Thanks to Lily Sutton, currently in her 2nd year of a pre-registration Physiotherapy Master’s at Teesside University, for researching and putting this piece together. Head to the bottom of the page to find out a little more about Lily.
When you think about your weekly workout routine, do you consider when to schedule in a work out for your pelvic floor? I’m guessing that the answer is no, and that pelvic floor muscle training does not take priority over your weekly HIIT class or Yoga class. This article may not be about the most glamorous of subjects, but in writing this I hope to educate you more about these important but often overlooked muscles down there and to inspire you to get your pelvic floor in shape!
Why is the pelvic floor so important?
All bladder, bowel and sexual functions require a healthy pelvic floor. Many women are unaware that the muscles that make up the pelvic floor need to be trained to keep them strong and healthy. Just like any other muscle in the body, the pelvic floor can become weak, overstretched, too tight, inactive or torn. The pelvic floor muscles lie underneath the pelvis and have two major functions:
1) To support the uterus, bladder and bowel.
2) To contribute to the opening and closure mechanisms of the pelvic organs (to contract and relax to control the release of excretions).
Up to 1 in 3 women may experience problems with their pelvic floor at some point during their life. This may cause problems such as urinary leakage, less pleasure during sex or a pelvic organ prolapse (more about this later). Even though problems with the pelvic floor are very common, due to the sensitive nature of the subject many women do not discuss this with medical professionals, and these problems often go underdiagnosed and undertreated. Although this problem is incredibly common and half of the population have a vagina, we are still awkward and often reluctant to talk about this. I think it is important to raise awareness so this subject gets the attention it deserves.
Who gets pelvic floor dysfunction?
You are more at risk of having problems with your pelvic floor if you have had children with a vaginal delivery, you are overweight, you have been through the menopause or you experience chronic constipation. However, pelvic floor dysfunction may affect young, physically fit women who take part in high-impact sports activity too, such as lifting heavy weights, plyometric training or trampolining (1, 2).
This is because high impact sports increase the intra-abdominal pressure (pressure concealed within the abdominal cavity) and this may overload and stretch the pelvic floor muscles.
Do I need to train my pelvic floor?
Dysfunction of your pelvic floor may cause urinary incontinence, pelvic organ prolapse or decreased sexual function. A pelvic organ prolapse is when one or more organs in the pelvis slip down from their normal anatomical position and bulge into the vagina. If you experience any of the symptoms below you may benefit from pelvic floor muscle training.
- Stress Incontinence
- Urinary leakage when you cough, sneeze, laugh or jump.
- Urgency Incontinence.
- Increased urgency to go to the toilet, which may result in leakage.
- Going to the toilet more often than usual.
- Decreased sensation during sexual intercourse.
- Discomfort during sexual intercourse.
- Feeling like you need to urinate during orgasm.
- A feeling of heaviness around your lower tummy.
- A feeling like there is something coming down into your vagina.
Even if you do not have problems with your pelvic floor now, this may affect you in the future, especially if you wish to have children. The Pregnancy hormone ‘Relaxin’, which works to ease the pelvic ligaments to allow for childbirth, coupled with the increased weight of your uterus during pregnancy can both contribute to making you more susceptible to issues with your pelvic floor.
However, it is important to note that these symptoms overlap with other conditions and may not be due to pelvic floor dysfunction, so it is important to see your GP if you do suffer from any symptoms listed.
So, what is pelvic floor muscle training?
The main aim of pelvic floor muscle training is to improve strength, endurance and coordination of the pelvic floor muscles to prevent involuntary urine leakage and to keep the pelvic organs in the correct anatomical position. Also, research has shown that strengthening these muscles has an impact on sexual enjoyment and performance by improving the blood supply and nerve activity in the area (3).
However, the pelvic floor can become over-active with increased muscle tone and this requires interventions to help relax the pelvic floor called ‘down-training’. The National Institute of Health and Care Excellence recommend women with stress incontinence or stress and urgency incontinence should perform at least 8 pelvic floor contractions, 3 times per day.
How do I train my pelvic floor?
Training your pelvic floor is really easy and really discrete. You could even train your pelvic floor when you are on your commute or when you are watching television, and no one would know.
- Sitting or lying comfortably, imagine you are trying to stop yourself passing urine, drawing your pelvic floor muscles upwards. (If you are unsure you are doing this correctly you could place your thumb inside your vagina to see if you can feel the muscles tightening). Do not hold your breath or tighten your abdominals, glutes or thigh muscles at the same time.
- Allow your muscles to fully relax after each contraction.
- Try long squeezes. How long can you hold the squeeze? Try to aim for 10 seconds.
- Try short squeezes. Quickly contract and then relax your pelvic floor. Aim to do this 10 times.
- At first your muscles may tire quickly and you may not be able to hold the squeezes for very long. This is completely normal and you will improve the more you practice as your muscles get stronger.
- Work up gradually with the aim of being able to do 10 long squeezes for 10 seconds, followed by 10 short squeezes.
- As your muscles get stronger and your pelvic floor contraction improves, you could try to do these exercises in other positions such as walking or during a squat.
Does it really work?
In 2014 a review of randomised control trials (the gold standard in research) looked at the effects of pelvic ﬂoor muscle training for women with urinary incontinence. 21 research studies with 1281 women contributed to the results of the research review. Women with stress urinary incontinence who trained their pelvic floor were 17 times more likely to report an improvement or a complete resolution of their symptoms compared to with women with no pelvic floor training. Also, in trials with women with stress and urgency incontinence, those who trained their pelvic floor were more likely to report symptom improvement or cure. The review concluded that pelvic floor muscle training should be the first-line treatment for women with any type of urinary incontinence (4).
Do you want to find out more?
If you feel you could benefit from pelvic floor muscles training and you are unsure you are doing these exercises correctly or your symptoms are persisting, speak to your GP or a Women’s Health Physiotherapist, who are experts in treating problems with the pelvic floor muscles.
- Carvalhais, A., Da Roza, T. and Sacomori C. (2018) ‘Pelvic Floor in Female Athletes: From Function to Dysfunction’, Women's Health and Biomechanics, DOI: 10.1007/978-3- 319-71574- 2_12.
- Carvalhais, A, Natal Jorge, R. and Bø, K. (2017) ‘Performing high-level sport is strongly associated with urinary incontinence in elite athletes: a comparative study of 372 elite female athletes and 372 controls’, British Journal of Sports Medicine, doi: 10.1136/bjsports-2017- 097587.
- Chartered Society of Physiotherapy (2018) Physios in Valentine's campaign to encourage men and women to ‘pucker up’, Available at: http://www.csp.org.uk/news/2018/02/13/physiosvalentines-campaign-encourage-men-women-pucker.
- Dumoulin, C., Hay-Smith, E. and Mac Habée Séguin, G. (2014) ‘Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women’, The Cochrane Database of Systematic Reviews, 14(5), DOI: 10.1002/14651858.CD005654.pub3.