A weak pelvic floor is a common occurrence that I come across. It affects 1 in 4 in the population with many more as a lot is undetected or not reported. Pelvic floor weakness can be a cause of a range of health issues such as incontinence, vaginal pain, pelvic pain, sexual dysfunction, organ prolapse. It can also be a contributing factor in chronic back and hip pain where the weak pelvic floor does not stabilise the pelvis. Although the occurrence is more common in women, it can present in men as well.
There is confusion on how to engage and train these muscles so I hope the information below will serve as a guide in correct training of the pelvic floor muscles.
Where is the Pelvic Floor?
The Pelvic floor is a group of muscles which form the floor of your pelvis. Their function is to support the pelvis, control bladder, bowel and sexual function. These muscles work in conjunction with your core muscle around the stomach to provide stability and support the organs.
How do I know if my pelvic floor is weak?
From my personal experience, my pelvic floor became weak by atleast 50% after childbirth. I was able to detect this weakness by comparing the activation of my muscles before pregnancy to after my son was born. My pelvis also became unstable whilst walking and during certain positions. Most often the pelvic floor weakness is only picked up when it becomes worse that symptoms appear. These symptoms are:
- Leak urine whilst laughing, sneezing, or during exercise
- Pass wind accidentally
- Difficulty with bladder and bowel control – cannot hold or difficulty emptying when on the toilet
- Vaginal or a rectal prolapse
- Pelvic pain
- Pain during sex
What causes pelvic floor weakness?
The pelvic floor can become weak with age, hormonal issues, heavy and incorrect lifting as it puts more strain on the pelvic floor muscles. These muscles weaken especially during pregnancy as the weight on the baby puts strain on the pelvic floor as well as during childbirth. Men can also get a weak pelvic floor especially if there is heavy and frequent lifting. If lifting, is performed incorrectly that puts more strain on the pelvic floor muscles.
Chronic coughing or sneezing can also weaken the pelvic floor as it puts strain on these muscles. Other reasons why it can weaken include being over weight or with chronic constipation.
Pelvic floor muscle training – How to Engage the pelvic floor?
It is important to ensure activation and engage the correct muscles before any strengthening. This will prevent further damage through incorrect technique and exercise. Please follow the points below to engage the pelvic floor for correct pelvic floor muscle training:
- Start in sitting or lying on your back, relax the stomach muscles and don’t hold your breath
- Gently squeeze the muscles you would use to stop urinating
- If you can feel the muscles working, only then lift upwards towards your head, otherwise continue practicing gentle squeezes
Avoid clenching the buttocks, bracing the stomach or holding the breath
Pelvic Floor Muscle Training – How to strengthen?
Once you are able to engage and activate the muscle in a comfortable position then:
- Practice doing 5-10 sec holds with 5-10 repetitions, 3 times a day
- Practice doing hold / relax fast contractions as well as this will train different muscle fibers
- Progress to standing position, then to walking
It is best to practice frequently throughout the day. Try to incorporate pelvic floor muscle training into daily living e.g. when you are waiting for the microwave, or whilst brushing teeth.
How to exercise to incorporate pelvic floor muscle training?
Once, you can comfortably do pelvic floor muscles in isolation, then you can progress strengthening further by adding movements. The exercises below are good for pelvic floor muscle training. They are designed to increase pelvic floor activation and improve pelvic stability:
Lie on your back, knees are bent. Engage the pelvic floor as you lift the hips up using your buttock muscles. Core muscles around the stomach may be used as well to further support the pelvis. Lift as high as you can control using your glutes, core and keeping the pelvic floor engaged. Practice lowering whilst holding the pelvic floor together and then release the pelvic floor once you are resting back down again.
Bent knee fall outs
Lie on your back with knees bent. Engage the core muscles around the stomach and the pelvic floor and slowly let one of your knees go out to the side. Other knee can stay bent. Stop before you feel yourself letting go of the pelvic floor muscles. Slowly bring the knee back into the start position whilst maintaining the pelvic floor. Gradually progress the range of how far you let your knee fall out as you get stronger.
Swiss ball leg lifts
Swiss ball leg lifts – Sit on a swiss exercise ball and engage the core muscles around the stomach and the pelvic floor to stabilise the pelvis. Slowly lift one knee up whilst keeping everything still. Slowly lower leg whilst maintaining everything still. You may use your breathing to assist. Breathe in as you lift the leg up and breathe out as you lower the leg. Take caution to not let the pelvis tilt to the side as you lift the leg up.
Single leg extensions
Lying on your back with knees bent. Engage the core muscles around the stomach and the pelvic floor. Slowly lift one leg up and straighten upwards. Slowly lower and maintain control over the pelvis. Bring the leg up and down as you maintain. This exercise can be combined with a pelvic bridge for an advanced progression. Ensure that you keep the leg movements small and focus on keeping the pelvis still as you move the leg.
What exercises to avoid?
It is important to avoid high intensity exercises which will put more strain on the pelvic floor until there is sufficient gain in strength. Some examples for of exercises that are not deemed safe are:
- Jumping, running, skipping
- Deep squats
- Curl ups, sit ups
- Heavy weights or any exercise creating downward pressure on the pelvic floor
It’s all about function!
Try and incorporate pelvic floor muscle training into your daily tasks to maintain muscle strength better. For example, engage the core and pelvic floor whilst doing any lifting tasks, picking up groceries, picking up your baby etc.
If you are unsure on how to engage the pelvic floor or have any queries then please get in touch on firstname.lastname@example.org or call 9354 7000 and make an appointment with Simran – an experienced musculoskeletal Physiotherapist who is passionate about sharing knowledge and improving health in the community.