The pelvic floor muscles are a broad sling of muscles that stretch from the pubic bone at the front of your body to the base of your spine (coccyx) at the back. They hold the pelvic organs in place - your bladder, uterus (womb) and bowel. Strong pelvic floor muscles can help to:
Tighten up your back passage as though you are trying to stop yourself from passing wind. At the same time tighten the muscles that you would use to stop yourself from passing urine. You should have a feeling of ‘squeeze and lift’ as you close and draw up the front and back passages. This is called a ‘pelvic floor contraction’. It is easy to use the wrong muscles instead of the pelvic floor muscles, so:
• Don’t clench your buttocks or squeeze your legs together
• Don’t hold your breath
Initially it may be easier to try this exercise in a comfortable position, for example lying on your side, to help you get a feel for where your muscles are. Once you know how to do the exercise in this position try doing it when you are sitting down or standing. It is important not to practise stopping your flow of urine mid-stream: this is not recommended as it may interfere with your normal bladder emptying.
In a comfortable position you can gently insert your thumb or index finger into your vagina. Tighten your pelvic floor muscles. You should feel the muscles move/tighten around your thumb/ finger. You should also feel the muscles relax as you release. You can check with a mirror. Hold a small mirror so that you can see the area between your legs. Tighten the muscles. The skin between the anus and vagina should move away from the mirror. If you see any vaginal bulging downwards as you try to tighten your muscles you are not contracting your muscles correctly.
If you think you are not doing the exercise correctly you should ask your GP to refer you to a specialist women’s health physiotherapist for further help.
Start by finding out what your muscles can do to give you a starting point for your exercise routine. Squeeze and lift your muscles.
You should aim to hold a pelvic floor muscle contraction for a maximum of 10 seconds and repeat up to a maximum of 10 times. At first you might not manage this and should be guided by how many seconds you feel you can comfortably hold for. It is important to breathe normally when you are doing your exercises. If you find you are holding your breath, try breathing out as you do the ‘squeeze and lift’. Breathe normally as you continue to hold. It is as important to learn how to relax your pelvic floor muscles fully as it is to tighten them. To help learn how to do this make sure after you have tightened your pelvic floor muscles you release them slowly with as much control as you can manage. Rest for four seconds or more between contractions. You should try to exercise your pelvic floor muscles three to six times a day.
This exercise helps your pelvic floor muscles to react quickly when you cough or sneeze to prevent leakage of urine. To do this pull up your pelvic floor muscles quickly and then relax fully. Aim to do this up to 10 times without holding your breath, three to six times each day. Each time you feel you are about to cough or sneeze, quickly squeeze and lift your pelvic floor muscles as strongly as you can and try to hold them until the coughing/sneezing has finished.
The pelvic floor muscles of women who have vulval pain will often have increased muscle tone. There may also be a protective guarding of these muscles if intercourse is attempted. Learning how to relax the pelvic floor muscles may be helpful to decrease this muscle tension and reduce pain. It is also important to avoid fast exercises (until you can release your muscles effectively), where you quickly tighten and relax the pelvic floor muscles, as these exercises may increase the pelvic floor muscle tone. However, performing slow exercises (where you hold the contraction) regularly, can improve the strength of your pelvic floor muscles and improve your ability to relax these muscles. Being able to relax the muscles is important for comfortable and enjoyable sex. If you are still unsure about how to relax your pelvic floor muscles, ask your GP to refer you to a specialist women’s health physiotherapist for further help.
If you have problems associated with a weak pelvic floor, such as bladder or bowel incontinence or prolapse symptoms, it may take 3 months or more of regular exercising to strengthen the pelvic floor muscles and notice an improvement. Similarly learning to relax these muscles effectively can take time and patience.
The Bladder and Bowel Foundation or B&BF is a UK wide charity that provides information and advice on a range of symptoms and conditions related to the bladder and bowel.
Bladder & Bowel Community
17 High Street
The Vulval Pain Society (VPS) is a confidential service for women who suffer from vulval pain.
PO Box 7804
Nottingham, NG3 5ZQ
Information on women’s health physiotherapy service:
Chartered Physiotherapists in Women’s Health are experts in pelvic floor muscle rehabilitation. To find your nearest specialist physiotherapist contact your GP or local physiotherapy department, or contact:
NHSGGC Obstetrics, Gynaecology & Pelvic Floor Physiotherapy website
Association of Chartered Physiotherapists in Women’s Health (ACPWH) www.acpwh.org.uk