Pelvic floor exercises

What are pelvic floor muscles and why are they important?

The pelvic floor muscles form a broad sling between your legs.  They stretch from the pubic bone at the front of your body to the base of your spine at the back.  They help to hold your bladder, uterus (womb) and bowel in place.  These muscles also give you control over when you empty your bladder or move your bowels.

While you are pregnant, hormones make these muscles stretch. As a result, you may find you leak a little urine (stress incontinence) when you cough or a sneeze.  The problem may carry on after your baby is born.  Up to a third of new mums are affected by postnatal urine leaks.

Later on, usually after the menopause, a weak or damaged pelvic floor can lead to prolapse.  This is where the pelvic organs move down and push against the walls of the vagina.  About four out of 10 women who are over 50 have signs and symptoms of prolapse.  If this all sounds a bit alarming the good news is that there is plenty you can do now to protect your pelvic floor.

How does pregnancy affect my pelvic floor?

Being pregnant can place a lot of stress on your pelvic floor muscles.  Your pelvic floor can become weak and stretched from as early as 12 weeks into your pregnancy.  Constipation, which is common in pregnant women, can put even more strain on your pelvic floor.

How do pelvic floor exercises help me?

Pelvic floor exercises, if done properly and often, can help to protect you from leaking urine while you're pregnant and after your baby is born.

You should be told how to do the exercises during your first pregnancy.  If you haven't been shown how to do pelvic floor exercises during your antenatal classes, ask your midwife about them at your next visit.  You may be able to take a physiotherapist's class at your local hospital.

Good pelvic floor muscles may help to:

  • support the extra weight of pregnancy
  • shorten the second stage of labour, when you push your baby out
  • heal the area between your anus and vagina (perineum) after birth, by increasing the circulation of blood to it

Another benefit is that women with stronger pelvic floor muscles may be more likely to have orgasms during sex.  So doing pelvic floor exercises could help you to have a more satisfying sex life.

How do I find my pelvic floor muscles?

Imagine that you are trying to stop yourself from passing wind and trying to stop your flow of urine mid-stream at the same time.  The feeling is one of squeeze and lift, pulling up and in around your front and back passages.  When you have practised the exercises for a while, you could try this during love-making, asking your partner whether he can feel the effect.

Some women will feel more happening at the front and some will feel more happening around their bottom. Don't worry too much about this.  As long as you can feel a tightening in at least one of these areas, you will be exercising your pelvic floor.

Of course, that sounds easy enough. But the catch is that you have to squeeze and lift without:

  • pulling in your tummy
  • squeezing your legs together
  • tightening your buttocks
  • holding your breath

When you first try pelvic floor exercises, it is best to start in a comfortable position, for example, lying down in a quiet place.  It may help you get a feel for where your muscles are.  Once you know how to do the exercises in this position, try doing them when you are sitting down.

How can I perfect the exercise technique?

When you start out exercising your pelvic floor muscles, you may find that you hold your breath as you squeeze. You'll need to learn to breathe normally as you do the exercises. This is because when you cough or sneeze, you breathe out forcefully.  If you can only tighten your muscles when you hold your breath, they will relax as you cough and won't stop urine leaks.

To help you get the technique right, try the following exercise:

  • Place one hand at the top of your bump and the other on one of your shoulders.  Breathe normally for four or five breaths.
  • If your breathing is relaxed, you should find that the hand on your tummy moves up and down more than the hand on your shoulder.  If this is not happening, try to stop your shoulders moving and let your tummy rise and fall naturally.
  • Gently pull up and in "down below" as you breathe out.  When you are learning, don't try to pull up so hard that you have to hold your breath.  Start with a gentle contraction until you have managed to co-ordinate your contraction with a breath out.
  • Try then to hold a contraction for a few seconds while you continue to breathe in and out as normal.
  • You may feel your lower tummy muscles tightening, and that's fine.  If you are tightening your upper tummy muscles (above your belly button) then you are trying too hard!  Go back to the breathing exercise and start again.
  • You should aim to be able to hold a pelvic floor contraction for 10 seconds while breathing normally.  If you lose your breathing control, stop and start again.

There is a way to help you check if you're doing the exercise properly.  Only do this check if you have not been told to avoid sex during pregnancy and do not have any bleeding or infections in your bladder or vagina.  Gently insert one or two fingers in your vagina when you are having a bath.  Start doing the exercises.  You should feel a squeeze and lift inside your vagina if you are exercising your pelvic floor muscles.

Once you have got the basic exercise down to fine art, you can add in fast pull-ups.  Begin by making sure you are breathing in a relaxed way and then as you breathe out, pull up your pelvic floor muscles and let go quickly.  Then try to pull up and let go quickly up to 10 times in a row without holding your breath.

This exercise helps your pelvic floor muscles to react quickly when you cough, sneeze or laugh. It only works if your pelvic floor muscles are strong enough to support all of your pelvic floor, which is why it is important to start with the slow contractions.

It is much harder to learn how to do these exercises after your baby is born, so practise as much as you can while you're pregnant.

How often do I need to exercise my pelvic floor muscles?

It is recommended you should exercise eight times, three times a day.  If you are having problems with leaking urine you may need to do them more often. In fact, it's a good idea to do as many as you can as you go about your daily routine.  You should aim to make pelvic floor exercises a part of your life for ever.