Your Pelvic Floor; What is it, Why you should work it and how.

If you’ve clicked through to read this, then in all likelihood you have had a baby (or babies) and are seeking advice on how to exercise or strengthen your ‘not-quite-doing-its-job’ pelvic floor, or you’re pregnant and been told you should start working on your pelvic floor – but not how. 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 a woman, 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 muscles that provide the ‘floor’ to the contents of our pelvis, including the bladder, uterus and rectum. A healthy and strong pelvic floor works alongside your deep abdominal and other ‘core’ muscles (more on this later) to assist with the good function of the pelvic organs. As part of this, it helps control the effective opening and closing of your pelvic orifices – or in layman’s terms, helps prevent the leakage of wee, poo and wind.  And it provides physical support to those organs too.

What can go wrong?

It’s really common for these pelvic floor muscles to become stretched and weakened in pregnancy as the weight of the uterus increases upon them. This leads to the muscles being unable to do their ‘opening and closing jobs’ as well, which leads to leaks. And in relation to its support role, a weakened pelvic floor can contribute to prolapse – the ‘falling’ of a pelvic organ from its usual place into the vagina or rectum.

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. There are many women who don’t experience any issues at all which is great, but it is still important to look after the muscle for the future too.

What can I do about it?

Let’s start by considering the core. It is in fact made up of the diaphragm, the abdominal wall, the pelvic floor, and the lumbar muscles of the spine. So, a lot that’s all connected there, managing the pressure that runs through your trunk. So it goes that if one of these elements is weaker, be that the abdominal wall through a tummy separation or diastasis, or pelvic floor as mentioned, or if your breathing is shallow through bad posture, or if your lower back is painful, then that pressure is not managed correctly – there is a break in the chain – and we’ll see the impact through those leaks, perhaps a ‘poochy’ tummy, and very quickly we can see that without these ‘core’ muscles working properly, we’re inevitably going to find ourselves with problems.

This all sounds bad, but let me reassure you that in most cases, it’s all very sortable!

1. Start with getting those pelvic floor exercises right. 

“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 wind’. That might have been okay in the past, but the thinking has moved on. The problem is the move is too tiny, too isolated, doesn’t factor in the full range of core muscles I mention above, and doesn’t prepare your pelvic floor for REAL LIFE. So we need to ask all the elements of the core to work TOGETHER, centred on your breath, and THEN 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 (‘sit bone’). 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 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 very important in connecting all the elements of your core together. Despite the fact it requires a bit more thought, the benefits in connecting everything together are 100% worth the effort.

2. Consult a Women’s Health Physiotherapist

In my view as a Holistic Core Restore® coach, it is essential that you see a Women’s Health Physiotherapist for a clinical assessment too. I’ve done it myself after both my children and the benefits are huge. Not only do they internally assess the strength and effectiveness of your pelvic floor exercise (are you doing them right), they assess for prolapse, the impact of any scar tissue for birth tearing or c-section, and assess for diastasis, postural issues, and muscle imbalances. I found it personally invaluable, but professionally it’s important to me and my fellow coaches to have this assessment and guidance when we are working with women of any age or life stage. (They can also diagnose a hypertonic or overactive, tight, pelvic floor, which I haven’t addressed here. That’s less common, and resolved with a different approach).

3. Find the right exercise professional

Linked to the above, it’s really important that women work with true experts, be that physiotherapists or fitness professionals. I know that so many mums want to just stick on the trainers and head out for a run, or take their baby to the nearest buggy bootcamp, and that’s great, but taking the right advice from the right person can take that experience from a bad one where symptoms start or become worse, to a good one where symptoms actually improve.  A graded, safe return to exercise based on your individual circumstances is the best approach, so I implore you to find your nearest Holistic Core Restore® coach, or thoroughly research any fitness professional before working with them, even if they claim to be appropriately qualified. I have a separate blog on what to look for.

4. Be kind to yourself with a whole-body approach

Our bodies went through significant trauma when we had children, be that 3 months or 30 years ago. And recovery takes time, whenever you start that recovery. Exercise can go so far, but we’ll always get better results when that’s combined with excellent nutrition and hydration to boost healing, cell renewal and hormone balance, and leading to good bladder and bowel health. Load good breathing and posture, and some good old-fashioned TLC on top of that and our bodies will not only look, but feel better.

Why do all 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 that’s a whole different blog.

So, 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 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?

Leaking is not something women have to put up with. Mostly we can work on this through the above. Pain, bleeding or discomfort is never ok. When in doubt, always refer to your GP.