What are the Pelvic Floor Muscles and what do they do?

jsw_pfm_with_diaphram.jpgThe pelvic floor muscles are a layer of muscles that stretch from the pubic bone at the front to the coccyx (tailbone) at the back. It is structured like a muscular trampoline. The pelvic floor muscles are frequently overlooked, even though they are one of the most important muscle groups in the body, contributing significantly to sexual response, guiding the baby’s head down the birth canal during child birth and providing support to the bladder, uterus and bowel. A strong and well working pelvic floor helps you hold on to a full bladder. It also helps you to hold on to wind when you want to. Your pelvic floor muscles tighten to prevent the leakage of urine when you cough, sneeze, laugh and move. Can you imagine what would happen if these muscles didn’t work properly? 

Where are my Pelvic Floor muscles?

Here’s a helpful exercise to help you understand and realise the small size of this muscle group:

  • Just put your hands under your bottom on each side, palms up and sit with your fingers under your sitting bones. The pelvic floor muscle spans this space (side to side).
  • Now find the pubic bone at the front and coccyx (tailbone) at the tip of the spine – this is the distance which the pelvic floor muscles span (front to back).

 How to identify your Pelvic Floor muscles

One way to help you to identify the pelvic floor muscles is to stop or slow the flow of urine midway through emptying the bladder. This is NOT recommended as a regular exercise.

Don't neglect your pelvic floor muscles!

Freda (not her real name), would like to share her story, her comments and feelings, to let you know how important pelvic floor muscle exercises are, and to encourage you to take note now, before it is too late and problems start. (It is never too late to actually get help, but it is easier to stop a problem from happening).

Freda has 3 children, and had her first baby when she was 22 years old. She was 26 when she had her second baby and then in her late 30's for her third. This is when the problems started, or became apparent.

Freda came to the Physiotherapist, not sure if she was doing her pelvic floor muscle exercises correctly. She experienced incontinence (leakage of urine) when she coughed and also on the way to the toilet - not always making it when she needed to go. This had been happening for a few months. She had been thinking "hopefully this will get better", but it didn't, and it was very upsetting. She was brave enough to mention it to her doctor, who suggested physiotherapy but also surgery if physiotherapy didn't help.

"It was very embarrassing to come to a Physiotherapist when I actually had a problem, but it was a relief to get some help, and to know that I could improve this situation. But if I had known years ago how important the exercises were, I wouldn't be putting up with this now at the age of 38. It is devastating to wet yourself, and it has affected my relationship. The muscles are so weak that sex feels 'like a canyon'. I feel very sloppy inside.

I wish I had known earlier when I had my first two children, but no one told me. I only got a brochure given to me after my second baby but I didn't know how important the exercises were. I didn't think I had a problem with my pelvic floor muscles back then, and I didn't think it was important for me to do the exercises.

It would have been easier to keep my muscles working when I was younger. It is such hard work to get the muscles back to working now, after years of not doing the exercises. I think women should do exercises before and during pregnancy, as well as after - it is easier than being 38 and experiencing leaking when you cough or want to go to the toilet!"

Luckily with the help of her Physiotherapist, Freda's problem slowly improved and she regained control over her bladder and pelvic floor muscles. But she felt strongly enough to share her story in the hope that other women will not neglect their muscles and will enjoy the benefit of all of the information, and physiotherapy advice that is available now.

Help - I have just had my baby and I can't feel my pelvic floor!

Isabel (not her real name/story used with permission) was shocked after the birth of her baby that she couldn't feel her pelvic floor muscles. She was expecting them to feel normal after the birth and was not prepared for the fact that she couldn't feel anything when she did her exercises. Now unlike a lot of women, Isabel had done her pelvic floor exercises regularly during her pregnancy, and had felt that her pelvic floor muscles were actually quite strong and working well, even at the end of her pregnancy.

What happens during labour is that the pelvic floor muscles help to guide your baby through the pelvis to be born. The muscles are designed to stretch and open up to allow your baby to be born, but sometimes they will stretch more than others. This can cause a weakness and 'numbness' of the pelvic floor muscles, as the nerves in the pelvic floor have also been stretched. This accounts for the lack of feeling experienced by Isabel.

Isabel contacted her Physiotherapist for an appointment and had her pelvic floor muscles checked a few weeks after the birth. The Physiotherapist was able to see that her pelvic floor muscles were working, even though Isabel couldn't feel anything happening. All of the exercises that she had done during pregnancy had paid off, as sometimes the muscles don't work at all if they get stretched a lot during the birth.

The Physiotherapist advised Isabel to continue doing her pelvic floor exercises as she was doing them correctly. The feeling would come back over time, and the exercises can help this.

The next week Isabel came back, feeling a lot better. She had felt reassured after the Physiotherapy appointment, and was now starting to feel her pelvic floor muscles again.

So if this happens to you, make sure you check that you are doing your exercises correctly, and continue to do them as the feeling should come back. It does vary as to how long it takes, from days to weeks, and sometimes even months to really feel them well again. Remember, seek help and further advice if you don't feel you are making progress. A Physiotherapist working in the area of Women's Health can help you, ask your Midwife, or see your Doctor.

Ideas to help you to remember to do your pelvic floor exercises.

Whether you are pregnant, planning a pregnancy or have had a baby, it is important to remember to do your pelvic floor muscle exercises and your tummy bracing exercises. This will help to keep your muscles strong if you are pregnant and help them to recover more quickly after your baby has been born. All women should do pelvic floor exercises, even once they have returned to normal after pregnancy.

