How do you really do pelvic floor muscle exercises properly?

Pelvic floor muscles are specifically targeted to the core issues surrounding weak pelvic floor muscles. To determine how strong or weak your pelvic floor muscles are, you may need to be assessed by a continence physiotherapist. This assessment process involves finding out how well the muscles are working including how they lift, how many seconds the muscles can hold for, the number of repetitions that can be done before the muscles get tired and how well the muscles tighten with a cough. All of this provides your physiotherapist with information so they can tailor an exercise program specifically to your needs.
Research by Thompson et al in 2006 showed that during pelvic floor muscle contractions, there are a proportion of women who incorrectly bear down instead of lifting up the pelvic floor muscle.

Learning pelvic floor muscle exercises

Research shows up to 50% of women trying to do pelvic floor muscle exercises from a pamphlet get the technique wrong, which means that the exercises won’t help or could make a problem worse.

Getting the technique correct is the first step in the training process, and needs to be emphasised by anyone teaching pelvic floor muscle exercises to women. Some people think a person should intuitively know how to perform pelvic floor muscle exercises however, they are complicated muscles and can be hard to isolate. Because you can not see them, it is hard to know if they are working correctly.

These new and specific instructions (below) have been developed by a group of specialists in the area to help you do your exercises in the most productive way possible.

How to do pelvic floor exercises

1 – Sit with your back straight and lean slightly forwards. This helps you focus on your pelvic floor muscles.
2 – Relax your thigh, bottom and tummy muscles.
3 – Breathe out and tighten the muscles gently around your urine passage as if trying to stop the flow of urine. Still holding this muscle, try and breathe normally. You should feel the vagina squeeze and lift up inside the pelvis (Hint: when squeezing, the ‘lift’ should feel like your muscle is being drawn up toward your belly button instead of in towards your spine).
4 – Remember the muscles that contract when you do this, and then relax.
5 – Breathe out, and tighten the muscles of your anal passage gently as if trying to stop passing wind. Holding this muscle, try and breathe normally.
6 – Remember the muscles that contract when you do this, and then relax.
7 – Now breathe out and try and do them both at the same time.
This is your pelvic floor exercise.
You should feel your back and front passages working. Focus more on the front part of the pelvic floor, like when holding on to a full bladder.

How to check you are using the right muscles

Correct technique is very important.
If you are doing your pelvic floor muscle exercises correctly you will:
– feel a ‘lift and squeeze’ inside your pelvis
– feel a ‘letting go’ when you relax your pelvic floor muscles
– keep your chest, upper tummy and ribs relaxed
– keep breathing normal and quiet. Don’t hold your breath as this does not help. The pelvic floor muscles are below the belt and not ‘up high’. Holding the breath sometimes can actually result in bearing down on the pelvic floor, so it is important that this does not occur.

Exercising your pelvic floor muscles

• Warm up your muscles with three quick flicks and let go
• Once this is easy, hold the lift for longer (eg. 3 secs or anything up to 10 seconds), before relaxing
• Make sure you continue to breathe normally while you lift up
• If you feel comfortable doing this, repeat it up to 10 times
• Make sure you use the correct technique – while breathing quietly, keeping everything above the belly button relaxed
• This can be done three times a day. This is a very general suggestion that should be tailored to your individual needs if you think your pelvic floor is weak.
Further advice is required if you:
• cannot feel your muscles hold or relax
• cannot feel a definite ‘lift and squeeze’
• cannot squeeze and breathe at the same time
• cannot stop the flow of urine
• don’t feel confident doing pelvic floor muscles by yourself
• don’t feel that you are making any progress

Where to get professional help

The Continence Foundation of Australia can provide information about local continence services, and the name of your nearest continence and women’s health physiotherapist, or continence nurse advisor.
For more information visit www.continence.org.au or call the National Continence Helpline on 1800 33 00 66 to speak with a continence nurse advisor who can offer you free information, advice and support and can provide you with a wide range of information resources.

The Continence Foundation of Australia can also provide you with general information and advice about issues relating to bladder and bowel health.