Pelvic Floor Exercises

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Introduction

The pelvic floor, also known as the pelvic diaphragm, are a collection of muscles that span the floor of the pelvis. The pelvic floor muscles enclose the pelvic viscera, including the bladder, intestines, and uterus (in females) and separate the pelvic cavity above from the perineal region below. The pelvic floor supports abdominal and pelvic viscera, maintains bowel and bladder continence, and functions in voiding, defecating, sexual activity, and childbirth.

Functions of the Pelvic Floor

Weak, strained, or overly tight pelvic floor muscles can lead to pelvic floor dysfunction, which may include pelvic pain, urinary/bowel incontinence, pain with sex, sexual dysfunction, and pelvic organ prolapse.

Pelvic floor exercises can strengthen and increase neuromuscular control over the pelvic floor muscle and may reduce or eliminate symptoms associated with pelvic floor dysfunction.

Indications for Pelvic Floor Exercise

The below symptoms may indicate the need for Pelvic Floor Exercises in all genders:

• Urinary incontinence/frequency/urgency
• Pain in pelvic region, genitals, perineum, or rectum
• Sexual dysfunction including erectile dysfunction, pain or numbness in the genitals during or after sex
• Pelvic organ prolapse, which may be felt as a bulge in the vagina (feeling or seeing a bulge or lump in the vagina or coming out of your vagina) or a feeling of heaviness, discomfort, pulling, dragging or dropping.

Activating the Pelvic Floor Muscles

Pelvic floor exercises begin with learning to simply activate the pelvic floor muscles.

• The first step is to find a comfortable position, attempt to relax all muscles, and focus on a steady breathing pattern.
• To activate the anterior pelvic floor muscles, replicate the action of stopping the flow of urine mid-stream.
• To activate the posterior pelvic floor muscles, replicate the action of stopping passing gas.
• To activate both the anterior and posterior pelvic floor muscles, combine the two above actions.

When activating the anterior pelvic floor muscles, it is important to not actually stop the flow of urine mid-stream when using the bathroom, as this may lead to difficulty with fully emptying the bladder.

Specific Exercises

Kegel

The Kegel exercise is probably the most widely known pelvic floor exercise. It consists of an isometric contraction of the pelvic floor muscles.

To do a Kegel exercise, follow these steps:

• Start by holding your pelvic floor muscles in for 5 seconds. It is important to keeping breathing during this contraction.
• After holding for 5 seconds, slowly and completely relax your muscles for 5 seconds.
• Repeat this process 10 times, at least 3 times every day.

Your pelvic floor muscles may get fatigued during this exercise. If this happens, stop and do the exercise at a later time.

Don’t use your stomach, leg, or buttock muscles when doing this exercise.

As you continue to practice these exercises, you should increase the time you hold and rest your pelvic floor muscles. Start with 5 seconds, and slowly build up the time each week until you’re holding in and resting for 10 seconds.

Resources

• Pelvic Floor Strengthening Techniques from the NHS: https://healthandcarevideos.uk/bladder?videoId=1595
• Pelvic Floor Relaxation Techniques from the NHS: https://healthandcarevideos.uk/bladder?videoId=1596