Most women will at some point in their life be told to “do your pelvic floor exercises”, but what does that actually mean? As a woman, I’ve always noticed that when people talk about the pelvic floor there is a lot of assumed knowledge. What I mean by this is that when someone (often a healthcare professional) talks to you about your pelvic floor, which is often when you are pregnant or after having a baby, they assume you know exactly what they are talking about and give you very little information about it. So when I started working in women’s health physiotherapy I was not surprised when most of my clients explained they weren’t sure how to do their pelvic floor exercises. So that’s why I wanted to put together a series of well informed, educational and easy to understand blogs to provide some information about the pelvic floor and answer some questions about it too.
In this blog I’ll start with the basics;
What is the pelvic floor?
What does it do?
And how do you know if it’s weak?
My future blogs will go into more depth about how to strengthen your pelvic floor and the best exercises to strengthen it. If you have any other questions you’d like to ask please feel free to leave a comment below and I’ll get back to you as soon as I can.
Let’s get started:
What is your pelvic floor?
Your pelvic floor is made up of muscles, fascia and fibrous tissue. These structures form the base of your pelvis and essentially stop your pelvic organs from dropping out of your body.
What is fascia? Fascia is a type of web-like connective tissue that surrounds organs and muscles in our body. It can be imagined like cling wrap and it helps support and suspend/hold up the organs in our pelvis.
What are our pelvic organs? Your pelvic organs are your bladder, uterus and bowel. These organs are all inside your pelvis and require support from above and below in order to maintain their position and not drop down.
What is the function of the pelvic floor?
The main purpose of the pelvic floor is to provide support to the pelvic organs. This is done by fascia and fibrous tissue holding the pelvic organs up. You can imagine it like a strong spiders web or cling wrap wrapped around these organs and offering them support. This is also achieved by the pelvic floor muscles. The pelvic floor muscles help to support the pelvic organs from below by providing upward support from underneath. So the fascia and fibrous tissue provide support from above and around the organs and the muscles provide an upward lift which then also takes the strain off of the fascia and fibrous tissue.
We have three openings within the pelvic floor; the urethra is the opening from the bladder allowing you to pass urine. The vagina is the opening from the uterus and allows you to birth a baby, and the anus is the opening from the bowel/rectum allowing us to pass faeces. As these are openings within the pelvic floor muscles, the pelvic floor is also what allows us to close or tighten these openings. So your pelvic floor not only helps support and hold up the organs of the pelvis, but they also give us some voluntary control over our bladder and bowel (so that we can hold on until we can get to a toilet!). The relaxation and tightening of the vagina plays an important role in sexual sensation and arousal.
As the pelvic floor muscles are the closing force for the bladder and back passage, this means they help prevent leaking of urine, gas and faeces. They work with your deep abdominals (NOT your 6 pack/rectus abdominus), your diaphragm and your back muscles to form a corset around your trunk –this is known as your ‘core’. A weakness in any one of these muscles causes a weakness within your core and can be a precursor to back pain. If your pelvic floor is weak or even if it is overactive (hypertonic), it can cause problems such as stress incontinence. Stress incontinence is leaking of urine when you cough, sneeze, laugh or even when you exercise – running, doing star jumps or bouncing on the trampoline.
How do I know if I have a weak pelvic floor?
This is a good question, as women are often told, or assume, they have a weak pelvic floor if they have certain symptoms. Symptoms which could indicate you have a weak pelvic floor include leaking urine when you: cough, sneeze, run, laugh or jump. But everyone is different and some people may find they only leak if they go for a long run, some may find it is jumping on the trampoline that causes leaking, others may only have a problem if their bladder is relatively full and then they sneeze that they leak.
If you exhibit any of these symptoms then it is likely you have a weak pelvic floor. But did you know your pelvic floor could be strong but have low endurance (likely if you find you leak urine with running, as you need to have more endurance in your pelvic floor muscles to ‘hold on’ and not leak whilst you are running). So your pelvic floor could have good one repetition max strength (imagine doing a bicep curl, your one rep max would be the most weight you could lift for just one repetition, whereas your endurance would be lifting a weight which is a lot lighter but you could keep going for a lot more reps, say 100 reps). So your pelvic floor is a muscle and it works the same way. You can have good one rep max strength which means you may not have any issues with holding on and not leaking when you cough, sneeze or jump on the trampoline for a few minutes (as these all require one-off sudden, strong contractions of the pelvic floor). But you may find you leak when you go for a run for more than an hour – this may mean your low-level endurance is not great and you can’t hold on and prevent leaking when your pelvic floor gets tired over a longer period of time.
So the type of weakness you experience can vary too. This is why it is best to see a women’s health physio who can do a thorough assessment and test the strength of your pelvic floor muscles. By doing a detailed assessment they will be able to work out if your pelvic floor is weak and also what type of strength training you need to do – is it general strength or endurance you need to work on? I’ll explain more about different types of strength training for your pelvic floor in my future blogs, so make sure you sign up to be updated on my blogs if you want to read the blogs as soon as they come out. And if you’re looking for a women’s health physio and are based in Australia, here’s a link to the Women’s Health Training Association list of trained physio’s by location.
I hope you’ve enjoyed this blog and it’s answered some questions for you if you have any other questions feel free to comment below.
Have a great day.