By Charlotte Burton
PELVIC FLOOR PHYSIOTHERAPIST | MORNINGTON, VIC
Hi my name is Charlotte and I am a pelvic floor physiotherapist working in Mornington. I am passionate about educating women and men about their pelvic health and supporting them to live their lives to the fullest without fear of pain, leakage, prolapse or sexual dysfunction.
It is important to seek help from a pelvic floor physiotherapist if there is any doubt about how to perform your pelvic floor exercises correctly. We know that 1 in 4 women will actually perform an incorrect pelvic floor contraction and ‘strain’ or ‘bear down’ instead of contract. Furthermore, it is not always weakness of the muscles that is the cause of dysfunction, some patients actually have a hypertonic or ‘too tight’ pelvic floor. Just like any other muscle in the body, you can have tightness, weakness or BOTH! It is important to have this properly assessed to tailor your rehabilitation to your needs.
What is your pelvic floor?
The pelvic floor muscles (also known as the levator ani) sit at the base of our body and provide the floor to our pelvis.
The pelvic floor muscles have attachments to your pubic bone, tailbone and pelvis. Basically, they stretch from the pubic bone to the tailbone (front to back) and attached inside the 2 sitz bones too, on the ischial spines (side to side). The pelvic floor muscles are often described as a sling, hammock, parachute or trampoline and have the ability to move up and down.
What is the function of the pelvic floor?
- They support the internal pelvic organs – the bladder, uterus and rectum – helping to prevent prolapse
- They work with the deep abdominal muscles to form a muscular corset which stabilizes the spine
- They help keep the bladder and the back passage closed (to keep us continent) and relax to allow easy emptying
- Research tells us that 60-80% of women with stress incontinence can be improved and cured with pelvic floor muscle training and proper recruitment of muscles
- They help increase tone within the vaginal walls and increase sexual awareness
What happens to your pelvic floor during pregnancy and childbirth?
- The levator ani (pelvic floor) muscles are stretched by 1.5 to 3 times their normal length during a vaginal birth. No other muscle in the body has the ability to lengthen this much! This is why postnatal rehabilitation of your pelvic floor is so vital!
- Even if you didn’t push your baby out, your pelvic floor muscles have been stretched and strained by the 9 months of pregnancy and the baby’s weight putting increased load on the abdominal wall and pelvic floor.
- If you suffer abdominal separation, this can also increase the risk of pelvic floor dysfunction
What are signs of a pelvic floor dysfunction?
- If you have any of the symptoms below, please get in contact with a pelvic health physiotherapist for further assessment.
- Any leakage of urine with increased intra-abdominal pressure (extra pressure from coughing, sneezing, bending, laughing, lifting weights, exercise)
- Any leakage of urine when hurrying to the toilet, hearing running water or putting a key in the door when arriving home
- Increased frequency of urination (normal should be approximately 5 to 7 times per day and once at night)
- Difficultly emptying your bladder
- A dragging or aching sensation around the vagina or anus
- A sensation of a bulge or heaviness at the opening of your vagina
- Difficultly controlling wind or bowel contents
- Chronic constipation
- Pain and/or reduced sensation with penetration
- Recurrent urine infections (UTIs)
How to contract your pelvic floor?
- Find a quiet spot where you can sit or lie down and relax
- Focus your attention to your pelvic floor – the muscles around the anus, vaginal and opening of your urethra (wee tube)
- Squeeze the muscles surrounding the anus and vagina at the same time and lift upwards towards your pubic bone.
- Try to hold for 3 seconds without holding your breath (sometimes counting out loud can make it easier
- Relax and feel the muscle release and return to the starting position.
- Repeat 10 times.
The dos and don’ts of correctly contracting your pelvic floor muscles
- Do not use your inner thigh muscles
- Do not clench your buttocks
- Do not hold your breath
- Do not practice on the toilet when trying to emptying your bladder
- Yes, you should feel the muscle activate AND relax
- Yes, you should feel a squeeze in your anus and lift up into your vagina
- You can insert your finger into your vagina for feedback if you are struggling to find the muscles
- Yes your lower tummy will gently draw in
- To begin with – gentle is better than trying too hard to ensure the correct activation
How often should I exercise my pelvic floor muscles?
- It is important to practice pelvic floor exercises to strengthen your muscles and reduce the risk of incontinence and prolapse
- Even if you do not have any symptoms, these exercises prevent problems developing in the future
- Pelvic floor muscle strengthening can take 3-6 months to change the muscle morphology, which is needed to improve strength and bulk. This is why it is essential you are completing the exercises the RIGHT way and also CHALLENGING yourself as the muscle gets stronger.
- As your muscles get stronger, you should also be able to hold for longer, do more repetitions and complete in standing or during daily activities
- Aim to do a set of these 3 times daily
- Endurance training;
- Squeeze, lift and hold your pelvic floor muscles for 6 seconds.
- Rest for 6 seconds.
- Repeat 10 in a row.
- Co-ordination training;
- Quickly and strongly squeeze your pelvic floor, then without holding – let go completely.
- Try to repeat 10 in a row
- Functional training;
- This involves using your pelvic floor muscles in every day life situations (when you cough, sneeze, laugh, lift)
- Try to squeeze and lift your pelvic floor before and during these moments to prevent leakage and reduce strain on your pelvic organs
- Endurance training;
Is squeezing and relaxing on my own the only option?
- It is very common to lose interest, find it boring or still be unsure if you are doing your exercises correctly.
- Thankfully we have come so far and now have multiple biofeedback tools that your pelvic floor physiotherapist can recommend based on your specific assessment and needs
- You may have heard of vaginal weights, the Perifit, the Elvie or even electrical stimulation (if you have any signs of nerve damage) – all of which are most successful when used in conjunction with a proper assessment and treatment plan.
VISIT CHARLOTTE AT MORNINGTON PENINSULA FAMILY PHYSIOTHERAPY