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. See your doctor for a medical check-up and/or referral to a continence physiotherapist if symptoms do not improve.
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).
The pelvic floor muscles help close off the bladder and bowel outlets to help prevent leakage. Relaxation of the pelvic floor allows effective bladder and bowel emptying.The pelvic floor muscles may respond to sexual response and orgasm.
Factors contributing to pelvic floor muscle weakness:
- straining to empty the bladder or bowel with or without constipation
- persistent heavy lifting
- chronic cough (from smoking, chronic bronchitis or asthma)
- being overweight
- lack of general fitness.
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.
You should anticipate that improvement in pelvic floor muscle strength will take 3 - 6 months of regular training of the muscles.
Pelvic floor training programme
The first step is to correctly identify the muscles:
- Sit comfortably – your thighs, buttocks and tummy muscles should be relaxed.
- Breathe calmly, your tummy should gently rise and fall.
- Imagine trying to lift your vagina up inside or imagine you are trying to hold back urine, or wind from the back passage.
- When you lift your pelvic floor muscles, try to keep breathing into your tummy. (Do not brace your tummy tightly or hold your breath).
- 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.
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.
- When you are sure you can lift your pelvic floor muscles correctly, follow the guidelines below to improve the strength and function of your muscles.
- Aim to lift your muscles quickly and strongly.
- Hold from 1-10 seconds then relax the muscles completely.
- Rest in between each lift from 3-5 seconds.
- Repeat 8-12 times (This is 1 set).
- Do 3 sets per day.
To progress your exercises, as you lift and hold your muscles add three quick lifts on top of your sustained hold.
Aim for a quality lift. If your muscles are weak, allow more rest time in between each lift. You may only be able to achieve a few lifts at one time.
To improve the strength and function of your pelvic floor muscles, aim to exercise them everyday for at least 3 months.
After this period if your muscles feel strong, keep exercising them. Aim to do 3 sets, 3 times per week.
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
- do other exercise to stimulate good pelvic floor function such as walking or pilates. Going to the gym may also be beneficial but avoid heavy lifting/straining exercise if your pelvic floor muscles are weak.
There are health professionals qualified to help you with bladder control problems. Ask your GP for advice or contact the New Zealand Continence Association.
Pelvic floor muscles - a patients guide Family Doctor (NZ), 2015
Pelvic floor exercise guide Physiotherapy (NZ)
How physio can help pelvic floor disorders Physiotherapy (NZ)
Pelvic floor muscle training in women NZ Continence Association
Pelvic floor information Pelvic floor first (AU), 2013