First things first.
What is your pelvic floor and where is it?
The pelvic floor is a sheet of muscles that extend from the very end of your spine to your pubic bone at the front, forming a ‘platform’ between your legs. It provides the floor to your pelvis (the bottom part of your abdomen/ tummy) and supports the contents of your pelvis – your bladder and bowel.
It also helps to control:
- The urethra – the tube that takes urine outside of your body
- The anus – back passage, through which you open your bowels
Why do I need to exercise my pelvic floor muscles?
Because your pelvic floor muscles are the group of muscles that wrap around the underside of your bladder and rectum, strengthening them helps you keep better control of these organs associated with them and helps prevent some forms of incontinence. Strong pelvic floor muscles also help to achieve erection and may prevent premature ejaculation.
What if my pelvic floor muscles become weak?
Pelvic floor muscles can become weak, through lack of exercise (like any other muscle in the body), following surgery (to reduce your prostate glad for example), from being overweight or even from having a chronic cough, both of which put pressure on your pelvic floor and can stretch the muscle, making it less effective. If this happens you may experience a range of symptoms that relate to different types of incontinence:
- A tendency to leak urine when you cough, laugh or sneeze. (Stress urinary incontinence).
- A need to go to the toilet frequently (referred to as frequency) during the day or night.
- An urgent need to visit the toilet and leaking before you get there or if you don’t go (urge incontinence).
- An inability to control the passing of wind from your back passage.
- An urgent need to visit the toilet to empty your bowels and leaking stool before you get there or if you don’t go (urge faecal incontinence)
How can I strengthen my pelvic floor muscles?
To begin withyou need to know where your muscles are, so you can be sure you are exercising the right ones. Try to stopping the flow of urine in mid-stream or imagine trying to avoid passing wind by squeezing inside and pulling upwards – the muscles you feel while doing this make up your pelvic floor.
We’ve included two types of exercises: the first set of two will very specifically help you tone tighten your pelvic floor area and the second set helps you keep your general pelvic area fit and toned.
The good news is there are only two main exercises you need to learn – the fast twitch and the slow twitch and you can do them pretty much anywhere anytime: standing, squatting or lying down. But, we think it’s best to learn them in the following position so you can be sure you’re getting them right:
Sit on a chair, toilet seat or toilet lid, make sure that your feet are flat on the floor and your legs are slightly apart the lean forwards, resting your elbows on your knees.
NOTE: It is important that you do the slow twitch first and then the fast twitch each time you exercise your pelvic floor muscles.
Mastering the slow twitch:
- Draw up the muscles around back passage, as if you are trying to stop passing wind. Make sure that you do not contract your buttock muscles while you do this.
- Draw up the muscles around your urethra, as though you are trying to stop the flow of urine. Hold for as long as you can. For a count of five to start with for example.
- Then slowly relax and let go.
- Do as many repetitions as you can until you feel your muscles getting tired. Gradually increase the length of time that you hold each contraction (build up to 10 seconds or more if you feel you can).
Next - the fast twitch:
- Pull up the pelvic floor muscles as before.
- Hold for one second and then relax.
- Repeat until your muscles feel tired.
You may notice that it takes a lot of concentration to begin with to do these exercises correctly and that at the beginning your pelvic floor muscles tire easily. This is totally normal and it will get easier.
You might also find that you muscles ‘let go’ too quickly and that you cannot hold the slow twitch for a count of five straight away. If you can’t, just hold them for as long as you can. For example, if you can only hold the contraction for a count of three, use that as your baseline and build up gradually.
When you’re doing your exercises it’s important to try not to:
- Squeeze your buttocks together
- Bring your knees together
- Hold your breath
- Lift your shoulders / eyebrows or toes upwards. If you do any of these, you are not contracting (tightening) your muscles correctly.
How often should I do my pelvic floor exercises?
Aim to do your pelvic floor exercises every day and make sure you include both the fast and slow twitch. Fewer good squeezes are better than lots of half hearted ones, but try to challenge yourself, by attempting to do more repetitions and increase the holding time.
It will take several weeks of regular exercise to regain the strength in your pelvic floor muscles. And you’ll need to keep doing the exercises on a regular basis to stop your muscles becoming weak again.
If this is an individually planned programme, your nurse will discuss with you how often and for how long you need to perform these exercises.
How do I know my pelvic floor exercises are working?
You can feel your pelvic floor contracting by putting one or two fingers into your vagina whilst having a bath or shower. Tighten your pelvic floor so that the muscles squeeze your finger hard. If you notice a difference
Also you can test the strength of your pelvic floor by stopping the flow of urine mid-stream. This will feel similar to the twitch exercises above and uses the same muscles. You may not be able to completely stop the flow, but you may notice that you are able to slow the flow down. Gradually over the weeks you should notice an improvement. It is important that you do not do this test more than once a fortnight as it may cause problems with your bladder – it’s just a test to see how you’re muscle strength is progressing
If you don’t notice a change in your muscle strength after three months, ask for help from your continence nurse or your physiotherapist.
