The Pelvic Floor

The Pelvic Floor

The mystical pelvic floor – mentioned frequently and rarely understood. As a Women’s Health Physiotherapist, I feel it is my personal mission to reach as many people as possible and teach them about their pelvic floor muscles. Education is power! My blog this month will discuss the anatomy and role of the pelvic floor, what happens when it goes wrong, and the first steps to help you control and cure your symptoms.

The pelvic floor muscles, sometimes referred to as ‘Kegels’ are a sling of muscles that support your pelvic organs – Imagine a trampoline that spans the bottom of your pelvis from front to back and side to side. Just like a trampoline, they are able to move up and down. There are holes in your pelvic floor for passages to travel through – three in women, and two in men. These help to control the passing of urine, faeces, and wind at a time that is convenient for you. They play a massive role continence, sexual health, and core stability – so they’re pretty important!

How do I know if my pelvic floor muscles are affected?
Common symptoms of pelvic floor dysfunction include the following:

  • Urinary incontinence with laughing, sneezing, jumping or running
  • An inability to hold in wind when you want to
  • Faecal incontinence
  • Strong urges to go to the bathroom – a sudden, strong urge that is difficult to postpone – this can be for either bladder or bowel.
  • Increased frequency of going to the loo (normal is 4-6 times per day).
  • Constipation or an inability to empty your bowels fully
  • Painful sex or inability to have sex at all
  • Pain around the pelvis or abdomen

1 in 3 women will experience incontinence in their lifetime.
1 in 7 will experience stress urinary incontinence up to 7 years postnatally.
Between 40-80% of athletes will experience incontinence, depending on the sport.

It’s not just post natal women that are affected.

The stats show that pelvic floor issues are incredibly common but that most women ignore these
symptoms for years, often with detriments to quality of life and physical fitness.

What causes weak pelvic floor muscles?

They might be weak for a number of reasons,

  • Pregnancy, or multiple pregnancies
  • Heavy lifting
  • Constipation
  • Being overweight
  • Being deconditioned

How do I activate them?

Studies show that approximately 30% of women will perform a pelvic floor activation incorrectly when prompted. So firstly, you need to ensure that you are activating the correct muscles, as doing the exercises poorly can sometimes do more harm than good.

  1. Lie down or sit, with buttocks, thighs and abdominal muscles relaxed. Try to be in a quiet room –
    distractions make it much harder.
  2. Gently squeeze the ring of muscle around the back passage, as if trying to stop yourself from
    passing wind. Then relax. Try this 4-5 times, trying to isolate the muscles without clenching your
  3. You can also try whilst sitting on the toilet: try to stop the flow of urine mid-stream. Only try this
    a couple of times just as a check– doing it regularly can affect your bladder emptying routine.

You should feel a ‘lift and squeeze’ as you do the exercise. If you are struggling to isolate these muscles,
check in with your doctor, midwife, or women’s health physiotherapist and see if they can help you out.

How should I train them? How strong should they be?

Ideally you would be able to hold a pelvic floor activation for 10x 10 seconds. However, this is harder than
it sounds!

Try concentrating, performing a lift and try to establish the maximum amount of time you can hold it for.
Use this as a bit of a guide for your sets and repetitions.

E.g. if you can hold for 6 seconds, then start with 10x 6 second activations and gradually build up from

You should also try to do 10x faster squeezes afterwards – holding for only 1 second or so, and releasing
fully in between. Studies show that you should aim to do your pelvic floor exercises 2-3x per day, if you
are trying to build strength quickly. Usually once per day is OK for maintenance.

Also remember that in real life, the pelvic floor muscles do not activate in isolation. They’re always there
in the background, supporting our organs while we are upright, squeezing when we cough or sneeze, and
keeping us continent every time we lift something, walk up the stairs or exercise.
To get the MOST out of your pelvic floor function, we need to train them to work when we are moving –
not just staying still.

How can my Women’s Health Physio help?

At QV Physiotherapy, Laura can help to assess your pelvic floor muscles and subsequently create a specialised program to help you manage your symptoms as a long term cure. We have a real time ultrasound machine to help you identify what a ‘correct’ pelvic floor contraction looks like in real time. We can also help you to re-train and stretch tight pelvic floor muscles. Rehabilitation programs are tailored be sports or activity specific to help you get the most out of your pelvic floor training. If you are suffering from pelvic floor issues, please don’t continue to endure when help is out there. Call today to book your Women’s Health appointment and start taking control of your symptoms. If you have any questions, please don’t hesitate to contact the clinic and ask for Laura!