Do you forget to do your exercises regularly? If so, you could place some reminder dots in places that will remind you to do the exercises. For example, on the mirror, television, phone or computer; in the toilet (for after you have finished going, not during your flow); in your wallet; where you sit to feed your baby or toddler; or anywhere else that will remind you to tighten your pelvic floor and tummy muscles. Using a screen saver, a phone reminder, a note in your diary or on your calendar can also help you to remember to do your pelvic floor muscle exercises.

How NOT to do your pelvic floor exercises!

Over the years many women have become more aware of their pelvic floor muscles and of the need to do pelvic floor exercises to keep these muscles strong and working correctly. But also over the years there has been a lot of incorrect information on what is a pelvic floor exercise, and some women still are confused, or unsure if they are doing their exercises correctly.

Some of the ways NOT to do your exercises include:

  • Stopping and starting your flow of urine every time you go to the toilet.

This used to be promoted as an exercise, but is not recommended. This is a good check to see that you can do it, and to feel the muscles working. If you are just learning how to do the exercises it can help you to contract the right muscles. Doing this as a check before your baby is born, and also sometime after can help you to make sure that this action of the muscle is working well. But it does not mean that your muscles are completely back to normal if you can do this, as the muscles work in other ways too (like holding on if you need to go to the toilet, supporting our pelvic organs and tightening when we cough, sneeze, laugh, run or jump).

  • Tightening your muscles quickly and relaxing and doing 100's of these per day.

A quick contraction is OK to do as an exercise, but it is not the only way that the muscles should be worked. Some people mistakenly think that they are doing a great job of exercising their muscles this way, but it is important to also think quality, not quantity. The pelvic floor muscles should also be exercised by lifting and then holding them up inside, not just pulling them up quickly and relaxing them straight away. So it is important to do a combination of both quick contractions (and you don't have to do 100 per day - although you can if you want to), and slower holding contractions. To find out how to work out your hold time, use the booklet As Your Shape Changes. You can then also record your hold time, using the charts included in the booklet.

  • Lying on the floor and lifting your pelvis and hips up and down, while flattening your back against the floor.

This exercise is called the pelvic tilting exercise, and does NOT exercise the pelvic floor muscles (unless of course you deliberately tighten your muscles at the same time, which can be quite tricky to do). In the past this exercise was mistakenly taken to be pelvic floor exercises. Some women still think that this is what pelvic floor exercises involve and that they need to get on the floor to do them. Pelvic floor exercises can be done in sitting, when lying down or in standing positions if you are able to do them well, but do not involve the moving of your pelvis at all, except for when you are trying to get yourself in the right position to start with. Your pelvic floor muscles will work better when your pelvis is in a ‘neutral’ position, that is, when the curve of your back is normal and not flattened or arched. When you exercise your pelvic floor muscles, your pelvis should not move, and your pelvic floor muscles, which are on the inside of your pelvis, lift up and tighten.

Pelvic tilting exercises are good for back mobility, but after you are 16 weeks pregnant it is not recommended that you continue to exercise while lying on your back. They can then be done in a hands and knees position as a back stretch (also called the cat curl). A pelvic tilt can also be a good exercise to help start your tummy muscles to work again after your baby has been born, in addition to your post natal abdominal bracing exercises. But again remember, it is NOT an exercise for your pelvic floor.

  • Sitting to do the exercises and your body moves up and down.

If you are tightening your bottom muscles as well as or instead of your pelvic floor muscles, you will notice that your body moves quite a bit when you try to do the exercise, especially if you are sitting. This is incorrect, and does not work the pelvic floor muscles effectively. If you are tightening your bottom instead of your pelvic floor muscles, you will often feel more, but it means that your pelvic floor muscles are not working, so you won't get the desired results from doing the exercises this way. If you are tightening your bottom as well as your pelvic floor muscles, again you will probably feel like you are doing more, but all your extra effort is going into your bottom, not into improving or maintaining the strength of your pelvic floor muscles.

Focus more on the pelvic floor muscles on the inside, lifting them up inside, and try to keep your bottom relaxed as you do the exercise.

  • Squeezing your legs together.

Although this may help in an emergency, if you do need to do this, it is a sign that your pelvic floor muscles are not working as well as they should. Again if you do this when you exercise, it is the same effect (or lack of effect) as if you are tightening your bottom muscles instead of, or as well as your pelvic floor muscles.

Often when the pelvic floor muscles are weak or getting tired, the leg and bottom muscles will work. If you cannot stop this from happening it is a good idea to seek some extra advice and a check from a Physiotherapist working in the area of women's health, or your Midwife.

  • Holding your breath when you tighten your muscles.

Often when you are first learning how to do the exercises and you need to concentrate very hard, you will hold your breath. As you get better at doing the exercises, then you should learn to be able to tighten them, and to breathe at the same time. This may take several weeks or even a month or two to be able to master this.

  • Tightening your tummy really hard.

Although it is OK for your lower abdominal muscles to tighten (the area below your belly button), you should not feel your whole abdominal wall tighten and pull in. If you feel the area under your rib cage really pulling in then you are probably trying too hard, or tightening your tummy instead of your pelvic floor muscles. Focus lower down in your vaginal area as you work to contract your pelvic floor muscles.

You will still read in some books, magazines and brochures that you shouldn't tighten your tummy muscles at all when you do your pelvic floor muscle exercises. The latest research by Physiotherapists in Australia shows that it is OK for the lower tummy muscles to work when you tighten your pelvic floor muscles, and in fact this should happen. It is normal that your pelvic floor and lower tummy muscles actually do work together. To start with this may not happen, but as you get better at both your pelvic floor and pregnancy or postnatal abdominal bracing exercises, this should get easier. Check in As Your Shape Changes, in the section called "Putting it all together", for further information on progressing to this, once you have mastered each exercise individually.

Pelvic floor diagram reproduced with kind permission from The Continence Foundation of Australia.

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