The pelvic floor is not a muscle we typically think of “exercising” until something goes wrong. However, the pelvic floor supports our pelvic organs, helps with motor control of the pelvis, aids in lymphatic drainage and venous return, maintains control of our bladder and bowel, and has a sexual function. With all the roles that the pelvic floor plays it would only make sense that we should be exercising it, not only when an issue arises but to prevent any issues in the first place!
In order to exercise these muscles appropriately, we must first understand where they are, and what state they are in. The pelvic floor is composed of the muscle fibers of the levator ani and associated connective tissue which span the area underneath the pelvis at the bottom of our trunk. It functions as the base of our inner core muscles and works together with the diaphragm. To learn more about the core check out Jennifer Frey’s blog on Redefining Core Stability.
The condition of the pelvic floor can be influenced by many things, for example it may be weak or atrophied due to menopause, or pregnancy/ delivery. The pelvic floor can also have tension or scar tissue from pelvic procedures and vaginal deliveries. The group of pelvic floor muscles is also highly influenced by stress and anxiety. It is one of the first places to “tense up” as a response to stress. Therefore, it is important to be doing the correct exercises for YOU to see the best results. Individualised pelvic floor exercises are an effective way to conservatively treat pelvic floor dysfunction such as prolapse, incontinence, pelvic pain, and many more, when done properly.
When we think of exercises for the pelvic floor, the first thing that comes to most of our minds are Kegels. Kegels are an exercise developed by Dr. Arnold Kegel in the 1940’s as a way to strengthen the pelvic floor. They consist of a squeeze and lift of the pelvic muscles. Kegels or pelvic floor contractions may be very beneficial for some individuals, however, there may be individuals that should not be doing them right away. In cases where the pelvic floor muscles have tension or trigger points, the exercises to start with are those meant to relax and release tension in the pelvic floor. This is often the case in patients with pelvic pain but can also be the starting point for patients with incontinence or prolapse, depending on the assessment of the pelvic floor. Doing “Kegels” with an already tense, irritated pelvic floor will only exacerbate any issues you may be experiencing.
Once tension has been addressed, focus may shift to strengthening of the pelvic floor. A pelvic physiotherapist can assess the strength of your pelvic floor with an internal (vaginal) exam. As the pelvic floor works in conjunction with the diaphragm it is important to time the contractions with your exhale and relax the pelvic floor as you inhale. When we feel for a pelvic floor contraction internally, we want to sense both a squeeze as well as a lift of the pelvic floor. Some cues work better for some than others, but common cues used to create this contraction are:
Common mistakes made when performing a pelvic floor contraction are breath-holding or straining, using compensatory muscles such as the glutes or adductor (inner thigh) muscles and giving downward pressure. For this reason it is helpful to have a pelvic physiotherapist assess your pelvic floor contraction to know if you are performing them correctly.
Once a good contraction is achieved, pelvic floor strengthening exercises can be progressed to more challenging variations such as a longer endurance hold or multiple quick contractions in a row. The pelvic floor contraction can be timed during another more functional exercise, such as a bridge or squat. Ensuring the pelvic floor is engaged during other core or full body exercises can be a further challenge as well. Eventually, we train your pelvic floor to be a fine-tuned and responsive system that no longer needs a lot of conscious thought so you can do the activities you want.
Pelvic floor exercises, when done properly, can help to resolve many pelvic floor dysfunctions. Knowing which exercises are appropriate for you helps you enjoy the activities and lifestyle that are important to you. Having an assessment with a Pelvic Physiotherapist will allow you to know where to start with your exercises.
References:
Velde, J. V., & Everaerd, W. (2001). The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Behaviour Research and Therapy, 39(4), 395-408. doi:10.1016/s0005-7967(00)00007-3