How to do your Pelvic Floor exercises correctly.

Following on from our last blog post on what, where and why we exercise the pelvic floor muscles, this blog covers how to do the exercises correctly.

Quick refresh on the anatomy: the pelvic floor muscles are a bowl shape at the base of the pelvis with 3 openings for the urethra (bladder opening), vagina and anus.

Contracting the pelvic floor muscles:

When you contract the pelvic floor muscles, you want to squeeze around the 3 openings and lift the base of the bowl upwards. Think about changing the shape of the bowl from a noodle bowl to a pasta bowl. As we squeeze around the openings and lift the bowl base up, we create a crease in the tubes coming from the bladder and bowel. This creates another barrier to leakage. 

Mental imagery can help contract pelvic floor muscles too. Some of my favourite cues are:

·       Squeezing around your anus and lifting towards your belly button

·       Squeezing a tampon and lifting it up inside towards your uterus

·       Like a claw hand from a toy machine, that closes around a toy and lifts it up towards the top (the uterus).

·       Imagine trying not to pass wind in public.

When you have managed the contraction, you want to hold it for a few seconds before fully releasing the muscles. It may take a few seconds for some people to feel this release, or it may not be felt at all. If you notice this, give yourself some more time before doing another contraction to make sure you have completely relaxed your muscles. Sometimes taking a big deep breath down into your belly can be helpful in relaxing your muscles too.

How long do I hold the contraction for?

There is no easy answer to this unfortunately. It’s a process of trial and error to work out where your starting point is.

When you do a contraction and then hold it, we use the sensation of the release to tell if you have held on to the contraction for the whole intended duration. If you don’t feel a release, or only a small release, your muscles have fatigued.

Fatigue is not bad. We want to work our pelvic floor muscles to the point where they get tired when we exercise them, because this is what makes a muscle stronger. In saying that, we don’t want to fatigue too quickly. Ideally, we can do 7-8 repetitions before fatigue sets in.

If you are feeling fatigued before this point, you're trying to hold for too long. You are better off reducing how long you hold for by 1 second until you find the point where you can manage 7-8 reps before fatigue starts.

If you can do 10 reps with no fatigue (i.e. you can hold on for the whole duration of all 10 reps), it is too easy. Increase how long you are trying to hold on for by 1 second more, and build this up until you fatigue only in the last few repetitions. This way you will challenge the muscles appropriately.

Ways to challenge your muscles more:

Doing the pelvic floor exercises as above will help build your muscles' strength. But, like other muscles in our body, our pelvic floor also needs endurance and speed.

Endurance is the ability to hold on for long periods of time, like when you hold on to get to the toilet. Speed is the ability to quickly contract your muscles, which we use for coughing, laughing or sneezing.

To work on endurance, aim to contract your pelvic floor approximately 50-75% of your maximal contraction and hold for as long as you can. Have a rest, and then repeat 3-4 times.

To work on speed, aim to contract your pelvic floor muscles to 100% quickly, then relax the muscles completely as quickly as possible. Repeat 10-20 times or until your muscles fatigue.

Not sure if you’re doing it correctly?

If you’re not sure you’re doing your pelvic floor muscles correctly, seeing a pelvic floor physiotherapist can be really beneficial. The physiotherapist can assess how you contract and relax the muscles, what's their strength, endurance and speed like. They can also look for any other factors influencing your pelvic floor muscles such as prolapse, overactive muscles, or scar tissue. The physiotherapist can then give individualised advice and exercises to suit you.

The Continence Foundation of Australia has a registry of Pelvic Floor Physiotherapists which can be a helpful resource to find one near you.