If you experience any bladder weakness, you should consult your doctor or health care professional before starting any sort of pelvic floor exercise.
What are Pelvic Floor Muscles?
Pelvic floor muscles are a group of muscles in the pelvis that form a sheet or hammock from the pubic bone at the front to the coccyx at the back, forming a figure of eight around the vagina, urethra and rectum, helping to support the bladder, vagina and bowel and to close the urethra and rectum and prevent prolapse.
The muscles of the pelvic floor need to be kept firm and slightly contracted to prevent stress incontinence.
They can be damaged or weakened in various ways and can sag and become ineffective due to strain caused by pregnancy and childbirth, a chronic or smoker’s cough, lack of general fitness, lack of use, changes due to menopause and age, too much heavy lifting, prostate surgery, chronic constipation and being overweight.
If your pelvic floor is damaged you may leak urine when you cough, sneeze, laugh, shout, exercise, blow your nose, lift, get up from a chair, bend or stretch.
Pelvic floor exercises can strengthen these muscles which will improve bladder control and stop leakage of urine. As with all muscles in the body, the more they are exercised, the stronger they will become.
Locating and Isolating the Pelvic Floor Muscles
It is essential to exercise the pelvic floor muscles regularly and correctly to keep them strong. It is important to locate and isolate the correct muscles.
To ensure you are working the correct muscles at the front, think about stopping midstream when urinating.
The rear muscles can be identified by squeezing the back passage area inwards and upwards; think about preventing passing wind.
The muscles work as a team and the rear muscles in action will coordinate with the muscles found around the bladder.
Pelvic Floor Muscle Exercises
There are two types of pelvic floor exercises:-
Quick pelvic floor exercises are when the muscles are rapidly tightened then relaxed repeatedly. This helps the muscle to stop the urine leaking when you sneeze, laugh or exercise, (typical in stress incontinence).
Slow pelvic floor exercises are when the muscles are tightened slowly and held for at least 10 seconds then slowly relaxed. This helps the muscles provide support for your bladder and bowel.
There are different opinions concerning quantity of repetitions each session and quantity of sessions each day:-
10 slow exercises and 10 fast exercises – x 4 a day
5 slow exercises and 5 fast exercises – x 10 a day
Once the muscles are stronger and you have regained control, continue to carry out the exercises three times a week. Build it up at a pace that suits you.
How to carry out the exercises
When you are familiar with the exercises, they can be performed in whichever position you feel most comfortable. To start, it may help to sit on a hard surface such as a toilet lid or cross legged on the floor, with the abdomen, buttocks and thighs relaxed. In either of these positions you can actually feel the pelvic floor muscles lifting up and away.
* Think of a wash bag with a drawstring closure. If you hold the wash bag with one hand and pull the drawstring upwards, the opening will initially close, then it will lift.
* Think of squeezing the water out of a sponge.
* Imagine a diamond shape with the pubic bone at the front, the coccyx at the back and the two ‘sit bones’ either side. Think of drawing the sit bones together.
* Think of your body as a building with 10 floors and the pelvic floor muscles as an elevator within your body:- for the quick exercises think of squeezing and lifting the elevator to the third floor for the slow exercises think of squeezing and lifting the elevator to the tenth floor
* Either continue to breathe normally or incorporate a breathing pattern, e.g. for quick exercises: inhale to prepare, exhale to squeeze and lift, inhale to release, exhale to squeeze and lift, etc., for slow exercises: inhale to prepare, exhale slowly to squeeze and lift, inhale to hold, exhale to release slowly.
* Isolate the pelvic floor muscles – don’t tighten your stomach**, bottom or thigh muscles.
SLOW Slowly tighten, squeeze together sides to centre, wrap around the front, (prevents tightening buttocks) and pull up the pelvic floor muscles one floor at a time as high & as hard as you can. Hold tightened for at least 5 seconds, (progressing to 10), if you can, then release, lowering one floor at a time until completely relaxed, then repeat
QUICK Pull the muscles up quickly and tightly, then release completely slowly and with control & repeat As the muscles get stronger, you will find that you can hold for longer than 5 seconds, and that you can do more repetitions each time without the muscles getting tired. It takes time for exercise to make muscles stronger. You are unlikely to notice improvement for several weeks – so stick at it! You will need to exercise regularly for several months before the muscles gain their full strength.
* Ideally all the time and always when lifting and exercising, gently squeeze and tighten the pelvic floor muscles approximately 30%, (to third floor out of ten), to a point where they are comfortable, you can just feel them working and you can hold them * Continue to drink fluids as normal
* Just to check – once only – try to deliberately stop mid flow when passing water. NB After this, wait a few minutes then ensure bladder has completely emptie
* Keep a check on your weight
* Only urinate when the bladder is full, don’t go frequently ‘just in case’
* Medical aids and devices are available but they will not do the work for you – only you can improve the tone of your muscles – no effort, no improvement
If you have any pain or notice no improvement after 3 months, it is advisable to seek medical assistance. You may need to exercise for up to 6 months before you see a full improvement.
**Because the pelvic floor muscles aid in activating Transversus Abdominis, the muscle that wraps horizontally around the torso and comes down to the inguinal ligaments, you may feel a gentle tightening like cling film wrapping around in the lower abdomen when the pelvic floor muscles are working. This helps to protect the spine.