Pelvic Floor Exercises
INTRODUCTION The pelvic floor (PF) muscles are found at the base of the pelvis & help to support the bladder, womb & bowel which are found within the pelvis. When there is an increase in pressure in the abdomen e.g. during lifting, coughing, bending or straining, the muscles & ligaments are important in maintaining the correct position of the pelvic organs. Without this support, organ prolapse or leaking of urine (stress incontinence) can occur. Bladder, bowel & sexual function all require strong pelvic floor muscles. Not everyone with symptoms has a weak pelvic floor but sometimes people do not understand how to activate these muscles correctly.
Spine
Uterus Bladder Pelvic Bone
Pelvic Floor Muscles Vagina
Anus Perineum
Reproduced with permission of Pelvic Obstetric and Gynaecological Physiotherapy (pogp.csp.org.uk)
PROBLEMS AFFECTING THE PELVIC FLOOR Smoking - Can lead to a
Constipation - Repeated
chronic cough which puts pressure on the pelvic floor.
straining to empty the bowels can weaken the pelvic floor.
Weight - Being overweight
Pregnancy & childbirth
can affect the function of the pelvic floor
- These can affect the pelvic floor with the extra weight of pregnancy & the type of delivery experienced.
Lifting - Repeated or heavy lifting puts the muscles under strain.
Exercise - Heavy weights or high impact exercise (e.g. trampoline) can affect the pelvic floor
Menopause - Hormonal changes at this time can bring about symptoms or worsen existing ones. Any of the above problems can lead to symptoms.
HOW TO EXERCISE
1
Find the muscles. Make yourself comfortable in lying or sitting & imagine that you are going to try & stop yourself passing wind & urine. Tighten the pelvic floor muscles & feel them lifting upwards & forwards from your back passage. Try & avoid holding your breath & try to keep the leg & buttock muscles relaxed.
2
Check you are doing them correctly by using a mirror to look at the area of the perineum, between the vagina & back passage. You should see an upwards & inwards movement when you contract your pelvic floor. If there is a bulging outward then you need to stop; this action is incorrect & will worsen your problems.
3 4
Feel inside your vagina with either a finger or thumb to see if you can feel some tightening. If you are sexually active then you can try to squeeze during sex.
EXERCISE PROGRAMME Each person needs to work out their own programme of exercise according to their strength at the time of testing. Tighten & see how many seconds you can hold the muscle contraction. Long squeezes up to 10 seconds help to build endurance. The muscles should be allowed to relax fully in between each contraction or tightening. At the beginning you may find that you can only hold for 1 or 2 seconds. This will gradually build up as the weeks go by & you keep exercising. Short squeezes are a quick tighten & let go. Find out how many you can do before the muscles get tired. 10 is a good number to aim for but don’t worry if you can’t manage this at the beginning. Eventually the goal is being able to do 10 long squeezes held for 10 seconds & 10 short squeezes. Little & often is good if your holding time is short & you feel that your muscles are weak. Doing your exercises in lying will help too in these circumstances. Aim to exercise at least 3 times a day. As the muscles grow stronger (3 – 5 months) then you can increase the time held for each squeeze. You can also select different postures in which to exercise e.g. standing & walking. It is very helpful to tighten your PF before activities which cause an increase in intra-abdominal pressure such as: - coughing, sneezing, laughing, pushing, pulling, bending, lifting, getting up from sitting to standing. This also reduces the strain on the pelvic floor.
Remembering It’s good to have a daily routine for your exercises so that you develop a pattern. You could have a reminder on your phone. There are a number of pelvic floor apps available including www.squeezyapp.co.uk which is approved by the NHS You can get some red dots to stick on your watch, your bag or around your home as a reminder.
LIFESTYLE CHANGES These are changes which can reduce the pressures on the pelvic floor.
1
2
Constipation. If this a problem then seek advice to improve your bowel pattern. It may be that you are not drinking enough or not allowing time to have a proper bowel movement.
Bladder. Maintain your fluid intake so that the urine does not become too concentrated. It can be tempting to reduce fluids if you suffer from leakage but this can make things worse. Reduce your caffeine intake if you suffer with urgency & avoid fizzy drinks.
3 Weight. 4 Smoking. 5 Exercise.
If you are overweight then losing some weight can help with symptoms.
Stopping smoking reduces coughing & improves oxygen uptake in the body & so helps to improve symptoms. Changing the type of exercise you do can be helpful whilst you are working to improve your symptoms. A low impact activity, like walking, swimming or pilates should not aggravate your problem.
DO NOT stop doing your pelvic floor exercises once your symptoms improve. DO NOT practise a “mid-stream stop� as this is not good for bladder function. Do your exercises separately from passing urine. DO NOT cut back on your fluid intake as this can make things worse.
Urgency & frequency: Involving a sudden need to go & having to go more often Nocturia: Going to the toilet at night more than once. Prolapse: A feeling of something coming down or heaviness & can also be painful Seek help from a specialist physiotherapist with experience in treating people with pelvic floor problems if you are struggling to do your pelvic floor exercises or if you are not sure if you are doing them correctly.
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