Strengthening the Pelvic Floor

You probably don’t think about your pelvic floor—until you experience an embarrassing urinary leakage when laughing, coughing, sneezing, jumping, skipping, or running. Understanding the importance of the pelvic floor muscles and learning how to train them are of vital importance for women.

Since the pelvic floor muscles are often weakened during pregnancy and childbirth, and after menopause, many women will be affected by some sort of pelvic floor injury and/or weakness throughout their lives.

What is the pelvic floor?

The pelvic floor has been described as a muscular funnel situated at the lower end of the pelvis. The pelvic floor muscles support and surround part of the vagina, rectum, and urethra.

Why strengthen it?

It is important to consciously train the muscles of the pelvic floor in order to increase one’s mind-body awareness of those particular muscles. Physiotherapist Rick Jemmett suggests thinking of your muscles as if they were cylinders in a car engine. If the wire to the specific cylinder is frayed, the cylinder won’t receive a signal.

Many women have never been taught to activate these muscles so the “wire” that connects the pelvic floor to the brain is frayed, resulting in the brain sending inappropriate signals to the muscles.

What problems can arise?

Incontinence
The most common problems women experience due to weak pelvic floor muscles are varying degrees of urinary incontinence, also called stress incontinence. Pelvic floor muscles become weak after childbirth and during menopause and aren’t able to support the bladder, leading to incontinence.

Difficult urination
A slightly less common problem is difficulty urinating. Childbirth can cause a weakening or stretching of the pelvic floor muscles, which in turn allows the bladder, urethra, or rectal wall to bulge slightly into the vagina, causing discomfort during urination.

Prolapsed uterus
After menopause women might also begin to experience backaches, leakage of urine, or a feeling of heaviness in the pelvic region. This can be due to a prolapsed uterus, which occurs when the uterus drops down into the vagina. Again, this occurs because of a weakening of the pelvic floor muscles that normally support the uterus.

This weakening may also cause other organs to bulge into the uterus, including the bladder, the urethra, part of the intestine, or the rectum.

Prolapse is most commonly a byproduct of aging or injury during childbirth. It can also be caused by excess intra-abdominal (internal) pressure. Possible causes include being overweight or wearing clothing that does not allow you to breathe properly, such as a corset.

Prolapse also appears to run in families. You have a greater chance of it occurring if a female relative has also experienced it.

What can you do?

A simple exercise to strengthen the pelvic floor muscles is the Kegel. Although Kegel exercises cannot repair major anatomical injuries or defects, they can help to relieve the symptoms of the problems discussed above: urinary incontinence; bulging of the bladder, urethra, intestine, or rectum; or a prolapsed uterus.

Kegel exercises

Named after Dr. Arnold Kegel, the Kegel is the traditional exercise used to strengthen the pelvic floor.

To perform a Kegel, try to imagine engaging the same muscles that you would if attempting to stop urination. Kegels should be done daily and in different positions. Try performing Kegels sitting, lying down, and standing. You can perform Kegels four ways.

If you suffer from a prolapsed uterus or urinary incontinence, try to perform Kegels without engaging the abdominals.

Slow contractions

• Contract the pelvic floor muscles by imagining you’re stopping the flow of urine for 5 seconds, then relax for 5 seconds.
• Repeat 5 times.
• Eventually build up to 5 sets, holding the contraction for 10 seconds each time.

Quick contractions

• Squeeze and release your pelvic floor muscles quickly.
• Try to complete one contraction per second for 10 seconds.

Elevator Kegels

• Think of your pelvic floor muscles as an elevator shaft. This imaginary elevator shaft has five floors.
• In the beginning visualize your muscles at ground level, completely relaxed.
• Next, tighten your pelvic floor muscles slightly to visualize them reaching the first floor, then hold for several seconds at the first floor.
• Slowly imagine the elevator advancing floor by floor, making sure you pause at each floor until you reach the fifth floor.
• Then gradually release your pelvic floor muscles floor by floor, back to the ground floor.

Kegels on the stability ball

Since the pelvic floor muscles can be hard to locate, it can be helpful to have tactile feedback. Perform Kegels sitting on a stability ball, leaning slightly forward. This way you can feel your pelvic floor muscles against the ball. The tactile surface of the ball gives your brain feedback to help facilitate pelvic floor muscle contraction.

• Sit on a stability ball.
• Lean slightly forward so you can feel your pelvic floor muscles on the ball.
• Perform any of the previous versions of the Kegel, but this time pull your pelvic floor muscles away from the stability ball, without moving any other part of your body.