Pelvic Floor Muscle Exercises for Women

Where are they?

Healthy pelvic floor muscles create a firm, elastic, layered sheet of muscle supporting the pelvic organs (bladder, uterus, bowel). They attach to the front, back and sides of the pelvic bones, in both men and women.

What do they do?

Normal functioning pelvic floor muscles:

• provide active support for the pelvic organs which helps keep them in place (prolapse occurs when the organs drop downwards)
• help close the opening from the bladder (urethra) to hold urine in, for example when there is a strong urge to pass urine or during coughing, sneezing, laughing, and other strenuous activities such as running and jumping
• help close the opening from the bowel(rectum and anus)to hold in bowel contents (eg wind/diarrhoea)
• close the vaginal walls to keep tampons in and air/water out.  They are also active during sexual intercourse in both men and women
• Relax the bladder and bowel outlets to allow bladder and bowel emptying
• Assist the abdominal and back muscles to support the spine

What causes weakness of the pelvic floor muscles?

• Stretching from pregnancy and childbirth
• Strain from repeated - heavy lifting, coughing, sneezing
• Straining repeatedly to empty the bowel due to constipation
• Ageing
• Being overweight
• Being sedentary(inactive)
• Repeated strain from high impact activities (eg running/jumping) or abdominal muscle sit ups – especially if the muscles are already a little weakened.

Possible signs of pelvic floor muscle weakness?

• Urgent desire to empty bladder or bowel and feeling of not being able to “hang on” – this may lead to frequent toilet visits out of “fear” of having an accident
• Accidental loss of urine or bowel contents (eg wind, diarrhoea) – this may be associated with urgency or it may be associated with activity eg cough/laugh/exercising etc
• Bulging, heaviness in the vagina due to poor support of the bladder,uterus or bowel which may start to press downwards into the vaginal passage (prolapse). This may make bladder or bowel emptying more difficult
• Reduced sensation during sexual intercourse

How do you exercise the pelvic floor muscles?

A lot of confusion exists about pelvic floor muscle exercises. Like all muscles the pelvic floor muscles can be strengthened with regular exercise and this can improve bladder and bowel control.

Sit comfortably, leaning forward with your elbows resting on a table and your knees slightly apart.

• Imagine that you are trying to stop yourself from passing wind from the bowel and/or trying to stop the flow of urine. It is NOT recommended that you practice actually stopping the flow of urine on the toilet.
• You should be aware of a sensation of tightening around the back passage (anus) and vagina as well as a drawing in/ lifting of the skin away from the crutch of your underwear.
• Your buttocks and thighs should not be moving at all.
• You should feel the pelvic floor muscles “let go” as you relax them.
• The muscles need to be tightened firmly and held steadily for up to 10 seconds without holding the breath. Weaker muscles may only be able to hold for a few seconds initially.

A sufficient number of squeezes need to be done each time – at least 8-10 repetitions.  The muscles need to be rested between squeezes to allow recovery time – 5-10 seconds

As well as doing these longer squeezes it is often suggested to perform series of 8-10 fast, strong squeezes –  held only for 1-2 seconds.

Strengthening exercises should only take a few minutes at a time and be performed several times a day.

What if I can’t feel the muscles working?

It may be necessary to learn the correct pelvic floor exercise technique from a continence and womens’ health physiotherapist or nurse continence advisor.

Physiotherapists are “muscle training experts” and continence and womens’ health physiotherapists  are trained in the management of incontinence (bladder and bowel control problems).

A continence and womens’ health physiotherapist is well qualified to assess pelvic floor muscle function (generally with an internal vaginal or rectal examination), teach correct pelvic floor muscle exercises and design an individual training program to target each person’s specific needs.

Physiotherapists are also qualified to administer additional treatment that may be required, for example electrotherapy – this uses special equipment to stimulate very weak pelvic floor muscles, making them contract “automatically” until they are strong enough to be exercised.

They may also utilise biofeedback equipment to assist with the development of improved awareness of pelvic floor activity.This might include instruments which measure the  “squeeze” from inside or devices which are placed in the vaginal passage and held for short periods of time.

Remember

• It is essential that the correct muscles are identified before commencing a training program. Reading how to do them from a brochure or magazine  or being told how to do them may not be effective.
• Strengthening exercises alone  may not be effective in treating a bladder or bowel control problem (incontinence).
• Again as with all other muscles, a training program needs to include exercises which prepare the muscles for coping with everyday activities.This means developing pelvic floor muscle function during activities such as coughing, sneezing, bending and lifting as well as specific actions eg: swinging a golf club, running and jumping.
• Additional exercises to improve abdominal muscle function and your posture in general may also be necessary.  This is another reason why it is recommended to have an individual training program set for you by a specially trained physiotherapist (see below).
• It takes time for muscles to improve – you need to keep up a training program for at least 3 months and possibly for 6 months if your muscles are very weak to begin with.
• People with bladder and bowel problems should seek professional guidance to achieve best results. There could also be other causes/factors which need to be assessed.

How do I find a qualified physiotherapist or nurse continence advisor?

Contact:National Continence Helpline 1800 33 00 66