Most women will have been told at some point in their life to “do their pelvic floor exercises”. But what does this actually mean? How do you switch on your pelvic floor? And how do you strengthen it?
Women are often told that our pelvic floor muscles are the ones which stop us from peeing. This is true, but it’s not a good way to exercise your pelvic floor! It is fine to have a go (and try to stop your flow of urine when you’re on the toilet) to see if you know how to contract these muscles. But it is not a good idea to do this regularly – the reason being it is not good for your bladder as it is sending mixed messages to the bladder (start, stop, start, stop) and it can lead to you not fully emptying your bladder, which in turn can then lead to an increased risk of urinary tract infections. So, it is ok to try it once or twice, but definitely, don’t do this on a regular basis and definitely do not do this to try and strengthen your pelvic floor muscles!
So once you know where your pelvic floor muscles are and what they do, what is the best way to strengthen them?
Getting a good pelvic floor contraction
Before you rush off to try out any new-fangled pelvic floor exercisers or devices, the best thing to do is to make sure you have a good, strong pelvic floor contraction. In my experience, as a women’s health physio, the best way to start your pelvic floor exercise programme, is to lay down on your back, knees bent up and feeling relaxed.
Now, to get a good strong pelvic floor contraction, imagine you need to fart, but you want to hold it in. So you are going to lift from your back passage and feel the contraction through your pelvic floor. This should give you a stronger contraction than just thinking about trying to stop your flow of urine – this is because we are engaging some of the stronger pelvic floor muscles which wrap around the anus and give us the lift from the back passage.
So think about lifting from your back passage (and holding in that fart!) and now try and hold that contraction for 2-3 breaths in and out. This is when people often find they lose the contraction. But you need to be able to contract your pelvic floor and breathe! If you can’t keep the contraction whilst breathing, then this is where you need to start with your pelvic floor exercises. If you can’t keep your pelvic floor switched on and breathe, then you definitely won’t be able to keep your pelvic floor switched on when trying to do more complicated exercises or whilst you are doing a star jump!
Reps and Sets
If you can only hold your pelvic floor contraction for 2 breaths (and then you may feel like you’re losing the contraction or you have already let go) then this is where you need to start. So work out how many breaths you can hold your contraction for and start there.
For example start with this:
Switch on your pelvic floor and try and hold for up to 5 breaths. Relax and rest for 2-3 breaths. Repeat this 5-10 times. Make a note of how many breaths you managed and how many sets – this will be your baseline and try and do these exercises 2-3 times a day and you will find you will start to be able to hold the contraction for longer (we’re looking for up to 10 breaths) and aiming to get to 10 sets.
Once you can manage this you can start to move on to some exciting exercises!
Laying on your back with knees bent (you could also put a small ball/cushion between your knees and give it a gentle squeeze as this can make activating your pelvic floor easier). Switch on your pelvic floor. Now have your hands pointing up to the ceiling and as you breathe out, slowly lift your arms up overhead – keep the pelvic floor switched on –breathe in and bring the arms back to the start position. Try and do 5 arm lift and lowers and then let your pelvic floor relax. Repeat this 3 times.
Knee drop outs
Laying on your back with your feet hip width apart and knees bent up. Think about switching on your pelvic floor then take a breath in, as you breathe out let one knee drop out to the side a few centimetres – try and keep your pelvic floor switched on and your pelvis steady (don’t let it rock to the side) and then breathe in and bring the knee back to the start position, repeat on the other side.
So you are breathing out as the knee goes out to the side, breathing in as you bring it back to the middle. Try and keep the pelvic floor switched on through the exercise. Try and do this 5 times on each leg.
Laying on your back with your feet hip-width apart. Think about switching on your pelvic floor then take a breath in, as you breathe out, let one leg slide out long, try and keep your pelvis steady (don’t let it rock to the side) and then breathe in and bring the knee back to the start position, repeat on the other side. Try and do this 5 times on each leg.
Scissors – Level 1
Laying on your back with your pelvic floor switched on, take a deep breath in and as you breathe out slowly lift the right leg to table top position (right knee over hip with shin parallel with a flat ceiling) You need to concentrate on keeping your pelvis steady. Take a deep breath in here and with the out breath lower the leg back down to the floor. Keep your pelvic floor switched on and do the same with the left leg.
Repeat this 5-10 times on each leg trying to keep the pelvic floor switched on.
