Pelvic Floor Exercise & Health

Written By: Dr Emma Warner & Wendy Shum

Maintaining a healthy pelvic floor is essential for overall well-being, yet it is often overlooked. It is never too late to start taking care of your pelvic floor, and it is also never too early!  

Problems related to the pelvic floor can have a huge impact on both physical and mental health, with dysfunctional pelvic floor muscles potentially leading to various issues; including urinary incontinence, pelvic organ prolapse, and problems with sex and intimacy.  

Although pelvic floor issues can affect both men and women, but we will focus on the female pelvic floor anatomically. We will delve into the importance of pelvic floor health and knowing your own body, and also talk about how to find and activate your pelvic floor. 

Understanding the Pelvic Floor 

The pelvic floor is a group of muscles, ligaments, and connective tissues that form a supportive hammock-like structure at the base of the pelvis. 

Image from NHS - Kent Community Health, Caring for the pelvic floor muscle for people with female anatomy (25 Nov, 2022)

The pelvic floor plays a crucial role in supporting the pelvic organs above it and preventing them from sitting too low in the pelvis (a “prolapse”), but it is also involved in maintaining bladder and bowel control, and contributing to healthy sexual function.  

Many people associate pelvic floor problems with having children, and it is true that pregnancy and childbirth are two of the main risk factors for pelvic floor problems. However, people of all ages can experience pelvic floor issues, even if they have never been pregnant, and research has shown that pelvic floor problems are not uncommon in the younger female athlete population.  

The loss of elasticity in our tissues that occurs with aging, the increased pressure created by abdominal obesity, chronic coughs or straining, undertaking particularly high impact activities and certain other medical conditions can also cause changes in the pelvic floor muscles, which may lead to symptoms.  

What might I notice if I have a pelvic floor problem?  

• Leaking of urine, flatus, or faeces, usually when coughing, laughing or doing something high impact such as jumping or lifting heavy weights 
• A sense of heaviness or dragging around the pelvis or vagina  
• Difficulty with penetration or inserting a tampon, or sex not feeling the same 
• Constipation  
• Discomfort around the tailbone area  

What should I do if I have concerns about my pelvic floor?

As said at the beginning of this blog, it is never too late and never too early to think about your pelvic floor health!  

The best thing to do is to see a women’s health physiotherapist who specialised in pelvic health can do an assessment of your past history and your symptoms and do a thorough examination of your pelvic floor. The examination will often involve looking at how you perform simple movements, an assessment of your core strength and even sometimes how you are breathing. They can also, if you consent, do an internal examination of the vagina which will help them to assess if you have a prolapse, any areas of pelvic floor muscle weakness or tightness, and how best to help you move forward.   

They will also be able to help guide you on how to do pelvic floor exercises (often called “Kegels”) correctly and effectively, as it is not always as simple as just squeezing! They will also help teach you how to fully relax the pelvic floor muscles, as this is just as important as being able to contract them well.  

When most people think about pelvic floor issues, they tend to think of the pelvic floor muscles being weak or loose. However sometimes the problem can actually be caused by tightness or overactivity of the pelvic floor muscles, and you might need to work on being able to relax them instead. 

Even if you do not currently have symptoms it is worth getting a pelvic health screen, particularly if you are perimenopausal (with or without children) or if you are planning on getting pregnant, in order to have the opportunity to spot and prevent potential future issues. 

If you are experiencing particularly severe symptoms, or you have other problems such as vaginal discharge, bleeding or pelvic pain, you should go to see your doctor as a first step.  

Lifestyle Factors for Pelvic Floor Health 

Your doctor and / or physiotherapist may advise you to limit things like caffeine, fizzy drinks and alcohol whilst you are working on rehabilitating your pelvic floor, particularly if your symptoms are related to leaking of urine.  

Not smoking is also important, as smoking can restrict the blood flow to the muscles in the pelvic floor, potentially inhibiting their optimal function.  

It is also good to keep hydrated to a sensible level (many women reduce their fluid intake due to symptoms for fear of leaking) and ensure that your diet contains lots of fibre to prevent constipation. Constipation can be a bit of a “chicken and egg” problem, in that sometimes the constipation can be exacerbated by tightness in the pelvic floor, and sometimes the straining from chronic constipation can affect the pelvic floor function due to increased pressure going towards the pelvic floor when you bear down.  

Exercise and the pelvic floor   

Pelvic floor problems can unfortunately be very troublesome if you are an active person. The goal is always to get you back to doing what you love symptom free, and usually this is possible. You may need a course of treatment and exercises from your physiotherapist that gradually progresses, or sometimes all that is needed is a small adjustment in your running form, your breathing pattern or in the way that you are skipping, as an example, to enable you to better manage the pressure going down to your pelvic floor, and therefore your symptoms.  

How to do a “Kegel” 

Many people will have heard and been taught in the past to try to stop their flow of urine when on the toilet to help feel their pelvic floor muscles. Whilst this will indeed contract your pelvic floor, please do not do this consistently as it can lead to the bladder not fully emptying and increase your risk of urine infections.  

Research has shown that the most effective cue for most people to get a good pelvic floor contraction is to imagine you are stopping yourself passing wind.  

Can you do 10 slow, controlled repetitions from a full contraction to a full relaxation and a 10 second hold of a maximal contraction without feeling like you lose strength? Do you struggle to do the movement without using your buttocks and inner thighs for help? Do you not feel much happening at all?  

Trying different positions such as sitting or lying on your back with your knees bent as this can sometimes help you feel the contraction better if it feels difficult.  

Our women’s health physiotherapists can advise you if you need help. 

Reference 

1. NHS. Caring for the pelvic floor muscle for people with female anatomy. 22 Sept 2023 Retrieved from https://www.kentcht.nhs.uk/leaflet/caring-for-the-pelvic-floor-muscle-for-people-with-female-anatomy/