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Pelvic Floor Exercises


WHERE IS THE PELVIC FLOOR?

The pelvic floor is a sheet of muscles that extend from your tailbone (coccyx) to your pubic bone at the front, forming a platform or sling which supports the contents of your pelvis.

To identify these muscles, stand with feet slightly apart, turn in your toes, and imagine you are stopping yourself from passing wind. Then, imagine you are trying to stop yourself passing urine. You only have to do this once to make sure you have located your pelvic floor.

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WHY IS THE PELVIC FLOOR IMPORTANT?

The pelvic floor controls the bladder (urethra) and the anus, and in women supports the vagina. The pelvic floor can weaken for a number of reasons: childbirth, chronic cough, straining to open your bowels, being overweight, surgery, hormonal changes, too much heavy lifting or simply lack of exercise. This can cause bowel or bladder leakage and problems with sexual function.

Like any other muscle, the pelvic floor will strengthen with exercise, improving any symptoms of incontinence.

HOW TO EXERCISE YOUR PELVIC FLOOR

There are two types of exercises - slow twitch and fast twitch. It is important that you do the slow twitch first and then the fast twitch each time you exercise your pelvic floor muscles.

  • Sit, stand or lie comfortable with your knees slightly apart.
  • Imagine you are trying to stop yourself passing wind at the same time as you are trying to stop the passage of urine. Slowly squeeze and lift the muscles.

A feeling of gentle tightening in your lower abdomen is normal. To ensure that your pelvic floor muscles are working, try to avoid:

  • Squeezing you buttocks together
  • Bringing your knees together
  • Holding your breath
  • Pulling in your stomach
  • Lifting your shoulders / eyebrows or toes upwards.

To perform the slow twitch exercises:

  • Tighten your pelvic floor muscles and hold for as long as you can, up to ten seconds.

  • Try not to hold your breath - breath normally.

  • Slowly relax and let go and rest for the same length of time as you held the squeeze.

  • Repeat the tightening, hold, release as many times as you can, up to a maximum of ten.

These exercises will build the endurance of the muscles (ie the muscles can work harder for longer). As you improve, you will notice that you can hold your contraction for longer and do
more repetitions, compared to your starting point.

To perform the fast twitch exercises:

When laughing, coughing and sneezing, your muscles need to be able to react quickly so it
is also important to practise quick contractions. To do this, tighten the muscles quickly and
strongly and then relax.

  • Pull up the pelvic floor muscles as before.
  • Hold for one second and then relax.
  • Repeat 5-10 times or until your muscles feel tired.

The pelvic floor muscles tire easily and you may notice that it takes a lot of concentration to begin with to do these exercises correctly.

If you find that the muscles let go too quickly and that you cannot hold for long, just hold them for as long as you can. Use this as your baseline. For example, if you can only hold the contraction for a count of three, then every time you do your exercises, contract the muscles for a count of three. Gradually try to work up to ten squeezes over six months.

How often should I do my exercises?

Practice up to ten pelvic floor contractions three times a day. Make sure that every
contraction is a good one.

Do not expect instant results!

It will take several weeks of regular exercise to regain the strength in your pelvic floor muscles. You need to do these exercises for the rest of your life. If you stop exercising, your problems will return.

Further useful tips

Avoid being overweight. Maintaining the correct weight can make a big difference to your symptoms by reducing the strain on the muscles helping to control bladder and bowel movements.

Avoid constipation. Straining to open your bowels stretches the pelvic floor muscles, making them weaker. It is important to drink plenty of fluids and you may need to adjust your diet.

Drink plenty of fluids. Reduce your caffeine intake as these drinks may irritate your bladder. Try to drink more water - aim to drink between 3-4 pints (1.5-2 litres) of fluid a day. Do not restrict your fluid intake. This can make symptoms worse, as your urine will be more concentrated. Regular drinking at the same times each day is best.

Lifting. Women should avoid heavy lifting. Women do not have as much muscle in the middle of their pelvic floor, and heavy lifting increases the pressure in your abdomen and puts extra strain on your pelvic floor. If you do have to life something, remember to
tighten your pelvic floor muscles before lifting and hold them tight until you realise the load.

Exercises to avoid if you think your pelvic floor is weak:

  • double leg lifts
  • straight leg sit-ups
  • high impact exercise such as jumping and running.

These activities put extra stress and pressure on the pelvic floor muscles.

Movement changes. Try to tighten your pelvic floor muscles before coughing, sneezing and laughing. This will help to prevent leakage.

Pilates. You may also find that pilates exercises help. Pilates improves flexibility and strengthens muscle tone. It may help to improve your pelvic floor strength when used with the pelvic floor exercises.

Pelvic floor stimulator machines are available to buy from pharmacies and online, which can also help to strengthen the pelvic floor muscles. Please speak to your specialist nurse for more information.

Bladder emptying

It is important to empty the bladder completely each time you go to the toilet. Take your time. If you think your bladder may not be completely empty try rocking your pelvis forwards and backwards, it may help to empty a little more.

Frequency of bladder emptying

The bladder normally empties between 5 and 8 times per day. Leaving too little or too long a time between emptying may upset this normal function. This usually means emptying your bladder every 2 - 5 hours. Less than 2 hours or more than 5 hours may lead to problems. You may need to train your bladder to hold more, by trying delaying techniques when you feel the urge to go, such as:

  • keep calm and tighten your pelvic floor muscles
  • sit on a hard surface
  • curl your toes hard

distract your mind by counting backwards, singing a song, etc.

 

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