Pelvic Floor Muscles
You are not alone. One in three women in Australia is affected by a Pelvic Floor Disorder (PFD). While PFDs such as urinary/bowel incontinence, pelvic pain and pelvic organ prolapse are common, they are not a normal or acceptable part of aging. In fact, they can often be reversed and effectively treated with painless, low-cost treatments options.
Many women don’t realise that they can improve their pelvic floor muscles with exercises to manage and overcome a range of issues such as prolapse, bladder or bowel leakage and even constipation. These pelvic floor exercises are designed to improve muscle tone and prevent the need for corrective surgery.
What are pelvic floor muscles?
The pelvic floor is a sling of flat muscles that attach to the pubic bone at the front and to the tail bone at the back. These muscles form the floor of the pelvis, that is why it is called the ‘pelvic floor’.
Weakened pelvic floor muscles mean the internal organs are not fully supported and you may have difficulty controlling the release of urine, faeces or even wind.
The diagram below shows the pelvic organs and pelvic floor muscles in women.
The pelvic floor muscles are often described as a hammock lifting and supporting the pelvic organs that lie above. These muscles need to be able to contract to keep us continent, but also they must relax to allow for urination, bowel movements, child birth and sexual intercourse.
Problems with the pelvic floor can occur when these muscles are too weak (hypotonic) or too tight (hypertonic). It is also possible for these muscles to combine a pattern of too much tension in some areas while too relaxed in others!
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 our pelvic floor weakens.
There are many everyday events and activities that cause pelvic floor weakness. They do this by reducing the integrity of our pelvic floor muscle, increasing pelvic floor strain or reducing its nerve supply. Some of these risk factors cannot be changed.
- Vaginal birth
- Constipation (straining while on the toilet)
- Smoking and chronic coughing
- Heavy lifting
- Excessive high impact exercise
For some people the muscles can become too tight. This is a less common but very distressing problem, especially for women. The causes are often complex and professional help is required to resolve the problem.
In almost all cases it is possible to gain control over the pelvic floor muscles and to train them to do their job well.
What are the symptoms of pelvic floor weakness?
Having a weak pelvic floor can lead to a variety of problems including urinary (leaking wee when you cough, sneeze, laugh or exercise) and fecal incontinence because you can no longer squeeze the muscles and the sphincters at the bottom of your bladder. This kind of stress incontinence affects up to a third of new mums. Many women also complain of finding sex less satisfying, because of less sensitivity in the vagina. Vaginal prolapse is also common where there is a feeling of a bulge or like something is ‘coming down’ inside your vagina.
Having a weak pelvic floor does not mean that you will have symptoms to begin with. The body may find ways to compensate for pelvic floor weakness, however as we age, this becomes less effective.
Where are our pelvic floor muscles?
- Sit or lie down with the muscles of your thighs, buttocks and stomach relaxed.
- Squeeze the ring of muscle around the back passage as if you are trying to stop passing wind. Now relax this muscle. Squeeze and let go a couple of times until you are sure you have found the right muscles. Try not to squeeze your buttocks.
- When sitting on the toilet to empty your bladder, try to stop the stream of urine, then start it again. Do this to learn which muscles are the right ones to use – but only once a week. Your bladder may not empty the way it should if you stop and start your stream more often than that and has the potential risk of leading to bladder and urinary tract infections.
These exercises should not feel uncomfortable, though if you do feel discomfort, you should see your doctor.
Getting the technique right is the most important part of the pelvic floor muscle exercises.
Exercising pelvic floor muscles.
Exercising them should not show at all ‘on the outside’. You should not pull in your tummy excessively, squeeze your legs together, tighten your buttocks or hold your breath!
- Squeeze and draw in the muscles around your back passage and your vagina at the same time. Lift them UP inside. You should have a sense of “lift” each time you squeeze your pelvic floor muscles. Try to hold them strong and tight as you count to 8. Now, let them go and relax. You should have a distinct feeling of “letting go”.
- Repeat “squeeze and lift” and let go. It is best to rest for about 8 seconds in between each lift up of the muscles. If you can’t hold for 8, just hold for as long as you can.
- Repeat this “squeeze and lift” as many times as you can, up to a limit of 8 to 12 squeezes.
- Try to do three sets of 8 to 12 squeezes each, with a rest in between.
Tips to help you.
- Get into the habit of doing your exercises during normal day to day activities. For example, whilst cleaning your teeth or waiting for a kettle to boil.
- If you are unsure that you are exercising the right muscles, put your thumb into the vagina and try the exercises to check. You should feel a gentle squeeze as the pelvic floor muscle contracts.
- Tighten your pelvic floor muscles when you feel you might be about to leak - pull up the muscles before you cough, laugh, sneeze or lift anything heavy. Your control will gradually improve.
- Drink normally - about 6-8 large glasses of fluid a day, avoiding caffeine if you can. Water is best! And don’t get into the habit of going to the toilet ‘just in case’. Go only when you feel your bladder if full.
- Watch your weight - extra weight puts extra strain on your pelvic floor muscles.
- Once you have regained control of your bladder, don’t forget your pelvic floor muscles. Continue to do your pelvic floor exercises a few times each day to ensure that the problem does not come back.
Remember: you can exercise your pelvic floor muscles wherever you are - nobody will know what you are doing!
Myth Buster - Men do not suffer from incontinence.
Males and females both have a pelvic floor. Men can and do suffer from incontinence, however they are at less risk as their pelvic floors are not subjected to pregnancy, childbirth or menopause, however they are not immune to the avoidable risk factors (see list above).
Help is available.
If you think you are suffering from a pelvic floor disorder, please seek help right away!
North Perth Physiotherapy women's health physiotherapists specialise in pelvic floor muscle exercises. They can assess your pelvic floor function and tailor an exercise program to meet your specific needs. They can also prescribe other treatment options such as biofeedback and discuss relevant lifestyle factors with you.
Become empowered by knowing there is help!