Pelvic floor exercises should be simple, squeeze and relax and they are done, right?
Pelvic floor exercises are complex.
They require breath control, co-ordination & timing for starters. That’s before you try & isolate the “squeeze” to the correct passage. Women have three passages; the bladder, vagina & bowel, men have two; the bladder & bowel, so as women we have more to concentrate on. Then we have to harmoniously put all of this together to perform one pelvic floor squeeze.
This is before we acknowledge there are two types of muscle fibres found in our pelvic floor muscles; fast twitch & slow twitch fibres. So not only do we have to sync our breathing with all the different passages, we have to also do some exercises that are FAST and some that are SLOW.
Taking all this into consideration its no wonder many people struggle to feel & find their pelvic floor muscles without any proper education or training. Hence why many don’t work them I suspect or make them a priority muscle to exercise daily.
And daily we MUST work them if we want to take back control of our bladders, avoid frequent bathroom trips, stop trumping every time you stand up, prevent pelvic organ prolapse and so on.
So here are my top tips for performing a good pelvic floor exercise:
- Breathe. IN and OUT slower than your normal breath.
Pelvic floor muscles should be squeezed closed and drawn in on the OUT breath.
This completely throws a lot of people. So here is why that is important.
As we breathe in, our diaphragm moves down to allow more air into our lungs and in sync with this movement our are pelvic floor muscles. They work together like a piston. As we breathe out, our diaphragm relaxes and moves upwards to help air leave our lungs and so do our pelvic floor muscles.
You don’t want to draw a muscle in that is naturally bearing down and so you coordinate the squeeze with the out breath for this reason.
- Practising isolating the muscles around your pelvic organ passages.
Visualise your back passage and practise drawing it closed shut. Now try and draw some imaginary wind back up towards the front of your pelvis. So close and draw forwards might be a phrase to think about.
Do the same with your vagina passage, but this time think close and draw up.
Finally with your bladder, imagine closing your passage by stopping yourself having a wee and drawing that fluid back upwards and in towards your bladder at the front of your pelvis.
As women health physiotherapists we encourage ladies to recruit their pelvic floor muscles by squeezing in firstly your back passage, followed by the vagina in the middle and then the bladder at the front. So think about drawing those passages in wards and upwards.
It’s important to draw the pelvic floor muscles UP aswell as IN.
So how many squeezes, for how long and how often should you work them?
This all depends on your ability to feel and hold the squeeze in and up. I would recommend you try the 10 second test. Syncing your out breath with the drawing in & upwards of your back, middle and front passage, count for how long up tp 10seconds you can FEEL and HOLD your pelvic floor muscles for.
If you manage 2-3 seconds only then start with little and often. So for example, 3 repetitions with 3 second holds at least 3 -5 times a day. Build this up to 5 repetitions with 5 second holds 3-5 times a day.
Make sure you continue to breathe when you are holding your long squeezes. \its important that you DO NOT hold your breath.
The gold standard aim is for 10 repetitions with 10 second holds three times a day EVERY day.
We then want to also perform fast squeezes whereby we concentrate on drawing up and in ALL THREE passages at the same time quickly before releasing them. Ideally we are aiming for 10 fast squeezes, three times a day.
It’s so important that after all pelvic floor exercises; fast and slow we allow a rest period for the pelvic floor muscles to relax and lengthen.
In my classes I say words like ‘lengthen, soften, release, expand’ to help ladies and gents to relax their pelvic floor muscles before commencing their next squeeze.
It’s important we can relax and lengthen just as much as hold and strengthen our pelvic floor muscles.
If you are struggling to feel or find your pelvic floor muscles then please go and seek help from your local continence service or women’s health physiotherapist.
It is NOT NORMAL to not feel your pelvic floor muscles squeezing.
Please do not “put up and shut up” with leaking wee, poo or wind as help is out there for you to regain control.
Marie Fell is the founder of The Pilates Physio here in the UK. She is a qualified physiotherapist with over 12 years NHS experience in a wide array of specialisms and her passion lies in Posture, Pilates and the Pelvic floor! I am dedicated to helping empower ladies and gents to remain fit and active through class or 1:1 private Pilates/physiotherapy sessions. My mission is to empower, inspire and educate others to move freely and keep healthy and teaching Pilates with a clinician’s hat on allows me the best of both worlds.