What is the pelvic floor and why do I need to worry about it?
Sneezing and not worrying about the aftermath is a luxury that, for around 50% of women, disappears during pregnancy or after birth.
After growing and delivering a new life into the world, the body has had to soften and loosen quite a lot.
The pelvic and abdominal regions essentially house the growing fetus through the pregnancy, which, in order to do so, have had to elongate and widen significantly.
Then, as the baby passes through the birth canal, the pelvic floor has to open right up to allow the baby to be delivered into the world. But what exactly is this pelvic floor?
What is the pelvic floor?
The pelvic floor is one of the most incredible designs of human anatomy to which most people have given little thought.
It is actually made up of 8- 9 individual muscles that join together to create a strong structure forming the ‘floor’ of the ‘pelvis’.
The pelvic floor is a multilayered structure woven together made up of muscles, fascia, and ligaments sitting deep within the pelvis. It runs just deep to the gusset region, from the tailbone at the back, through the thighs to the pubic bone at the front.
The pelvic floor has many important roles, including:
- Producing a tight seal or ‘sphincter’ around the urethra and rectum to prevent leaking of urine, stool or gas from escaping.
- Create a strong support structure to prevent the internal organs from descending downwards into the vaginal space (when this occurs, this is called a pelvic organ prolapse).
- Provide the sensation and muscle tone required for pleasure during sexual intercourse.
- Functions with other core muscles to create stability for the spine, strength, and prevent injuries.
The pelvic floor is a dynamic structure, which can change every minute in response to the load on it.
At low-level activities such as standing still, it will be working to prevent urine or faeces from leaking, but at a low enough level that it doesn’t fatigue.
If it contracts too hard unnecessarily, then it won’t be able to work when it is really needed, such as during activities such as running or sneezing with a full bladder and bowel. These activities require the pelvic floor to have a momentary increase in activation at a strong level, and only a healthy pelvic floor will allow this to occur.
If any of these functions aren’t performing like they normally would, it is a sign that you are dealing with weak pelvic floor muscles that may need a little TLC.
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How do we know that something is wrong?
Many women think that pelvic floor issues after having a baby are ‘normal’ and they will eventually resolve themselves. This shouldn’t be taken as a rite of passage, and pelvic floor issues are unlikely to resolve themselves if they are still present by around 3 months post-birth.
Women should ask themselves the following questions to help work out if anything is wrong:
- Do you leak urine when you cough, sneeze, blow your nose or exercise?
- Do you leak urine on approach to the toilet, or have you had an unexpected accident when you didn’t think you needed to go?
- Do you find it difficult to control your bowels (wind or stool)?
- Do you feel a sense of heaviness/ dragging in the vagina or rectum?
- Do you feel something protruding from your vagina?
- When you pass urine on the toilet, is it difficult or does it seem different to before?
- Is sexual intercourse and intimacy painful?
- Does sexual intercourse lack sensation or feeling?
Ladies, if you answered ‘yes’ to any of these questions, then I would love you to get yourself to a women’s health physiotherapist or pelvic floor specialist.
Tips for strengthening your pelvic floor
Just like exercises, fitness, and weight loss, sadly there are no quick fixes. The pelvic floor is a group of muscles and just like those in your bicep, they will only get stronger from consistently exercising in a challenging way.
My main advice for women is first to learn how to do pelvic floor activation the right way first. Many women can’t believe how different a correct pelvic floor activation is when I teach them compared to what they thought and have been doing for years.
The best way to learn really is to have a one-off appointment with a pelvic floor physio who can assess what you are doing, give feedback and guide you towards effective pelvic floor muscle training.
Then, once you have it down pat, it’s important to add a little ‘spice’ to the program, as I’ll be the first to admit pelvic floor exercises are as boring as anything. A few tips to prevent you from falling off the wagon and keep you motivated:
- Individualised program: Get a pelvic floor strength program that is specifically tailored to you. It is WAY more motivating to have a challenge specific to your own pelvic floor and work on all the different muscle components rather than just a “ squeeze and hold at traffic lights” many women do.
- Pelvic floor equipment: Consider introducing pelvic floor weights, stimulation or specific probes. With some guidance from a professional, they can make it more effective and more interesting.
