- Pelvic Floor Exercises are important to do during pregnancy and should be restarted immediately after giving birth and continued for the rest of your life.
- Before you try strengthening your pelvic floor, be sure you are activating and connecting with the RIGHT muscles – if you are unsure, or don’t feel much happening, seek the advice of a women’s health physiotherapist.
- Check you aren’t cheating by using your bigger and more dominant abdominal and/or buttock muscles.
- Be sure to progress your exercises into functional positions throughout your daily activities (like when you go for a walk or hang the washing on the line).
Nearly everyone these days has heard of pelvic floor exercises and know they are important to do during and after pregnancy. Fewer people actually do them….and even fewer people actually do them PROPERLY. One research article showed that 60% of women who read a pamphlet about how to do pelvic floor exercises ended up doing them incorrectly! This article is designed to give you a good understanding of how you can best find the right muscles, activate them correctly and the strengthen them functionally within the activities in your daily life. It is important you read the lead-up article “What is Your Pelvic Floor – And How Can You Look After It?” before reading this article.
Strengthening Your Pelvic Floor Muscles
If you are pregnant, start your exercises immediately and continue 3 times a day until the birth of your baby. If you have just had your baby, start your pelvic floor exercises 24 hours after birth and continue a progressive strength program as detailed below. After 3 months continue your program once a day, everyday, as a maintenance program to sustain your strength throughout your life.
Identifying the RIGHT Muscles
It’s not always easy to find your pelvic floor muscles. You can’t really see them and they are tucked up inside you. Some women never even knew they were there so it may take some time to figure out how they work. First you need to identify the muscles you want to exercise – this can be especially difficult during late pregnancy and after birth. There are 3 different parts of your pelvic floor to identify;
(1) The muscles that control your urine flow
(2) The muscles that control your bowel sphincter
(3) The muscles around your vagina
• To find the muscles that control your urine, try to stop the flow of urine midway when you are on the toilet. You may not be able to do this initially, but it will help you identify the muscles. This is not an exercise and you should only test this once every few weeks, (as doing this repetitively may cause urinary tract infections). You know your muscles are getting stronger when you can stop the flow more quickly.
• To find your bowel sphincter muscles, tighten the muscles around your anus as if you are trying prevent yourself from passing wind.
• To find the muscles around your vagina, focus on tightening the muscles around your vagina. After birth and when your discomfort has reduced, it may be helpful to insert a finger into your vagina so you can feel the muscles tighten. After you have resumed intercourse, you can also practice tightening around your partner or “hugging your hubby” – this is an excellent way to exercise your pelvic floor.
Check out this video demonstrating how to find the right pelvic floor muscles.
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How To Contract Your Pelvic Floor Muscles
(1) Find a comfortable position, lying or sitting, with your BACK STRAIGHT
(2) RELAX your tummy and let it hang forwards
(3) BREATHE IN SLOWLY and deeply expanding your bottom ribs
(4) BREATHE OUT SLOWLY, leave your waist soft, slowly TIGHTEN the muscles around your front and back passages as if you wanted to stop yourself passing water and wind………Then try to LIFT to pull your vagina up inside your body (away from an imaginary pin)
(5) BREATHE GENTLY (don’t hold your breath) and count how long you can hold the contraction for without losing any strength
Watch this video to see pelvic floor muscles being contracted on the ultrasound
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Can you feel anything happening? If not, It might help to place one hand on your pubic bone and one on your tail bone and imagine gently pulling your tailbone towards your pubic bone.
If you have problems getting these muscles to work, don’t worry you are not alone! …. one in three women have problems during or after pregnancy. Contact a women’s health physiotherapist who can assist you with any difficulties you are experiencing.
Once you have these muscles working correctly you can start your Pelvic Floor Exercise Program…
Your Pelvic Floor Exercise Program
→ How long can you hold the contraction for before the muscles give in?
Write this number here : ______ sec
→ However long you could hold for, you must now rest for twice as long to give the muscles a chance to recover…..then repeat the contraction again.
→ How many times can you repeat this contract / relax combination before the muscles get too tired and you can’t feel them working?
Write this number here : ______ reps
→ Write your final equation here…. ____ sec contract, _____ sec relax x ____ reps (For example, 4 sec contract, 8 sec relax x 5 reps)
→ Each week increase the time you hold by 1 sec and the number of repetitions by 1 until you reach 10 x 10 sec holds. After that, follow the progressions listed below.
→ Repeat your exercise program 6 times per day for the first 6 weeks, 3 times a day until 3 months and then once a day, everyday after that!
→ Because the muscles get tired easily it is best to exercise little and often and Stop if you can no longer feel the muscles contracting and/or relaxing.
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What Not to Do
X Don’t cheat by squeezing your buttocks or thighs together – tighten around your passages only – really try to isolate this area.
X Do not hold your breath – if you can’t do it and breathe normally, your outer abdominal muscles are trying to help too much, so let them relax!
X Do not regularly stop your urine flow to exercise your pelvic floor muscles (use this only as an occasional test)
X Don’t do your exercises in a slumped position (like in the car)
X Don’t do curl-ups, crutches or sit-ups – if your pelvic floor is weak this will only strain it more!
If you are tensioning correctly, you will feel your lower tummy gently tension back – but if you try too hard or too fast, your upper waist will take over the exercise. Using your bigger abdominal muscles will put pressure down on your pelvic floor and do more harm than good.
Progressions
• As you get stronger, add some quick, hard, punch-like contractions into your program. Pull your pelvic floor up as hard and fast as you can – then relax. Try working up to doing 10 quickly in a row.
• The “Lift” exercise : Imagine that at rest your pelvic floor is a lift on the ground floor of a building. Can you make it gradually go up more and more floors? Tighten your pelvic floor muscles as hard as you can, then try to pull them up further and then further again, imagining the lift going all the way to the top of the building, before lowering to ground floor again.
• Do your pelvic floor exercises in many different positions – If you only do your exercises in lying or sitting then you will not strengthen effectively. It is crucial to progress your exercises to standing, walking, squatting and finally when lifting a weight.
This video shows you how you can progress your exercises as your strength improves.
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‘The Knack’
Try to practice contracting your pelvic floor before your sneeze, cough, laugh, get out of bed or do anything that increases the pressure in your abdominal area. This is called ‘The Knack’ and will help protect your ligaments and muscles from any further damage and unnecessary strain.
Life is busy and remembering your exercises is not always easy – here are a few tips to help – find one that works for you;
After going to the toilet
• When you wash your hands
• When you have a drink
• After you change baby
• When you clean your teeth, do the dishes or hang out the washing
• When you feed baby
• Write yourself a note on the fridge
• ‘Walk through the door, do your pelvic floor’
References
(1) Ashby E (2007) Pre and Post Natal Exercise for Women, course notes Specialist Certificate in Exercise for Women, Melbourne University.
(2) Bo K, Berghmans B, Morkved S and Van Kampen M (Eds.)(2007) Evidence Based Physical Therapy of the Pelvic Floor , Elsevier Ltd, Philadelphia.
(3) Carriere B and Feldt C (2006) The Pelvic Floor, Thieme, Germany.
(4) Chiarelli P (1995) Before and After, Queensland Health, Brisbane.
(5) Continence Foundation of Australia (2005) One in Three Women who ever had a Baby Wet Themselves, Australian Government, Canberra.
(6) Mantel J, Haslam J and Barton S. (2004) Physiotherapy in Obstectrics and Gynaecology, Butterworth-Heinemann, London.
(7) O’Dwyer, M. (2007) My Pelvic Flaw – Preventing Pelvic Floor Problems Throughout Life, Redsok Publishing, Buderim.
