Pregnancy is overwhelming right from the beginning. Right from the first few seconds that you see two pink lines to the exhausting times in the labour room to having that tiny bub in your hands, every bit of it is like a trip to the moon and back. You will have people talking to you about prams, car seats, houses, cots and the list goes on. But sadly not many women will tell you about those tiny muscles that bear the entire load before, during and after pregnancy.

The pelvic floor is pretty much the floor on which the whole journey rides on and we have got to talk more about them.

Where are they?

Why are they important?

How do we train them?

As someone who is writing a blog, I know that we all are just one click away to finding the information we are looking for but the challenge here is who we trust. As a physiotherapist I am always aware of the fact that before a client steps into my office he/ she has probably visited more google sites than doctors. This blog is an attempt to make the concept of pelvic floor simple and easy to absorb. So easy that next time if a friend is pregnant, the first words from your mouth would be, ‘do your pelvic floor, and let me show you how.’

What is your pelvic floor and where is it?

The pelvic floor is a sheet of muscles that extend from your tail bone (Tip of the lower back, point where your butt crack starts) to your pubic bone at the front. (The hard bit you feel when you press through your crotch)

These muscles form a ‘floor’ between your legs that supports the contents of your pelvis – your bladder, uterus (womb) and back passage. It also controls the openings of the following organs, which pass through it:

• The urethra – the tube which you pass urine through

• The vagina – birth canal, important during intercourse

• The anus – back passage, through which you open your bowels.

Why are they so important?

Unlike any other muscles, the pelvic floor muscles actually hold onto the contents of the body.

If they are strong, the overall health and hygiene of a woman depends on them especially through the turmoil of pregnancy when the woman’s body is going through so many changes.

If they are weak, it can cause problems such as, incontinence (the involuntary loss of urine or faeces) and prolapse (lack of support) of the bladder, uterus and bowel. The pelvic floor muscles also help you to control bladder and bowel function, such as allowing you to ‘hold on’ until an appropriate time and place.

Some of the common causes of pelvic floor muscle weakness are:

• Pregnancy

• Childbirth – particularly following delivery of a large baby or prolonged pushing during delivery

• Being overweight

• Constipation (excessive straining to empty your bowel)

• Persistent heavy lifting

• Excessive coughing

• Changes in hormonal levels at menopause

• Growing older.

How do I train my pelvic floor muscles?

It is recommended that all women exercise their pelvic floor muscles everyday throughout life, to prevent weakness and improve strength. Exercising weak muscles regularly, over a period of time can strengthen them and make them work effectively again.

Although with practice, pelvic floor exercises can be done anywhere and anytime, it is best to learn the exercises in the following position:

• Sit on a chair, toilet seat or toilet lid.

• Make sure that your feet are flat on the floor and your legs are slightly apart.

• Lean forwards, resting your elbows on your knees.

There are two types of exercises – slow twitch and fast twitch. It is important that you do the slow twitch first and then the fast twitch each time you exercise your pelvic floor muscles.

To perform the slow twitch exercises:

1. On a breath out, close and draw up the muscles around back passage, as if you are trying to stop passing wind. Make sure that you do not contract your buttock muscles while you do this.

 2. Keep breathing and continue to close and draw up the muscles around your vagina and urethra, as though you are trying to stop the flow of urine (Trying to stop urine mid-stream is a great way to get the feedback. Get into the habit ladies, but only do this once a fortnight to avoid any bladder infections).

3. Hold for as long as you can, and then slowly relax and let go.

Rest for the same amount of time.  Rest is important as these are small muscles and they fatigue easily. Once these muscles fatigue and if you continue to squeeze then there is a high chance that you would be using the surrounding muscles.  For example, hold for a count of 8 and then relax for a count of 8.

4. Slowly increase the length of time that you hold each contraction for and do as many as you can until you feel your muscle getting tired.

To perform the fast twitch exercises:

1. Pull up the pelvic floor muscles as before.

2. Hold for one second and then relax.

3. Repeat 5-10 times or until your muscles feel tired.

The fast twitch exercises can be done when you are travelling in trains, watching television and even bored in a meeting. It might even look like you are trying to concentrate on what your boss is saying so it’s a win-win for all because pelvic floor muscles tire easily and you may notice that it takes a lot of concentration to begin with to do these exercises correctly.

If you find that the muscles ‘let go’ too quickly and that you cannot hold, just hold them for as long as you can. Use this as your baseline. For example, if you can only hold the contraction for a count of three, then every time you do your exercises, contract the muscles for a count of three. Gradually try to work up to four, then five.

It is important to try not to:

• squeeze your buttocks together

• bring your knees together

• hold your breath

• lift your shoulders / eyebrows or toes upwards. If you do any of these, you are not contracting (tightening) your muscles correctly.

How often should you do your exercises?

Aim to do your pelvic floor exercises on a daily basis and be sure to include both types of pelvic floor contractions (both fast and slow twitch).

Fewer good squeezes are better than lots of half-hearted ones; however, you should try to challenge yourself by attempting to increase both the number of repetitions and the holding time. If you do not see a change in your muscle strength after three months, ask for help from your physiotherapist.

If you are an adventurer, then you can feel your pelvic floor contracting by putting one or two fingers into your vagina whilst having a bath or shower. Tighten your pelvic floor so that the muscles squeeze your finger hard. Ladies, self-feedback is the best feedback.

Every two weeks, test the strength of your pelvic floor by stopping the flow of urine mid-stream. This will feel similar to the exercises above and uses the same muscles. You may not be able to completely stop the flow of urine to begin with, but you may notice that you are able to slow the flow down. This is your baseline assessment. Gradually over the weeks you should notice an improvement. It is important that you do not do this test more than once a fortnight as it may cause problems with your bladder. This is just a test to see how you are progressing.

Use ‘the knack’ – always try to brace your pelvic floor muscle (by squeezing up and holding your pelvic floor contraction) before you cough, laugh, sneeze, lift anything heavy, or prior to any activity you know is going to be strenuous.

***Do not expect instant results! It will take several weeks of regular exercise to regain the strength in your pelvic floor muscles. You need to do these exercises for the rest of your life. If you stop exercising, your problems might return.

Please contact us on 8555 4099 or Book Online if you would like to book an appointment with one of our experienced Physiotherapists.

Written by Urvi Shelar, Physiotherapist