Training strengthens pelvic floor

Many women have weakened pelvic floor muscles after childbirth or associated with factors such as ageing, lack of exercise or obesity. Doing pelvic floor muscle exercises on a regular basis should help improve urinary continence problems. It may take some weeks for the benefit to be seen. See your doctor for a medical check-up and/or referral to continence physiotherapist if symptoms do not improve.

What is the pelvic floor?

The pelvic floor is the layer of muscle that stretches from your pubic bone in the front to your tail bone at the back, forming the floor of the pelvis. It is the main support structure for the pelvic organs (bladder, uterus, bowel).

• a toned pelvic floor supports the bladder and bowel
• a toned pelvic floor helps close off the bladder and bowel outlets to help prevent leakage. Relaxation of the pelvic floor allows effective bladder and bowel emptying
• a functional pelvic floor also contributes to sexual response and orgasm.

The pelvic floor muscles

Factors contributing to pelvic floor muscle weakness

• pregnancy
• childbirth
• straining to empty the bladder or bowel with or without constipation
• constipation
• persistent heavy lifting
• chronic cough (from smoking, chronic bronchitis or asthma)
• being overweight
• lack of general fitness

How do I strengthen my pelvic floor muscles?

The first step is to correctly identify the muscles. Sit comfortably - your thighs, buttocks and tummy muscles should be relaxed. Lift and squeeze inside as if you are trying to hold back urine or wind from the back passage.

• If you are unable to feel a definite 'squeeze and lift' action of your pelvic floor - don't worry! even people with very weak muscles can be taught these exercises.
• If you feel unsure whether you have identified the correct muscles, try to stop your flow when passing urine, then restart it. Only do this to identify the correct muscles to use - this is a test, NOT an exercise.
• If you are unable to feel a definite 'squeeze and lift' action in your pelvic floor muscles you should seek professional advice.

Starting your pelvic floor muscle training programme

At first you may need to perform these exercises while sitting or lying down. As the muscles strengthen, you can progress to exercise standing up. As in any muscle training activity, start with what you can achieve and progress from there.

If you can feel the muscles working, exercise them by:

1. Squeezing/ tightening and drawing in and up around your anus (back passage), vagina and urethra (bladder outlet). Lift up inside and try to hold this contraction strongly for as long as you can (1 - 10 seconds). Keep breathing! Now release and relax. You should have a definite feeling of letting go.

2. Rest 10 - 20 seconds. Repeat Step 1 and remember, it is important to rest. If you find it easy to hold, try to hold longer and repeat as many as you are able. Work towards 12 long, strong holds.

3. Now try 5 - 10 short, fast strong contractions. While you are exercising:

• do NOT hold your breath
• do NOT push down instead of squeeze and lift
• do NOT pull your tummy in tightly
• do NOT tighten your buttocks and thighs.

Try to set aside 5 - 10 minutes in your day for this exercise routine and remember, quality is important. A few good contractions are more benefical than many half-hearted ones and good results take time and effort.

Remember to use the muscles when you need them most: always tighten before you cough, sneeze, lift, bend, get up out of a chair, etc.

How do I progress my programme?

Increase the length of time you contract the muscle and number of holds you do in succession before experiencing muscle fatigue. Work towards 12 long, strong holds. Increase the number of short, fast contractions. Always do your maximum number of quality contractions.

Some helpful hints

• seek medical advice for chronic cough
• keep your weight within a healthy range for your height and age.
• develop good bowel habits
• you should anticipate that improvement in pelvic floor muscle strength will take 3 - 6 months of regular training of the muscles.

The best results will be achieved by seeking help from a physiotherapist/ continence advisor who will design an individual training programme especially suited to you. Pelvic floor exercises may also be useful for people on a bladder training programme.

How to seek help

There are health professionals qualified to help you with bladder control problems. Ask your GP for advice or contact the New Zealand Continence Association (details below under 'Further Information and Support').

Original material provided by the New Zealand Continence Association and edited by everybody, July 2005. Reviewed by everybody, September 2011.