation, breathing control and gradual loading with functional exercises is required to train the pelvic floor muscles effectivley.

As a side note the pelvic floor can also be overactive but that is a topic for another day!

Pippa is a highly specialist physiotherapist trained in women’s health assessment and a certified Pilates instructor. Please get in touch for any further information or appointment advice. You can read more about her here.