Part 2: Finding The Pelvic Floor

For many women the pelvic floor muscles can be difficult to find at the best of times, and so after birth it can feel like a real challenge to even know if you are squeezing the right thing. If you still feel that you can’t feel your pelvic floor muscles or they are not lifting when you try and do a pelvic floor squeeze, please read the first part of the blog (Connecting to Your Pelvic Floor) https://thebumproombeyondbirth.ie/4-part-pelvic-floor-series-part-1/ as it will guide you through some visualisation and breath work to help you improve your awareness of your pelvic floor. Here, in part 2 of the blog, we are going to work on getting the correct pelvic floor muscle contraction.

Are Pelvic Floor Exercises Suitable for Everyone?

Before we start it is important to say there are some women that pelvic floor exercises may not be appropriate for, in particular, those with overactive (hypertonic) pelvic floor muscles. A hypertonic pelvic floor occurs when the muscles in the pelvic floor become too overactive, constantly switched on and are unable to relax. Instead of contracting these muscles further you will need to retrain them to let go first.

How do I know if I have a hypertonic pelvic floor?

You may have one or more of the following symptoms:

  • Difficulty emptying your bowels.
  • Pelvic pain.
  • Coccyx pain.
  • Painful sex.
  • Vaginismus.
  • Urinary incontinence.
  • Incomplete emptying of the bladder.
  • Slow flow of urine.
  • Hesitancy or delayed start of urine stream.
  • Urinary urgency (rushing to the toilet).
  • Urinary frequency (going to the toilet greater than 7 times a day).
  • Painful urination.
  • Pain on pelvic floor exercises.

If you think that you may have a hypertonic pelvic floor, it is best to continue with the visualisation and breathing work in the first part of the blog for a few weeks before progressing, however, best advice would be to book an appointment with a chartered physiotherapist who specialises in women’s health, who will assess your pelvic floor and give you an individualised plan.

If you do not suspect a hypertonic pelvic floor it is time to begin finding and training the pelvic floor muscles.

How can I find my pelvic floor muscles??

The most important part of the pelvic floor muscle exercises is to identify the correct muscles. There is no point doing 3 sets of 10 if you are not even squeezing the right thing!

  • Relax the muscles of your thighs, bottom and tummy. Let your tummy muscles hang loose too.
  • Take a deep relaxing breath into your tummy.
  • Squeeze in the muscles around the back passage as if trying to stop passing wind.
  • Imagine pulling the back passage/coccyx forward towards the pubic bone in front.
  • Nothing above the belly button should tighten. Some tensing of the lower part of the abdominal wall may happen. This is not a problem, as this part of the tummy works together with the pelvic floor muscles.
  • Then relax.
  • If you cannot feel your muscles contracting, change your position and try again. For example, if you cannot feel your muscles contracting in a lying down position, try lying on your side or move into a seated position instead.

I fond some women can work the front and the back of the pelvic floor well together but if you have had a difficult birth or are experiencing incontinence I think it is worth isolating the front part of the pelvic floor as well as doing the exercise outlined above (don’t worry they only take a few minutes to do).

  • Relax the muscles of your thighs, bottom and tummy.
  • Take a deep relaxing breath into your tummy.
  • Imagine a small marble at the vaginal entrance. Now imagine pulling that marble up inside.
  • You will feel more effort at the front of the pelvic floor with this one.
  • Nothing above the belly button should tighten. Some tensing of the lower part of the abdominal wall may happen.
  • Then relax.
  • If you cannot feel your muscles contracting, change your position and try again. For example, if you cannot feel your muscles contracting in a lying down position, try lying on your side or move into a seated position instead.

If you are struggling with pelvic floor issues I would recommend doing the two exercises above in isolation but if you are feeling good you may be able to combine the two together and work the pelvic floor as whole.

Another great cue for pelvic floor exercises is to use the pelvic diamond analogy from the visualisation in part one of the blog. Focus on bringing the 4 corners of the diamond together as you contract your pelvic floor and release as you let go.

Another strategy is to put one hand on your pubic bone and your other hand on your coccyx bone, as you lie on your side, and gently draw your pubic bone back towards your coccyx as you contract your pelvic floor. You should feel a small narrowing of the space between the tailbone and the coccyx as you contract your pelvic floor.

Play around with the different cues and you will find which one works best for you.

 

The Stop Test: Good or Bad???

In short, good test, bad exercise.