Intermediate to advanced exercises
Leg slide with arm lifts
Switch on your pelvic floor, have your hands pointing up to the ceiling. Now as you breathe out, slowly lift your arms up overhead – keep the pelvic floor switched on – and at the same time slide your right foot away from the body. Breathe in and bring the foot and arms back to the start position. Try and do 2-3 on each side (each leg) and then let your pelvic floor relax. Repeat this 3-5 times. You can then try and do this with the opposite arm reaching away – so left arm and right leg sliding away – then swap sides. Repeat 5- 10 on each side.
Scissors – Level 2 (Double leg lift)
on your back with your knees bent up – feet hip width apart. Engage your pelvic
Breathe out float one leg into the ‘table top’ position (your knee over your hip and the shin parallel with the ceiling). Now think about having 2 springs attached to your ribs and your pelvis (one on the right and one on the left) think about tightening up these springs – so you draw your ribs towards your pelvis – you should feel your abdominals working a bit harder with this activity. Try and hold this position and then as you next breathe out float your other leg up in to table top (so you are now in a double table top position) Hold this for 2-3 breaths and then on your next out breath float one leg back down to the floor. Breathe in and on the out breath float the remaining leg back to the floor. Relax for a few reaths and then try this again. The aim is to try and hold the double table top position for up to 10 breaths whilst keeping the pelvic floor switched on. Important note: Always bring one leg down at a time from this position as it protects your lower back from being strained.
Scissors – level 3 (Tap downs)
Follow the instructions for the previous exercise (Scissors level 2) to come up in to a double table top positon. Once in a double table top position, on your next breathe out you are going to tap one foot down to the floor (keep the knee bent) and breathe in as you float it back to table top, breathe out as you tap the other leg down and breathe in as you bring it back to table top. Keep going with this for 10 taps if you can (do it for more if you can!) When you have finished make sure you bring one leg down at a time from this position – as it protects your lower back.
Important focus points:
If, when you come to double table top you feel your back arch/ you aren’t able to control your lower back – then this exercise is too much for you at the moment – go back to Scissors level 1.
Remember it is important to be able to control the lower back and have the strength in your core for these exercises before moving on.
Laying on your back with your knees bent up, switch on your pelvic floor and then link your hands together and put them behind your head, keeping your head heavy in your hands, float your head and hands off of the floor ( think about connecting your ribs to your pelvis). This is your start position. Take a breath in, as you breathe out slide your ribs further towards your pelvis (keep the head heavy in your hands) and as you breathe in let the ribs come back away from the pelvis (like a mini sit-up). So as you breathe out you curl up and connect your ribs to your pelvis, as you breathe in you curl back down, taking the ribs away from the pelvis. You are trying to keep your pelvic floor switched on throughout the movement. And you are thinking about sliding the ribs towards the pelvis (shortening the gap between ribs and pelvis) NOT about coming up into a sit up.
What about Apps on your phone?
There are quite a few apps out nowadays that claim to help improve your pelvic floor. They are all pretty basic and usually have a reminder service so you can set reminders to do your pelvic floor exercises. Some of them also then have a timer and a programme which then tells you to switch your pelvic floor on for a set amount of time (e.g. 5 seconds), then rest for 5 seconds etc. Each app has slightly different sets and programmes and the app will usually take you through a workout of switching on and holding your pelvic floor for approximately 1 minute. I’m going to review some of the apps on the market in my next blog so keep watch out for my next blog where I’ll give you the low down on the best pelvic floor apps.
Other products and pelvic floor exercisers
You can buy various products to assist in strengthening your pelvic floor, TENs machines, weights, cones etc. But I would start with making sure you can switch your pelvic floor on and doing the basic holds with breathing for up to 10 seconds at a time. If you are struggling with this or not sure if you are switching your pelvic floor on the I would definitely recommend seeing a women’s health physiotherapist to get a proper assessment and find out what your pelvic floor is doing.
If you are wanting more info on different pelvic floor exercisers watch this space as my upcoming blog is going to be all about pelvic floor devices.
Make sure you can switch on and hold your pelvic floor contraction for up to 10 breaths whilst laying down. Progress through some simple exercises that involve arm and leg movements whilst maintaining your pelvic floor contraction. If you are unsure if you can contract your pelvic floor or don’t feel like you are progressing, then definitely go and see a women’s health physiotherapist for a proper and thorough assessment.
For more info on pelvic floor phone Apps and pelvic floor exercise devices, watch out for my upcoming blogs for more info.