Pelvic Floor Strengthening Exercises
Although we don’t like to talk about it, most of us notice that after childbirth we don’t have the pre-pregnancy pelvic muscle control we once had. This occurs because the weight of the baby in your uterus pushes down on your pelvic floor organs (which is why you felt you needed the restroom all the time, especially in the last trimester), and stretches the muscles of your pelvic floor.
Because of the stigmatism around incontinence and pelvic organ prolapse, pelvic floor dysfunction is significantly under-reported. The reality is that 41-50% of women over the age of 40 worldwide suffer from pelvic floor dysfunction, however, only 17% of these women seek medical help for the condition. Pelvic floor issues have been found to negatively impact one’s quality of life, disrupt personal relationships, our social lives, and mental wellbeing.
The good news is that there are medical professionals out there who can help improve your situation. Physical therapists specifically trained in the area of Women’s Health can help you manage this condition yourself through education and the modification of certain lifestyle factors.
What is the Pelvic Floor?
In simple terms, the pelvic floor is made up of a layer of muscle running like a hammock from the pubic bone in the front, to the coccyx (tailbone) at the back. The openings of the bladder, bowel, and vagina pierce the pelvic floor but are all surrounded by voluntary contractile muscles. As the pelvic floor contracts, these three passages close. Any weakness of the pelvic floor will therefore result in the ineffectual closing of these passages.
The pelvic floor muscles also play a critical role in sexual function. Strengthening these muscles can help reduce pelvic pain during intercourse and increase the sensation of your orgasm.
For optimal functioning, pelvic floor muscles need to have the ability to maintain their tone (which means a low-level constant contraction), be able to perform strong, quick contractions (to prevent urinary leaking or incontinence), and be able to relax to allow for urination, defecation, and intercourse.
The Benefits of Pelvic Floor Strengthening
Improve bladder and bowel control
Reduce the risk or severity of pelvic organ prolapse
Conditions pelvic floor muscles to aid childbirth
Increase sexual sensation and pleasure
Improve the outcomes and recovery from childbirth and surgery (such as in the case of a hysterectomy)
Improve overall quality of life (knowing that you won’t have embarrassing mishaps in public)
Pelvic Floor Muscle Identification
Before beginning any type of strengthening program, it is important that you are able to identify the correct muscles. The pelvic floor muscles are those that stop the flow of urine, stop gas, and tighten the entrance of the vagina. In order to find these muscles, sit on the toilet and midway through emptying your bladder, see if you can successfully stop the stream. It is important to note that this is not part of the strengthening program, but merely a way for you to isolate the correct muscles.
Another method to identify the pelvic floor is to lie on your back and relax the muscles of your thighs, buttocks, and abdomen (tummy). In this position, imagine you are preventing the passing of gas. If you are performing the exercise correctly, you will feel the muscles around your anus contracting. Lastly, pretend that you have inserted a tampon (if you use tampons) and try to suck the tampon as deep into the vagina as possible. This will help you identify the pelvic floor muscles surrounding your vagina.
Once you are confident that you know which muscles make up your pelvic floor, you can start with the strengthening. (For a more detailed explanation of the anatomy of the pelvic floor, watch this video.)
Pelvic Floor Exercises
1. Start with deep breathing:
Before starting with pelvic floor strengthening, it is important to ensure that you are breathing correctly. As girls, we were taught to keep our tummies flat by tightening the muscles of our abdomen (to avoid looking fat). The diaphragm (the muscle that flattens below your lungs to cause an in-breath) pushes down into the abdomen, causing a rise of the bellybutton. However, if we are unnaturally tightening the abdomen, we will breathe solely into the chest. As a result, any exertion (such as lifting a heavy object) puts pressure on the organs of the pelvic floor and increases the risk of prolapse.
To perform breathing exercises:
Lie flat on your back with your knees bent and your arms stretched out at your sides.
Take a deep breath in through your nose and allow your belly button to rise with the in-breath.
Hold the breath for 2 seconds and proceed to breathe out through your mouth.
Repeat for 5 minutes.
Once you are confident that you are not breathing into your chest, but into your abdomen, you can begin with the pelvic muscle strengthening.
2. How to correctly perform Kegel’s Exercises
After you have correctly identified the pelvic floor muscles and know how to breathe correctly into your abdomen, you can begin with strengthening.
Lie on your back with your arms outstretched at your sides, as above.
Contract the muscles of the pelvic floor (those that prevent urination, of the anus and the vagina as described). These are known as Kegel’s exercises.
In a quiet setting with no distractions, perform the Kegel’s exercises and determine how many contractions you can do, and how long you can hold them. Don’t do more than 5-10 reps at a time with a 3-5 second hold.
Ensure that you don’t hold your breath while performing the contractions.
If time allows, practice these exercises 3 times a day for 10 minutes each.
You can also sit while performing the exercises, as long as you can isolate the pelvic floor muscles and maintain a good breathing pattern.
In conclusion, pelvic muscle strengthening is important for preventing and improving incontinence and pelvic organ prolapse. It also helps with pelvic floor recovery post-surgery, improves sexual function, and aids in childbirth. Before starting with a pelvic floor strengthening, ensure that you are breathing correctly, and can isolate the desired muscles. For the best results, perform Kegel’s exercises three times a day for ten minutes each.
References
Davis, N. (2019, March 7). 5 Pelvic Floor Exercises for Women. Retrieved January 2021, from Healthline: https://www.healthline.com/health/fitness-exercise/pelvic-floor-exercises
Pelvic Floor First. (n.d.). Working your pelvic floor. Retrieved January 2021, from Pelvic Floor First: http://www.pelvicfloorfirst.org.au/pages/pelvic-floor-muscle-exercises-for-women.html
Physiopedia. (n.d.). Kegel's Exercises: Females. Retrieved January 2021, from Physiopedia: https://www.physio-pedia.com/Kegel%27s_Exercise_:_Females