In every day life we all have to deal with forces going through our bodies. These may be things such as; pushing a trolley round a supermarket, picking up something heavy from the floor, twisting to get something down from a cupboard overhead or just sitting and standing from a chair. All of these movements require muscles, ligaments, tendons and the nervous system to work as a team so that you do not hurt yourself.
The pelvic floor muscle are involved in all of the above, they sit at the base of our bodies and provide the floor of our pelvis. In addition these muscles support the bladder, uterus, rectum and help with the normal function of these organs.
Have you had any of the following?
- Bladder or Bowel problems either as a child or adult
- Vaginal Birth
- Been pregnant
- Had chronic constipation or straining to pass hard stools
- Lifted really heavy weights at the gym or at work
- Had chronic lower back pain
- Had a chronic cough
- Had a very sedentary job
If you have checked at least one of these and don’t train your pelvic floor, then you may be at risk of a pelvic floor related dysfunction.
The pelvic floor muscles are involved in both voluntary and involuntary actions. They have the ability to work without you thinking about them but can contract when you ask them to. They are staibilisers, postural muscles, and are extremely important for the continence mechanism. Unfortunately the muscles naturally decline in strength as we age and the other factors mentioned can also have negative effects.
Pelvic floor disorders:
Constipation is one of the most common gastrointestinal complaints, and one of the possible effectors, is pelvic floor dysfunction and outlet obstruction3. Being able to pass a stool requires a series of movements that are mediated through the action of the nervous system. Without proper coordination of the pelvic floor muscles contracting and relaxing you can get impaired rectal evacuation and slow colonic transit time. The good news is, pelvic floor training has shown to improve constipation.
Stress urinary incontinence is a distressing health problem mainly for women. It can impact heavily on lifestyle and can even make women shy away from physical activity. Pelvic floor muscle training can be very effective and studies show that cure/improvement rates can be as high as 65-80% in the short term and in the long term it seems to only diminish if exercises are not kept up.
Vaginal birth is considered the leading risk factor in pelvic floor disorders5. The passage of the babies head is associated with the largest forces and stretching of the pelvic floor muscles and leads to trauma. In addition vaginal delivery can also cause anal sphincter injury. This does not mean that every woman who has delivered their baby vaginally will have pelvic floor issues straight away, but over time they may experience loss of function or other issues mentioned above.
Training the pelvic floor effectively:
There is no quick fix to training the pelvic floor. Several studies show that in the longer term, improvements are not maintained if pelvic floor exercises are not continued. Exercises should focus solely on the pelvic floor muscles and not encourage the deep abdominal muscles to take over.
The goal is to improve the function of the pelvic floor muscles focusing on their strength, endurance (the ability to stay activated over longer periods of time) and also to increase the structural support for the pelvic organs. These three aspects should be achieved in a controlled manor without over-stressing.
The reason we use breathing as an exercise to prime the pelvic floor is as follows. As we breathe in the diaphragm contracts and as we exhale it relaxes. If we are under stress as we breathe in, such as during exercise, our abdominal muscles contract alongside the diaphragm causing something called intra-abdominal pressure. This can also cause the exhale of breath to be more vigorous as abdominal muscles remain active as the diaphragm relaxes to let the air out. Alongside these abdominal muscles, the pelvic floor also contracts to help protect the internal organs. If functioning correctly it should be constantly reacting to intra-abdominal pressure, however if there is dysfunction you can see why people have urinary leaks during exercise, coughing, sneezing laughing etc. Studies have shown that Pelvic floor muscle training should be used in respiratory rehabilitation programmes.
- Begin lying on your back with your knees bent and your feet flat on the floor. You can rest your head on a pillow so that it feels supported. Place one hand on your chest and the other hand onto your stomach.
- Start to slowly breathe in through your nose and let the air flow drop down into your stomach. The hand on your chest should not move and the hand on top of your stomach should start to raise upwards. You want to avoid pushing out with your abdominal muscles the movement should be relaxed and natural.
- Gently exhale through your mouth, let your stomach relax and the hand on your chest should remain relaxed.
Diaphragmatic breathing with activation of the pelvic floor muscles:
- Using the techniques above, begin your diaphragmatic breathing. Do a few rounds of breath so that you know you are doing it correctly.
- Next draw the muscles around the urethra, vagina and anus up towards the centre of the body. Make sure the pressure is gentle.
- Keeping the tension how many diaphragmatic breaths can you take keeping the same tension?
- To start with hold for 1-2 breaths, overtime you are hoping to be able to cycle 5-10 breathes without the muscles fatiguing.
- The tension should never be too strong as we are trying to get the muscles to work for you subconsciously in the long run.
- GOAL: aim to do 5-10 contractions 3 times per day for 8-12 weeks and see how different your pelvic floor feels.
If you feel you would like to learn more about pelvic floor rehabilitation then please email: firstname.lastname@example.org and we can book you in for a consultation.
1: Croft (2014) Pelvic Floor Essentials 2nd edn. National Library of Australia Cataloguing-in-publication entry.
2: S.P Jurgensen et al., (2017) Relationship between aerobic capacity and pelvic floor muscles function; a cross-sectional study. Brazilian Journal of medical and biological research. 50 (11)
3: Baffy et al., (2020) Pelvic floor dysfunction and refractory Constipation. www.worldgastroenterology.org.
4: Neumann et al., (2005) Physiotherapy for female stress urinary incontinence: a multicentre observational study. Australian and New Zealand Journal of obstetrics and gynaecology, 45:226-232.
5: Callewaert et al., (2015) The impact of vaginal delivery on pelvic floor function – delivery as a time point for secondary prevention. BJOG: An International Journal of Obstetrics & Gynacology, 123:5
6:Hagen S, Stark D, Glazener C et al., (2014) Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. The Lancet, 383:796-806
7: Park & Dongwook (2015) The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. J. Phys. Ther. Sci, 27:2113-2115
8: Bo et al., (2014) Evidence based physical therapy for the pelvic floor: bridging science and clinical practice. 2nd edn. Elsevier London:UK
9:Dr Splichal (2015) Barefoot Strong, Unlock the secrets to movement longevity. Dr Emily Spichal: UK