Keeping Me Well - Cardiff and Vale University Hospital

Pelvic Floor

The pelvic floor muscles has 5 functions. It:

  • Keeps us continent in urine and faeces
  • Gives stability to the spine and pelvis
  • Supports the abdominal and pelvic contents
  • Has an important role in sexual function
  • Provides a protective reflex

It is one of the hardest exercises to get right as the muscle lies within the body and it is often taught incorrectly by encouraging women to create a squeeze in vagina using “everything you have”.

It is really important to find the correct muscle, and the best way to do this is as follows: 

  • Lie comfortably on your bed and squeeze around your back passage as if trying to stop yourself from passing wind.
  • Then squeeze as if to stop yourself having a wee.
  • Try and focus on the “upward and forward lift” of the muscle moving deep within the vagina. 
  • It’s important to get this right before you progress any further.

The most common way to cheat when doing pelvic floor exercises is to use your tummy, bottom and thighs to create a feeling of movement in the wrong place. To help you with this, it is better to focus on the “upward and forward lift” moving your back passage towards your pubic bone.

Sometimes, women have a muscle that is so weak, movement cannot be identified, they resort to bearing down to help create some feeling of movement within the vagina.
This is completely wrong and should be avoided. The following tests will help.

  • Belly button test. Your belly button should remain relatively still while performing a pelvic floor exercise. 
  • Mirror test.  Using a mirror, look at your vagina and back passage. When you do a correct pelvic floor contraction, there should be some movement of the muscle AWAY from the mirror. You should not see any bulging TOWARDS the mirror as it means you are bearing down.

If you have recently had surgery or a baby do not do this next test (self examination) until at least 6 weeks after surgery or delivery.

  • Self Examination. This one is really important, because it will tell you what your muscle is actually doing. Place your finger / thumb into your vagina, then tighten your pelvic floor. If you are doing this correctly, you will feel your finger lift in an upward and forward direction. With strong muscles you will also feel your finger being drawn inside. If your finger is being pushed out, it means you are bearing down. If you feel nothing, don’t worry, you may not be using the correct technique or your muscle may be weak.

Once you are happy that your muscle is working correctly, and you have a good technique, it’s important to improve the connection between your brain and your pelvic floor muscle. This can best be done by focusing, with your mind, on the ‘upward and forward lift’ and particularly on the ‘letting go’ of the pelvic floor muscle as you repeatedly contract and relax it. Improving this connection enables your muscle to work more efficiently.

The ‘Escalator’ Exercise

  1. Imagine your pelvic floor is a escalator.  Tighten your muscle and imagine the escalator going up to the top level.  As you relax, feel the escalator lowering slowly to the ground level.
  2. To progress this exercise, tighten your pelvic floor in stages until you reach the top level ie tighten to the 1st level then the 2nd level etc. Relax the same way through each level.
  3. A further progression would be to alternate ‘the level’ you tighten too, e.g. 1st – 3rd – 2nd – top – ground.   

These exercises are most effective when you really concentrate on the lift and lowering feeling of the pelvic floor as you contract and relax the muscle.

If your muscle is to be of any use to you, you need to be able to do a pelvic floor contraction and breathe, walk, etc, all at the same time. Once you are happy that you can feel an ‘upward and forward lift’, and you can identify that movement with your mind and you know that you’re not cheating, then you can progress to the next stage.

So far you have been contracting your muscle lying down, now try altering positions, eg sitting, standing, along with introducing activity, eg walking, climbing the stairs, ironing etc. Check that you can feel the same lift and lowering feeling in the new positions, and during the activities, as you felt when lying.

A good technique means you can contract your muscle while breathing normally, talking or during any of the above activities. If you have difficulty with this, try counting aloud while you contract your muscle. Aim for at least 50% of your maximum hold during activity.

You are now aware of your pelvic floor muscle.  To further improve its strength and
co-ordination it’s important that you find out what it can do, and then just do ‘a little more’.  If you over do it, your muscle will become tired and not work as effectively, and symptoms may temporarily increase. If you under do it, you will make no improvement. We want your muscle to be able to:

  • have the ability to respond quickly
  • hold on for a length of time
  • repeat contractions without tiring quickly.

Because you are an individual you will need your own individual personal exercise programme.

Many women think that if they can contract and relax their pelvic floor muscle, it will automatically work for them when needed, eg preventing wetting on coughing or prolapse developing / worsening when lifting. This is not the case. For the muscle to do its job, you will need to actively contract your pelvic floor muscle to the best of your ability BEFORE and DURING those activities that cause or may cause symptoms.
This is called functional bracing.

Change and improvement takes time an effort. Remember make YOUR muscle work for YOU by using it when YOU need it.

Keeping Me Well - Cardiff and Vale University Hospital

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