If you’ve clicked through to read this, then in all likelihood you have had a baby (or babies) and are seeking advice on strengthening your post-baby body, or you’re pregnant and been told you should start working on your pelvic floor now. Whatever the case, you’ve no doubt been told hundreds of times that pelvic floor exercises are key and you should be doing them every day. And it’s true; if you’re pregnant, had a baby (delivered vaginally or via c-section) or simply if you are female (!) then exercising your pelvic floor daily is critical in both the short and long term.

But in my professional and personal experience, this is where the information ends, and where we get stuck. We know we should, but we don’t know why or how. So before we go on, let’s go back to basics.

What IS the pelvic floor?

The pelvic floor is the ‘sling’ of muscle that connects the pubic bone at the front to the coccyx at the back. It provides the ‘floor’ to the contents of our pelvis, including the bladder, uterus and rectum. A healthy and strong pelvic floor muscle works alongside your deep abdominal, or ‘core’ muscles (this is key) to assist with the good function of the pelvic organs. As part of this, it helps prevent the leakage of wee, poo and farts. A weak pelvic floor can lead to leaks or prolapse - the ‘falling’ of a pelvic organ from its usual place.
This leads us nicely onto ‘why exercise it?’. You can see why it’s important to keep it functioning well - and not only if you are experiencing problems (such as those leaks) or preparing for birth. Its role in supporting and assisting so much bodily function means a strong and healthy muscle is essential to good bladder and bowel health and positive sexual function and sensation too.

So HOW can I exercise it?

“I just squeeze and release don’t I”, is the phrase I hear most often from clients and friends. Yes, we’ve all heard of kegels. You know, when you squeeeeeze and release to ‘stop a wee or a fart’. That might have been ok in the past, but the thinking has moved on a bit. The problem is the move is too tiny, too isolated, and doesn’t factor in those abdominal muscles I mention above. So, let’s start by considering that the deep tummy muscles and pelvic floor are connected, and consider how we might work them together. If we do this then we can double the impact and exercise the core and pelvic floor at the same time. Let’s add in effective breathing to do this, and we’ll be getting the most bang for our buck, and can leave kegels in the past where they belong. In its simplest form, try this:
1. Sit comfortably, back straight, feet on the floor nice and square in front of you. Relax your lower body.
2. Place your hands above each other on your stomach.
3. Inhale gently (no chest puffing), and as you SLOWLY EXHALE visualise your pubic bone coming to meet your coccyx. Now squeeze the muscles to lift up towards your ribcage, exhaling the whole time. I imagine a lift shaft, or one of those metal cuddly toy grabbing machines at fairgrounds.
4. You should hopefully be able to feel your tummy muscles contract slightly under your hands, and your pelvic floor muscles lift.
5. When you’ve run out of ‘out breath’, inhale and then exhale to release the muscles strongly ‘back down’. Repeat around 10 times, ideally a 2-3 times a day.
6. Importantly, DON’T clench your bum or inner thighs, and DON’T hold your breath!
7. The lift might feel weak initially, but after a few weeks of work, should start to feel stronger.
The out breath here is SO important in connecting your core and pelvic floor together, working both your deep abdominal muscles and your pelvic floor at the same time. Despite the fact it requires a bit more thought, the benefits in connecting everything together are 100% worth the effort.

In fact, the beauty of this approach is that you can (and should) incorporate this ‘out breath on effort’ approach into ALL aspects of your day to day life. So whether you’re lifting the baby/toddler, the shopping or the car seat, breath OUT positively and connect that pelvic floor as you lift, and you’ll be not only protecting your pelvic floor and core, but WORKING THEM POWERFULLY at the same time.
The same goes for ‘bracing’ those muscles when you cough or sneeze, which put lots of pressure on the pelvic floor. Link the deep tummy muscles with the pelvic floor quickly before the sneeze or cough, and we’re getting into some really good, protective, habits.

Why do this long term?

As we’ve established, the pelvic floor needs to be worked like any muscle in the body. So if you don’t work it, in the same way as lack of exercise would see arm muscle definition disappear, the same will happen here too. Add to this the fact that the menopause causes a fall in Oestrogen production which affects tissue strength, you can see that strengthening the muscles of the pelvic floor and core now will to help to counteract these hormonal changes too. Ask your mum and as I found you’ll discover that several of their friends are having prolapse correction surgery in their 50s-70s.

But working those pelvic floor muscles is not something that’s the preserve of women who have had babies, it is something we should ALL be doing, and building into our lives and exercise routines today, and every day. For pregnant women, getting in the habit of working these muscles will assist during birth and should help to minimise the after effects (see above!). And for women who don’t have children it is also important as the same hormonal changes will incur in menopause whether you’ve had children or not.

When should I seek medical help?

If you have any concerns about leaking or general discomfort then please do consult your GP or ideally a specialist women’s health physiotherapist. Leaking, aching or pain is never ok, and not something women have to put up with. Mostly we can work on this through the exercises above, good nutrition, and appropriate physical exercise, but sometimes that’s not the case. When in doubt, ALWAYS refer to specialist women’s health practitioner and follow their advice.

In summary, we need to build pelvic floor exercises into our daily lives to look after our long term health. There’s lots I haven’t mentioned here including the importance of good posture and nutrition in core and pelvic health, but let’s keep it simple for today. Get lifting and breathing! And of course do contact me directly if you have any questions.