The Importance of Keeping Your Pelvic Floor Strong With Physiotherapy
The pelvic floor muscles sit at the base of our body and are the muscular platform that supports the bladder, bowel, uterus and vagina. They assist with effective function of these organs and they work intimately with our deep abdominal muscles (transversus abdominus), our diaphragm and deep spinal muscles to form an internal cylinder that supports our spine. They also contribute to sexual sensation.
Your pelvic floor is the centre of your femaleness, however most women don’t even think about their pelvic floor until something goes wrong with it and then accept it as ‘normal’ and are too ashamed to speak to someone about it. Pelvic floor problems are certainly common but they are NOT normal and we need to learn how to correctly activate and strengthen our pelvic floor muscles and adopt healthy daily habits, as well as practical knowledge to protect the pelvic floor through our life stages. During and after pregnancy they are stretched and need restrengthening to tighten them back up. Even if you haven’t got symptoms of a weak pelvic floor, regular exercise of them is the only way to prevent issues later on.
“Prolapse, loss of continence, loss of sexual function and the resulting poor quality of life should NOT be accepted as the consequence of childbirth, over-activity or ageing.”
Signs of a weakened pelvic floor, poor abdominal control and/or bladder dysfunction can be:
Any leakage of urine with increased intra-abdominal pressure (extra pressure from coughing, sneezing, bending, laughing, lifting weights, certain exercises like jumping on a trampoline, jogging)
Any leakage of urine when hurrying to the toilet or on hearing running water or putting a key in the door when arriving home
Increased frequency of urination (normal should be approximately 5 to 7 times during the day and once at night for drinking 2 litres of fluid — you will need to go more times if you have a higher fluid intake
Dragging or aching sensation around vagina or anus which can be due to prolapse (relaxation) of the pelvic organs
Problems in controlling wind or bowel contents
Chronic constipation due to difficulty in emptying your bowels causing a need to strain (also known as obstructed defecation)
Any perineal discomfort, pain during sex or lower back aches
So how do we strengthen our pelvic floor?
Pelvic floor muscles are no different from any other muscle in our body. If we think of our gluteals or biceps, or even our heart, in order to keep them as strong as possible and healthy we need to exercise them right? However did you know that 50% of women do their pelvic floor exercises incorrectly? For this reason I highly recommend seeing a women’s health physiotherapist to make sure you are doing them the right way. In the meantime here is a place to start —
Pelvic floor muscle training by Sue Croft (Women’s Health Physiotherapist) —
Initially start in the lying position (to take weight off the muscles). Keep the spine neutral — neither arched or flattened. Start by establishing low slow breathing. Do not puff up chest, keep your shoulders relaxed and feel the gentle rise and fall of the abdominal wall.
Draw the muscles gently in and up around the urethra, vagina and anus (as if you are stopping the flow of urine and/or holding in wind). Contracting the muscles gently is important when first learning how to correctly activate the muscles. The action you should feel is a lift and squeeze pressure.
Keep breathing as you hold the contraction. At the same time place your fingers on the pubic hair line and you may feel your lower abdomen gently tense, drawing away from your fingers. This is a good thing. Your inner thighs and buttocks should remain completely relaxed.
To start with, hold only for a few seconds, then build up gradually to a 10-15 second hold and ultimately longer while continuing to breathe. Initially practise 3 to 5 at a time so not to unduly fatigue the muscles. It is also really important to relax completely between each contraction.
Remember many women following childbirth may have significant nerve damage or muscle damage (levator avulsion) and will have very weak pelvic floors regardless of how many pelvic floor muscle contractions they practise. So a well coordinated, long endurance muscle is, for some women, as important as a strong muscle.
The pelvic floor muscles are striated voluntary muscles, so when you perform exercise repetitions of these muscles, they can bulk up and strengthen — thus improving urinary incontinence.
When working out your exercise program, if we look at general exercise science, healthy voluntary muscle can increase its strength by up to 30% after an intensive 8-12 week program of muscle strengthening. So if you aim to do 5-10 contractions, 3 times per day, as long as their is some healthy muscle present, after 8-12 weeks you should notice an improvement in strength of the pelvic floor muscles.
Once you have the correct activation of the pelvic floor muscles, it’s good to add in some maximal contractions. To finish try 10 quick lifts to challenge coordination and speed of the pelvic floor muscles as this can come in very handy as practice for times of an unexpected cough or sneeze.
It is also then important to vary your positions when practising your pelvic floor exercises and progress to using them functionally, for example while in a good standing or sitting posture.
Good bathroom habits are also really important. You should go the minute you have a moderate to strong urge and avoid the ‘just in case’ trips to the toilet. Constipation and the need to strain to pass a bowel motion should be avoided as it puts excessive strain on the pelvic floor muscles and organs (ensure adequate fibre and fluid) and another handy tip is to put a small stool or phone book under your feet while sitting on the toilet (this lifts the knees above the hips, helping you straighten the back passage and makes it easier to pass a bowel motion).
As no woman is the same, seeking the advice of a women’s health physiotherapist is your best way to learn how to activate your pelvic floor where exercises can be individually tailored to meet your specific needs.
I hope this guide leaves you with the confidence and knowledge about what the pelvic floor is and how to ensure that it will continue to function with peak efficiency throughout your life. And in the words of Mary O’Dwyer:
“ I urge you to make this information a part of your female wisdom, talk about it and ensure it is passed on between generations of women.”
Nat x
Local pelvic floor physiotherapists we recommend:
Lori Forner — www.loriforner.com (Brisbane, QLD, Australia)
Sur Croft — www.suecroftphysiotherapist.com.au (Brisbane, QLD, Australia).
Shona MacIndoe — Ph. 0431484350 (Tintenbar, NSW, Australia)
Resources:
My Pelvic Flaw — Mary O'Dwyer
The Pelvic Floor and Core Handbook — Mary O’Dwyer
Pelvic Floor Recovery — Sue Croft