Do I Really Need to Do Pelvic Floor Exercises??
If you are reading this and you are pregnant or have had a baby then the answer is definitely YES. If you have carried or are carrying a baby the resting tone in your pelvic floor is more often than not decreased, so that means that the pelvic floor will have a little bit further to travel to support the bladder. This does not always lead to symptoms of leaking, but waiting until you have symptoms before you start your pelvic floor muscle exercises is not the best idea. Strength training of your pelvic floor muscles over time can help restore the resting tone of your pelvic floor. If you are experiencing symptoms of leaking on coughing or sneezing there is a lot of evidence supporting isolated pelvic floor muscle training to cure these symptoms. Even though they are not the most exciting of exercises they do bring great results if done regularly. The guidelines recommend pelvic floor exercises 3 times a day https://www.nice.org.uk/guidance/ng123/chapter/Recommendations. This sounds like a lot but the most difficult bit is getting the habit started.
The pelvic floor is complex, it not only need to be strong but it needs to be fast to respond quickly to changes in pressure, such as a cough, sneeze or sudden movement. It also needs to co-ordinate with the abdominal muscles and the diaphragm when we are moving and exercising to support the bladder and vagina. That’s a whole lot of jobs that your pelvic floor needs to be good at and our training needs to reflect that.
What Do I Have To Do?
If you have not been doing your pelvic floor exercises already, it is best to set 10-15 minutes aside where you will not be disturbed (This is the biggest challenge for many women!!).
- Start lying down if you have just had a baby (You can progress to more upright postures as you improve your strength).
- Take a few deep breaths in and slowly out releasing any tension in your jaw and your tummy as you breath out.
- Squeeze up at the back passage as though you were stopping wind. Aim to pull the back passage forward towards your pubic bone. Let it go (Really important part of the exercise) and release.
- You may feel a little pressure building in your lower tummy, which is ok but you don’t want to feel any tension building higher than your belly button.
- Keep an eye out for the cheats I showed you in the second blog post (upper abs, diaphragm, buttock and leg muscles). If you are prone to using one of these cheats try to pull up your muscles on a breath out.
- Don’t worry so much about holding the muscles until you are sure you are isolating your pelvic floor muscles correctly. If you have tried an number of times but still feel that you do not know what you are doing, booking an appointment with a women’s health physiotherapist can be really helpful and get you set on the right track.
Watch this video for pelvic floor exercises
Isolate different areas (Front/Back)
I find some women benefit from doing the front part pelvic floor in isolation also. Bring your attention to your bladder and vaginal openings. Imagine pulling a marble up inside your vagina (I know it sounds ridiculous but try it). You will feel the muscles around the vagina pull in and up.
Endurance Pelvic Floor Exercises
We would all love to be able to do 10 x 10 second holds but after giving birth most women will take a number of months to get to this level.
Begin with a 2 second hold of your pelvic floor muscles and build from there. As you are letting go try to feel the let go. Feel if you had as much let go as your pull up. I often see women who contact really good for one second and then slowly let go instead of holding the muscle contraction up at the top, essentially slowly fading away rather than holding.
As you get comfortable with 2 seconds, progress to 3, 4 and so on and slowly build up to 10 x 10 sec holds. Remember counting to 10 does not mean you are holding the pelvic floor muscles to 10 so try to tune into what your muscle is doing.
Aim to do 10 repetitions of between 2-10 sec holds (depending on where you are at).
A large sigh out at the end of the set of exercises to fully release the pelvic floor.
Watch here to follow along with a dull set of pelvic floor exercises https://www.youtube.com/watch?v=YsjxADwHAus.
Sometimes a faster pelvic floor is what you need. This is especially true if you leak on a cough or a sneeze. To exercise the fast fibers of your pelvic floor you pull up your pelvic floor as before but this time nice and fast. Quickly pull your pelvic floor up to the top and release all they way back down. make sure you are doing a proper lift and not just flicking up and down. Repeat for 10 repetitions.
Learning to consciously contract before and during an increase in intra abdominal pressure ( Cough/sneeze), which basically means training your body to pre contract your pelvic floor before a cough/sneeze or lifting something heavy is what “The Knack” is all about. The key to this is speed of reaction and just the right amount of contraction (The Goldilocks Rule – Not too little, not too much, just enough). I fond some women over contract and end up bracing and breath holding which ultimately ends up with a downward pressure on the pelvic floor. There is a lot of evidence to support “The Knack” for improving leaking on cough and sneeze so practice your fast contractions and getting them in before a cough or a sneeze.
So Can I Really Do Them Anywhere?
Yes BUT only if you are actually doing then properly. When you have been training them for a while and can feel the muscles work well then of course you can do them in the car or in the doctors waiting room but if you are struggling to know what you are lifting up or you feel your buttocks clench every time you pull up your pelvic floor then you are going to need to lie down and make some time for your pelvic floor exercises.
What About All These Pelvic Floor Gadgets?
The pelvic floor apps such as Squeezy https://www.squeezyapp.com/can be great to remind you to do the exercises. It is so easy to have great intentions but suddenly a few weeks have passed with no exercises done!
Vaginal cones and pelvic floor stimulators available on line, which can have their place in pelvic floor rehabilitation but you would need an assessment with a women’s health physiotherapist before starting using one of these.
What if I Get Pain?
If you experience pain during your pelvic floor exercises, it is worth booking an appointment with a pelvic health physiotherapist for an assessment and in the mean time refer back to Part 1 of the pelvic floor blog which focuses on breathing and a pelvic floor meditation https://thebumproombeyondbirth.ie/4-part-pelvic-floor-series-part-1/.
In the next blog post we will take the pelvic floor to the next level and look at getting the pelvic floor ready for impact and returning to exercise.