- Pelvic floor app: Consider using a pelvic floor app that reminds you and allows you to record your exercises. This means there are no excuses for forgetting either!
- To the beat: One of my favourites is to play a song once per day and do pelvic floor exercises to the beat of the song for the whole song (Beyoncé is fun for this one!)
- Everyday moments: Try to sneak in some extra pelvic floor squeezes by strongly activating every time you sneeze, blow your nose, stand out of a chair or lift an object. This is called ‘the knack,’ and as well as strengthening, it often prevents leakage.
Pelvic floor muscle exercises
Pelvic floor muscle exercises, commonly known as Kegel exercises, are designed to strengthen the muscles that support the pelvic organs. These exercises can be beneficial for both men and women in improving pelvic floor and sexual function. And as with most exercises, there’s a variety – let us quickly brief you!
First up – kegel exercises. To perform Kegel exercises, start by identifying the pelvic floor muscles. One way to do this is by stopping the flow of urine mid-stream – weird, we know. Once identified, contract these muscles by squeezing them for a count of 3-5 seconds. Then, aim to relax the muscles completely for the same amount of time or slightly longer. Simple, right? Just repeat this contraction and relaxation cycle 10-15 times, 3-4 times a day.
Next up are quick flicks, commonly referred to as fast twitch. This exercise involves quickly contracting and relaxing the pelvic floor muscles in rapid succession. Contract and relax the pass through the pelvic muscles as quickly as possible for around 10 seconds, then rest for a few seconds. Repeat this 10-15 times in a row.
You can also give those muscles strength and control with bridges to squats, or even just simply getting those daily chores done, like carrying groceries or standing up from a seated position.
Then there’s technology. Biofeedback and electrical stimulation involve devices that provide feedback or stimulation to help you identify and strengthen pelvic floor muscles more effectively.
But remember, it’s best to engage with these pelvic floor exercises after consulting with a professional. As the kids often get told – don’t try this at home! In the meantime, make sure you’re maintaining a healthy weight and staying hydrated.
Where to get help
You can get pelvic floor muscle support by visiting a health clinic, pelvic health physiotherapist, gynaecologist, or medical professional to get your weakened pelvic floor and organs in shape.
Frequently asked questions
1. What causes pelvic floor dysfunction?
Pelvic floor dysfunction can be caused by various factors such as childbirth, aging, obesity, chronic constipation or straining, surgery, nerve damage, or repetitive heavy lifting. It can lead to issues like incontinence, pelvic organ prolapse, or pelvic pain.
2. How can I strengthen my pelvic floor?
Pelvic floor exercises, also known as Kegel exercises, are the primary way to strengthen these muscles. To do Kegels, squeeze the muscles you use to stop the flow of urine, hold for a few seconds, and then relax. Repeat this several times a day. Other exercises like squats and bridges can also help indirectly strengthen the uterus and pelvic floor.
3. Are pelvic floor exercises safe during pregnancy?
Yes, pelvic floor exercises are generally safe during pregnancy and are actually recommended to help prevent urinary incontinence and prepare for childbirth. However, it’s advisable to consult with a healthcare provider for personalised advice before commencing any pelvic floor exercises or training.
4. What are the symptoms of a weak pelvic floor?
Symptoms of a weak pelvic floor can include urinary or fecal incontinence, pelvic organ prolapse (a sensation of pressure or bulging in the pelvic area), pain in the pelvic region, discomfort during intercourse, and difficulty controlling the urge to urinate.
5. Can men have pelvic floor problems, too?
Yes, men can experience pelvic floor muscle dysfunction, often related to conditions such as prostate problems, chronic constipation, or surgery in the pelvic area. Symptoms of pelvic floor weakness may include urinary issues, pain in the pelvic region, and sexual dysfunction.
6. What should I do if I experience pelvic pain?
If you experience pelvic pain, it’s important to consult with a healthcare provider, such as a gynecologist or urologist, who specialises in pelvic health. They can assess the cause of the pain and recommend appropriate treatment, which may include physical therapy, medication, or other interventions depending on the underlying condition.
Sources
The Royal Women’s Hospital, The pelvic floor, n.d
Queensland Health, How to find and exercise your pelvic floor muscles (for women and men), May 2023
Mayo Clinic, Kegel exercises: A how-to guide for women, December 2022
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