Try this for stress incontinence - ‘The knack’
If you’re suffering stress incontinence, try to brace your pelvic floor muscle (like you’ve learnt above) before you cough, laugh, sneeze, lift anything heavy, or prior to any activity which makes you leak. As your muscles get stronger, this little trick becomes more effective.
Try this if your bladder is not emptying properly
You may lose or leak a few drops of urine after you think you have emptied your bladder (called after-dribble). Even if you’ve waited a bit and shaken it can still happen and wet your trousers.
After-dribble occurs because the urethra is not being emptied properly, most commonly due to weak pelvic floor muscles. The best way to deal with this is to push the last few drops of urine out by squeezing your pelvic floor muscle.
Here’s how you can do it if they’re not strong enough to do it on their own. After passing urine, wait for a few seconds to allow your bladder to empty then place the fingertips of one hand close to your anus. Keeping a gentle pressure, draw your fingers forward towards the base of your penis. This pushes any remaining urine forward to where it can be emptied by shaking in the usual manner. Repeat this twice to make sure that your urethra has been properly emptied.
(EB Note: I’m presuming these next exercises are suitable for men too? Should we just check?)
Extra exercises for your pelvic floor
Here are a few, more general exercises that will keep your pelvic floor toned and help with incontinence.
- Lie on your back with bent knees hip-width apart and feet flat on the floor.
- Inhale slowly, contract your pelvic floor muscles and lift your hips.
- Hold for up to ten seconds (keep breathing!).
- Lower your hips back down and release your pelvic floor gently.
- Start at five and build up to ten repetitions, as you get stronger.
- Stand with your back against a wall, feet hip-width apart.
- Inhale; contract your pelvic floor muscles.
- Lower yourself into a squat as though sitting in a chair.
- Hold for ten seconds. Rise back up to standing andrelease your pelvic floor. Rest for ten seconds. That's one repetition. Start slowly but try and build up to ten.
- Stand with your legs together.
- Contract your pelvic floor muscles and jump your legs apart while bringing your arms overhead.
- Release your pelvic floor as you hop your legs back together.
- Repeat for 30 to 60 seconds.
Dead Bug Crunch
- Lie on your back.
- Extend your arms straight up toward the ceiling. I
- nhale, contract your pelvic floor muscles, and extend your right arm beyond your head and right leg forward.
- Release pelvic floor muscles and draw arm and leg back to starting position.
- Repeat with left arm and leg.Build up to ten repetitions on each side.
Yoga for your pelvic floor
Yoga is often suggested as a good way to help strengthen not just the pelvic floor but as an all-over way to keep fit and flexible. Here are a few simple movements that specifically target your pelvic floor. You’ll need a yoga mat and remember to relax the pelvic floor on each inhale and contract it on each exhale.
- Stand with your feet about mat-width apart, toes off mat and heels on it.
- You’re your knees and lower into a squat.
- Move thighs apart slightly wider than your torso and press elbows against inner thighs, bringing palms together in front of chest.
- Lengthen spine, moving tailbone toward floor and lifting crown of head toward ceiling.
- Breathe deeply and aim to hold for one minute.
Why it works: This pose lengthens the pelvicfloor, allowing it to contract more forcefully.
Reclined Bound Angle
- Lie on mat with your knees bent and feetflat on floor.
- Bring soles of feet together and allow knees to fall out to sides.
- Rest arms by sides with palms up.
- Close your eyes and breathe deeply.
- Hold for one minute.
Why it works: Your inner thighs help stabilize your pelvic floor. This exercise helps them become more flexible. When they’re flexible, you’re able to activate your pelvic muscles more deeply.
Legs Up the Wall
- Sit on the floor with one side of you body just touching a wall.
- Swing your legs up against the wall while slowly lowering your back and head to the floor – keep your legs straight.
- Allow your hands to fall to your sides, palms facing up.
- Close your eyes and breathe deeply, relaxing into the pose.
- Hold for one minute.
Why it works: The thinking here is that the change in gravity puts a little pressure on your diaphragm, allowing you to breathe more deeply and to fully relax the pelvic muscles without any fear ofspillage. Again this makes the muscles more flexible which is good for control.
- Kneel with your knees mat-width apart and toes touching.
- Walk hands forward and lower your torso between your thighs, resting forehead and nose on mat.
- Extend your arms and press palms into mat and your hips toward heels.
- Close your eyes and breathe deeply.
- Hold for one minute.
Why it works: To be strong, your pelvic floor also needs to be flexible. This pose helps opens up your lower back, allowing your pelvic floor to expand and stretch with each inhale.In time this helps with flexibility and strength.