The Pelvic Floor is a vital muscle in your body: it underpins your bowel, bladder and the uterus, and supports your back and spine. Refer to the picture which shows the muscles that stretch like a hammock from the front to the back of your pelvis. When these muscles are strong and healthy they give us complete control and support over our bodily functions and help contribute to satisfying sex. The muscles consist of two types: fast and slow twitch. You need to strengthen both fast and slow to support your core.
In the absence of exercise, simply getting older brings muscle deterioration. But childbirth, pushing on the loo, hysterectomy, menopause, lack of oestrogen and muscle tone, obesity, bad breathing habits, excessive coughing, poor posture, weak gluts, stress, and high impact exercise like running, jumping and weight lifting can also contribute to a weak and ineffective Pelvic Floor (stats show high reports of female fitpros with weakness).
Leaking urine is embarrassing, inconvenient and happens to one in three women due to a weak Pelvic Floor. First signs show when you cough, sneeze, laugh, run or exercise, or not reaching the loo in time. At its worst, it leads to a prolapse (suffered by millions of women). Weak Pelvic Floor can also contribute to bad posture, back and neck pain, and can take away our freedom and confidence to enjoy an active life.
Pelvic floor strength test / Isolating / Functional exercises
Pelvic Floor restoration and maintenance exercises are incorporated in many Pilates classes. You start by isolating the Pelvic Floor muscles and then incorporating your core – diaphragm, deep abdominals and deep back muscles. If these are dysfunctional you need to start with the basic exercises to learn to isolate the muscles. If you have no problems, just keep mobile and do the following three functional exercises. The functional and movement based exercises can be 70% more effective than just kegel /pelvic floor exercises (research by Dr. Bruce Crawford Pfilates Urogynecologist) because they incorporate the muscles that work to provide stability to the pelvis and PF, and maintain your posture and alignment: gluteus minimus, the hip adductors, and deep hip rotators. During our Pilates classes we advise you to breathe out on the exertion and when you start to engage the PF muscles. Ideally you’ll do these easy yet effective exercises for the rest of your life.
Get to know your pelvic floor (PF) muscles (checks and exercises)
POSITION – Neutral posture (check in the mirror) either seated (don’t cross legs as you can use your gluts/ buttock muscles) or lie down on your back, bend your knees and keep your feet flat then (if pregnant, lie on your side).
To test the strength:
- Stop your wee mid flow on the loo (only do this once or you’ll risk getting a bladder infection).
- Tighten the muscles around your vagina and back passage and lift inwards and upwards. Count how long you can hold for, then completely relax the muscles. Aim to hold for 10 secs. The Chartered Society of Physiotherapists recommends you practice this contraction just before you get out of a chair, cough, and sneeze or laugh to increase support and to retrain a weak pelvic floor.
Exercises to isolate the pelvic floor:
Fast Pelvic Floor contractions: Lift quickly – like an on/off switch – hold for one second. Repeat 10 times.
- Slow Pelvic floor controlled contractions: Imagine your PF muscles are an elevator at the ground floor of a building. As you contract and breathe out, imagine the elevator rising, slowly, to the second and third floors. Release slowly as the imaginary elevator lowers to each floor and returns to the starting position. Breathe in and relax completely. Repeat 10 times holding for 8-10 seconds. This increases endurance for impact activities (eg trampoline, running and weight lifting).
POSITION – Lie on your back with your hips and knees bent, find a neutral curve in your lower back, engage your Pelvic Floor and lower abdominals on each exercise.
- Pelvic tilt: gently rock your pelvis forward and back (anterior then posterior pelvic tilt). As you rock back breathe out and pull in your PF and abdominal muscles, feel your low back pressing and hold 30-60 seconds. This mobilises and lubricates the joints of the spine and hips, improves and increases
blood flow, combines deep breathing and PF activation.
- Inner thigh squeeze: place a pillow or ball between the knees and squeeze, repeat x 10. To progress, lift and straighten legs towards ceiling, open, exhale then close and squeeze repeat x 10. Aim to strengthen your deep abdominals, hip flexors, and inner thigh muscles.
- Curl up: engage pelvic floor, breathe out, pull in your belly button and lift head x 5. Aim to improve core strength. (If Diastasis rectus, hug arms across chest and gently pull hands towards each other.)
- Stretch inner thighs: hug knees in to relax the back and rock then open the knees wide, hold 30 secs.
POSITION – Standing
- Squats 1: legs wide, push bottom back as if going to sit back on a chair. Repeat x 10-50. Aim to stretch and strengthen core, bottom and legs and lower back.
- Squats 2: slowly lower yourself down into a deep squat, bottom near your heels (you may need to hold onto the back of a chair for support). Place a pillow behind your knees (to take some pressure off the knee joints) or remove for a deeper hip and thigh stretch and stand with your heels on a firm cushion. Do not let your back round or your tailbone tuck under. Lengthen your spine and lift your head, maintaining a neutral spine position. Hold 30 secs repeat x 3. (Feet flat is harder).
- Squats: repeat above with PF squeezes (PF muscles are slightly lengthened so a good position to really sense the contraction and relaxation against gravity. Repeat x 5-10, fully relax between repetitions.
Hannah Epps is a Pilates teacher based in Surrey and running courses online. She has specialised in post-natal and pelvic floor dysfunction for over 10 years. This article is a combination of her research, courses, workshops and experience. For more information on classes click here and for more info on the Yummy Tummy programme click here