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Pelvic Floor

What and where is the pelvic floor?

Pelvic floor muscles in men and women are a group of muscles which form a sling of support from the pubic bone at the front of the pelvis, to the tail bone at the back.  They also stretch out to the side towards the “sitting bones” of your pelvis.

To find the pelvic floor muscles:

  • Sit on a firm chair and rock forward and back becoming aware of the bony pubic bone at the front and the bony coccyx or “tailbone” at the back.
  • Rock from side to side and become aware of the bony part of the pelvis or “sitting bones” deep under the buttock muscles.  The pelvic floor muscles are right there at the base of the pelvis supporting the bladder and bowel in men and the bladder, bowel and uterus in women. 
  • Try sitting on your hand, turn your palm up and feel the tail bone, pubic bone and sitting bones.  The pelvic floor muscles will be right there just above your hand.

Bands of the muscles also encircle the bladder and bowel openings and help to keep them closed appropriately and so prevent incontinence when we laugh, cough, sneeze, exercise or simply when we feel that we are busting to go to the toilet.

Superficial muscles also help with sexual function and arousal.

How can I make the pelvic floor muscles work?

  • You will feel these muscles working if you gently tighten round the front passage as though stopping the flow of urine mid-stream.  (It is not advisable to actually stop the flow of urine mid-stream more than once every 2 weeks or so.  When you have a wee, you need to let the muscles relax so that you can empty your bladder fully.)
  • You will feel these muscles if you gently tighten up around the back passage as though you were trying NOT to pass wind.
  • Men will feel these muscles if they tighten and lift testicles up.
  • If you have good pelvic floor muscles, you will feel a tightening and lifting feeling through the vagina in women and above testicles in men. 

Points to remember:

  • Although we talk about the “pelvic floor muscles”, and there are indeed several of them, they all work together.  It requires high level pelvic floor function and awareness to feel the difference between the different pelvic floor muscles.  In the early days of a rehab program don’t worry about feeling the difference between the different muscles.  They just feel like one muscle working through the whole area around bladder and bowel region.
  • Remember that if you are weak, or have never thought about this before, it may not be easy.  You may not feel squeezing or lifting.  You may only feel a gentle “fluttering” feeling.
  • It is quite common for people to try too hard to make the muscles work so that your buttocks and maybe even tummy muscles work too hard.  Underneath, the pelvic floor may not be working at all.
  • If in any doubt, you must see a trained Pelvic Floor Physiotherapist to have your muscles assessed and to learn how to do these vital exercises.

Who needs to do pelvic floor exercises? 

  • Any woman who has ever had a baby (1 in 3 women who have ever had a baby will suffer incontinence).
  • Anyone who experiences loss of urine inappropriately for any reason. 
  • Anyone who experiences even the smallest inappropriate faecal loss or who cannot control wind.
  • Anyone trying to overcome persistent low back pain.
  • Anyone trying to overcome certain chronic sporting injury where “core stability” is an issue.
  • Anyone wanting to start a “pilates” exercise program.
  • Anyone who does heavy lifting in life which can cause prolapsed pelvic organs and incontinence.
  • Anyone who lifts heavy weights as part of a sporting program.
  • Anyone who does high levels of impact exercise such as gym exercise, boxing, martial arts, netball, basketball etc.
  • Anyone who suffers from chronic cough for any reason such as allergy or chronic lung problems.
  • Any man who has undergone prostate surgery.

How many exercises should I do?

The answer to this question depends utterly on what you, as an individual can do already.  It would be like saying “what can I do to get fit to run a triathlon?”  The answer would depend on whether you have ever exercised before, how old you are, whether you have any injuries etc. etc. In other words, an exercise program must be tailored to the individual.  Research consistently shows that those that are told what to do or who are simply given a leaflet to read will often get the program wrong.  

BUT, as a guideline:

A training program might consist of 5 – 8 pelvic floor squeezes, holding each for 5 or so seconds, doing this 3 times each day.  It might include some longer holds of up to 20 – 30 seconds for “endurance”.  For someone who has achieved strength goals, they might need to do a maintenance program of up to 12 squeezes and holds once daily.  In the end, EVERYONE should be using these muscles on and off all day in daily activities.  This is the ultimate key to success.

If you have any doubts about your pelvic floor function, contact us to see Caroline Bender or Usanee Heron from “Peninsula Pelvic Floor Physiotherapy” at The Sports Injury Clinic.