“How do I know if I’m doing my pelvic floor exercises correctly?”
One of the most common things women tell me is that they just aren’t sure what they’re doing when it comes to their pelvic floor exercises. It’s not part of the curriculum at school (although sign me up I’d love to teach it!), it’s not something your parents know how to teach you, it’s not something you’re born knowing… but it REALLY should be! 1 in 3 women will experience problems with their pelvic floor at some point during their life. This is far too high a number and I really believe we can change it by spreading awareness.
Common problems include, but are NOT LIMITED TO:
· Urge incontinence
· Stress incontinence
· Prolapse
· Increased urinary frequency
· Heaviness/dragging in your pelvic floor
· Constipation/problems emptying bowels fully
· Lack of sexual pleasure
· Painful sex
From my experience most women seem to have a basic understanding of the “stop wee” muscle. You may be able to stop a wee mid-flow (although we don’t recommend this) but that doesn’t tell me that you have a strong pelvic floor, or even that you are using it properly.
Truthfully, the best way to see if you are using your pelvic floor muscles well is to see a pelvic health physiotherapist. During the vaginal examination, we are able to check for signs of prolapse (both externally and internally) and make a diagnosis if present. We test not only strength, but sequencing, co-ordination, endurance, power, and overall efficacy of the muscle. We are able to distinguish which muscles need work, identify areas of pain, tension or restriction. We check whether you are compensating with other muscles (spoiler: you probably are) and of course correct and coach your technique.
All of these factors are very important, and every vagina is different. Going through pregnancy and childbirth is an absolutely massive physical challenge and, in most cases, trauma for your pelvic floor. Nothing beats individualised assessment, advice and treatment; if you are having ANY problems I urge you to reach out to a pelvic health physiotherapist. However, I wanted to share with you some tips that my clients over the years have found very helpful – and this is aimed at complete pelvic floor beginners!
1. Choose the right position
If you aren’t sure whether you can “really feel” a pelvic floor contraction, this could be for several reasons. One of the main ones is your starting position may be too difficult – standing and sitting are both more challenging than lying down on your back or side, as gravity isn’t working with you. Especially if you do these whilst sitting and doing something else at the same time – like driving – you’re often setting yourself up to fail. It’s too much distraction for an already neglected and tired muscle.
The “principle of specificity” plays a role here. If you want better isolated pelvic floor function; you need to practice isolated pelvic floor exercises! The other benefit of starting a pelvic floor exercise program in lying is you generally have better focus on your breathwork – which brings us nicely onto the next point.
2. RELAX before you contract
Overactivity in the pelvic floor is very common, for so many reasons. For the muscles to be properly effective, it is crucial they are able to switch OFF as well as ON. Prepare for a few contractions with a couple of deep breaths. RELAX on the inhale. Synchronising your contractions with your breath is important for a very simple reason; your pelvic floor will contract much better on an EXHALE.
We can think of your “core” as a cylinder. At the top, we have the diaphragm acting as a roof. At the bottom, we have a floor… you guessed it, the pelvic floor! There is a complex network of soft tissue and fascial connections throughout the cylinder, creating a tensile structure that responds to any activity at either end!
When you inhale, your diaphragm contracts and flattens, creating a vacuum effect that primarily draws air into the lungs. So naturally, this creates a negative pressure that pushes down on your pelvic floor. You will find it easier to relax the pelvic floor on the inhale for this reason.
When you exhale, the diaphragm relaxes and moves upwards again. This creates a positive pressure that in turn helps to draw up the pelvic floor.
Not always easy to master, but you can (and you should) optimise your pelvic floor training by synchronising it with your breathing.
3. Squeeze & lift… your bumhole
I hope you’re not offended reading the word bumhole. It’s just a word and I think it just sounds better than anus, sphincter, back passage, rectum… there’s no confusion when I say bumhole. And it’s my blog. So bumhole it is!
Most of us completely neglect the posterior muscles of the pelvic floor, which is a MASSIVE missed opportunity as they are actually the strongest part! When you look at WHERE the major PF muscle group (levator ani) is, they all attach around the bumhole (or “rectal canal” on the diagram). SO, if you start your contraction here, you are already using the most powerful muscles and you will get much better results.
Start by firstly squeezing your bumhole shut, then try LIFT it up. Hold for the duration of the exhale, and relax and let it go on the inhale. Simple!
4. Don’t force it!
A common mistake I see women make is that they just try too hard, get frustrated with it and give up. You don’t have to squeeze as hard as you possibly can every time; it makes it very difficult to really feel what is happening because you are probably overcompensating by clenching your bumcheeks, leg muscles, your stomach…
All you need is a definite “squeeze and lift” sensation from your bumhole, and a definite relaxation when you let it go. Start with a very gentle contraction and see if you can improve the sensation of feedback.
We can think of your muscles like the “hardware” – but you must remember the “software” will need updating! Getting those neural highways between your brain and your pelvic floor muscles busy again takes time and consistency. Think of this a little like a well-trodden path; if you don’t go down it very often, it can get overgrown with weeds and obstacles that have fallen onto the path and make progress difficult. Once it is in constant use, it is much easier to maintain!
Once you are able to get some good feedback by practicing these exercises in the right way, then you can start to try and build some consistency by practicing them regularly (3 x a day is a good aim, but anything is better than nothing). This may only be a couple of minutes at a time to start with – QUALITY is more important than quantity. When you feel yourself begin to fatigue, just stop and come back to it. Once you feel a bit more confident that you are getting good quality contractions, then you can start to practice long squeezes, short quick squeezes, and vary the positions that you do them in.
Pelvic floor exercise is something that will NEVER not be important for you, and should be a lifelong habit. Just like any other muscle, the training should be varied and functional; but don’t overcomplicate it to begin with. There is a very useful free resource from the POGP here for more advice. I’d love to hear from you – have you found this blog helpful? Do you still have questions? Is there anything you’d like to know more about? If so, get in touch – and as always thanks for reading!