What is the pelvic floor and why does it become weak?
The pelvic floor is a complex layer of muscles and ligaments which stretches like a hammock from the pubic bone at the front of your pelvis to the coccyx at the bottom your spine.
The pelvic floor has several functions:
- it supports your pelvic and abdominal organs, especially when you are standing or straining it helps the water pipe stay closed when you cough, sneeze or strain
- it is used to control leakage of wind or motions from your lower bowel
- it helps to heighten sexual awareness by tightening during intercourse
The pelvic floor can be weakened by childbirth, prolonged straining to empty your bowels, lack of exercise and the menopause. It may also simply become weak as a result of ageing.
A weak pelvic floor gives you less control so that you may leak when you exercise, lift, cough or sneeze.
How can exercising the pelvic floor muscles help?
It will improve, or even stop, leakage of urine. Like all other muscles in the body, the more you use and exercise them, the stronger they become and stay.
How do I find the pelvic floor muscles?
It is not easy to identify your pelvic floor muscles. Exercising them should not be visible from the outside.
Here is what to do:
Step 1
Sit comfortably with your knees slightly apart. Imagine that you are trying to stop yourself passing wind from your bowel. To do this, you must squeeze the muscle around the back passage. Try lifting and squeezing the muscle as if you have wind. You should be able to feel the muscle move and your buttocks or legs should not move at all. You should notice that the skin around your back passage tightens up and creates the sensation of lifting you from your chair.
Step 2
Imagine that you are sitting on the toilet to pass urine and try to stop yourself from producing a stream of urine. You should be using the same group of muscles that you used before, but you will find this a little more difficult. Do not try to stop the urinary stream when you are actually passing water because it can cause problems with bladder emptying.
Step 3
Try to tighten the muscles around your back passage and vagina, by lifting up inside as if you are trying to stop passing wind and urine at the same time. Do not tense your abdomen, squeeze your legs together, tighten your buttocks or hold your breath. If you can master this, most of the muscle contraction should be coming from the pelvic floor.
How do I practice the exercises?
You need to develop two types of muscle activity, slow and fast.
- to practice slow contractions
Do the exercises above and try to hold the pelvic floor tight for up to ten seconds. Rest for four seconds and then repeat the contraction as many times as you can, up to a maximum of ten.
- to practice quick contractions draw the pelvic floor rapidly upwards and hold this for one second.
Repeat up to a maximum of ten times. This will protect you against sudden leakage during coughing, laughing or exercise.
Aim to do one set of slow contractions followed by one set of fast contractions up to six times a day. Do not over-do it or the muscles will get too tired.
Exercising the pelvic floor muscles can strengthen them so that they provide the support you need which will improve your bladder control.
The exercises can be performed standing, sitting or lying down but you may find it easier at first to do them sitting down.
Other things that help
- get into the habit of doing your exercises regularly and linking them to everyday activities e.g. do them after emptying your bladder, while answering the telephone, standing in a queue or whenever you turn on a tap
- if you are not sure you are doing the exercises correctly, insert a thumb or two fingers into the vagina.
- use the pelvic floor exercises to prevent leakage before you do anything which might make you leak; this way, your control will gradually improve
- avoid going to the toilet “just in case”; go only when you feel that your bladder is full
- watch your weight; extra weight puts more strain on your pelvic floor muscles and your bladder
- avoid constipation. Straining can put excessive pressure on your bladder and bowels
- pelvic floor exercises take three to six months to produce maximum benefit, but you should continue them for life to prevent problems recurring or worsening; you should seek help from a health professional if there is little or no change in your symptoms after exercising for three months
- other methods which help some women include weighted vaginal cones, biofeedback and electrical stimulation; consult your GP, urologist or specialist nurse or physiotherapist for more details