Many women find the pelvic floor a hard concept to grasp. Unlike other muscles in the body, such as the bicep, the pelvic floor is hidden from view, and as a result is one of the most challenging muscles to connect with. More than 50% of the female population doesn’t know how to do a correct pelvic floor contraction, with 25% actually doing it in a detrimental way. No wonder 1/10 women need surgery for their pelvic floor!
My advice to women is, if you are going to put the effort in and embark on a pelvic floor strengthening program then do yourself a favor and have your pelvic floor assessed by a trained professional. This one single appointment can potentially save you time, money and distress later in life by ensuring your technique is correct and that you have a program that is going to be effective enough to lay down pelvic floor muscle bulk. This will require you to have an internal assessment which I promise is not nearly as scary as it sounds, in fact most women leave saying ‘ I wish I had done that earlier’.
Once you know how to do pelvic floor activation then I encourage women to treat the pelvic floor like you do your teeth. Our teeth play a very important function for our body, they need to be strong, and we only get one set so we need to look after them! Likewise, the pelvic floor needs to be strong. We only get one of them and it requires work and maintenance – we need to work on it for a short period of time daily!
An effective pelvic floor program really should have 3 components:
1. Endurance holds i.e. 5-15 sec holds x 8 – 10 reps
2. Power lifts i.e. 5-10 max 1 second lifts x 3 sets
3. Functional activation i.e. combining it with your squats
What exercises are bad for your pelvic floor?
Firstly, there is no bad exercise. Only bad technique. There are some exercises however that people commonly perform in a way that can be detrimental to the pelvic floor if there is an injury or pelvic floor weakness. These include:
1. Exercises that require breath holding i.e a clean and press style deep squat
2. Exercises with high impact in a vertical position such as skipping, jump box, star jumps and sprinting
3. Exercises that exert more force through the body than what an individual’s core strength can safely handle. i.e standing shoulder presses with weights that are too heavy will result in straining directly through the pelvic floor
How long after having a baby does your pelvic floor take to recover?
The answer to this really is ‘how long is a piece of string’. Every single woman’s body is different. The impact of pregnancy, degree of tearing in labour , naturally occuring muscle bulk, and commitment to pelvic exercises varies between individuals. It takes around 4 months for the pelvic floor “ hiatus’ which is the size of the opening that has occured during birth to return close back down. It then takes a longer period of time for nerve recovery, and muscle recovery. Everyone is different but I generally find this takes till around 12-18 months post -natal to really regain good strength and high level function.
*It’s important to note that even women who have had a cesarean are subject to a weak pelvic floor postpartum due to the impact of hormones and loads through the pelvic floor in pregnancy.
Can your pelvic floor fully recover to what it was?
In many cases it’s possible although in some cases, it’s not.
It really is dependent on what degree of tearing has occurred, and the impact that birth has had combined with genetic composition. We know that 30% of all women will have a significant internal tear called an avulsion, which means it’s unfortunately impossible for the muscle to return to its pre-birth strength. Remember this is the minority. For the majority of women, with hard work, consistency and the right program – it’s possible! In fact, many women comment that they are stronger than pre-baby after following a very specific pelvic floor program.
If you are looking for a starting point, start with this:
1. Get an image of the pelvic floor in your mind by looking at an anatomical drawing
2. Notice the pelvic floor is internally, so that is where you need to feel the contraction.
3. Place your fingers in your vagina, or imagine you are if you prefer not to.
4. Next use the muscles in your vagina to gently squeeze onto your fingers like trying to give them a hug.
5. Once you have that feeling, try not and lift your fingers up a little with yoru deep vagina muscles.
6. How long can you hold for?
7. Things to check – are your breathing? Make sure you dont breath hold! Are you tensing your bottom or abdominals strongly? Remind yourself the pelvic floor is INSIDE and that is where you are trying to target.
Once you get the hang of it, start practicing some long endurance holds, and some faster stronger activations. Build this up over time.
Some women find when they do pelvic floor exercises that the muscles actually get too “ tight” and go into a spasm. This can lead to other issues such as painful sex, urinary urgency or hip pain. This is important to know and is one of the reasons I highly encourage anyone embarking on a pelvic floor journey to get to a Women’s Health Physiotherapist. In one session they will work out what type of pelvic floor you have, and teach you the technique that is right for your body based on your strength level and any other issues you may have.