If you are still struggling to find your pelvic floor then “The Stop Test” can be done as a test. Try to stop or slow the flow of urine midway through emptying the bladder on the toilet. If you can, stop the flow of urine over the toilet for a second or two, then relax and finish emptying without straining. This ‘Stop Test’ may help you identify the muscles which control the flow of urine. It is not recommended as a regular exercise. Stopping the flow of urine repeatedly on the toilet is not an exercise. This should only be done as a test and repeated once a month at most and never done repeatedly.

Pelvic floor exercises are not necessarily easy to do correctly as the pelvic floor is difficult to isolate. When done correctly, they are very effective but practicing the wrong technique may cause more of a problem.

Common substitutions/Cheats.

In the early phase of pelvic floor exercise you must forget about strength and work on technique. Many women try too hard with learning pelvic floor exercises and end up tightening waist, legs and buttock muscles. This is obviously a waste of you precious time if you are not even working the muscles you had set out to work, and it many cases you will be doing the opposite of what a pelvic floor exercises and bearing down which in turn will weaken the pelvic floor rather than strengthen it.

Here are some of the common pelvic floor “cheats” I see in the post natal classes and in my physiotherapy practice. Slow down your pelvic floor lift and observe for any of the following cheats. If you find one you will have to train your body out of this before you start pelvic floor muscles holds and strengthening.

Diaphragm      “The Breath Holder”

The diaphragm and the pelvic floor work together and so I will often see women cheat by using their diaphragm. When you breathe in your diaphragm descends and the pelvic floor drops and on an exhale the diaphragm lifts up along with the pelvic floor. If you hold your breath while doing your pelvic floor holds you will feel like you are doing good pelvic floor work but in reality your diaphragm is doing all the work, so all you will improve is your ability to hold your breath! Pelvic floor muscle contractions are often taught on a breath out to avoid breath holding and splinting with the diaphragm. To do this you breathe in and as you breathe out pull up your pelvic floor muscles. Aim to breath in and out gently as you hold the pelvic floor muscles.

Obliques/ Abdominal Muscles     “The Ab Clencher”

Using your outer abdominal muscles when trying to do the pelvic floor is a common strategy I see used. This, unfortunately promotes incontinence and prolapse, as the pressure of the abdominal contraction will force pressure downwards on the pelvic floor ultimately weakening your pelvic floor. To look for this you will need to lift up your top and watch your tummy as you are doing a pelvic floor exercise to see if this applies to you. If you see movement in the muscles above your belly button, creasing at the upper tummy or your waist narrowing, you are using your abdominals and potentially doing harm by doing your exercises like this. Slow down your pelvic floor contraction and only lift as high as you can keeping your abdominals relaxed.

Buttocks and Inner Thighs .    “The Butt Gripper”

Your buttock or inner thigh muscles should not clench as you contract your pelvic floor and so the best way to check this is to place your hands on your buttock muscles and note any tension building as you contract your pelvic floor. if you are in sitting you may notice your body lifting in the chair or your knees being pulled together. The buttock and inner thigh muscles are near the pelvic floor but they will not be able to support your bladder on a cough or sneeze.

Posterior Pelvic Tilt .    “The Tilter”

Your lower back should not need to move as you squeeze your pelvic floor muscles so watch for you back flattening out as you contact your pelvic floor muscles.

 

Please watch the following video clip to see the cheats in action.

https://youtu.be/04JUDx0-PDw

 

Be patient with yourself in the finding phase as it can be very frustrating especially if you are prone to muscle substitution. It takes time to get the correct muscle strategy again. Start lying on your side/ on your back or sitting for a few weeks before you progress to standing. Many women who can correctly tension their pelvic floor in sitting, however when they stand up, there is more pressure downwards and they go back to substituting with the abdominals.

How Can I Tell for Sure I am doing Them Right?

The answer to this question really is that you need to have it checked by a Women’s Health Physiotherapist to be 100% sure you are doing it correctly. If you are not sure that you are doing the exercises correctly or you are having symptoms of pelvic floor weakness an appointment with a women’s health physiotherapist will be worth booking.

In Part 3 of the blog I will take you through a full set of pelvic floor exercises and you can work along with me once you are happy you are not using other muscles in your attempt to strengthen your pelvic floor.

All our post natal programmes include detailed pelvic floor work. If you would like more information click here https://thebumproombeyondbirth.ie/online-courses/.

 

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