Pelvic floor exercises for women

The pelvic floor muscles form a hammock at the base of your pelvis, spanning across the bottom of your spine (coccyx) to the bone between your legs (pubic bone).

• They support the pelvic organs such as the bladder, uterus and rectum, especially when you are standing or exercising.
• They support the bladder to help it stay closed.
• They control wind and when ‘holding on’ with your bowels.
• They increase sexual satisfaction during sexual intercourse.

• You may leak urine when you exercise or when you cough.
• You may have a sudden feeling of needing to rush to the toilet or leaking on the way to the toilet.
• You may have leakage of stool (faeces) or difficulty controlling wind.
• You may have sensation of a prolapse (a feeling of heaviness or lowness in the vagina).
• You may feel less satisfaction during intercourse.

One of the most effective things you can do to reduce these symptoms is to try and strengthen your pelvic floor muscles.

• Pregnancy and childbirth - during pregnancy, the extra weight puts pressure on your pelvic floor. Delivery can also weaken the pelvic floor.
• Menopause - changes in hormones can have an influence on our pelvic floor.
• Lack of exercise - like any other muscle in the body, the pelvic floor muscles need regular exercise to maintain good tone. If they are not exercised regularly, they may become stretched and weak so that they no longer work effectively.
• Pelvic surgery - e.g., hysterectomy, prolapse repairs, surgery to your back passage or bowels.
• Straining to open your bowels - the ‘pushing down’ movement when you strain to open your bowels can overstretch your pelvic floor and make it weaker.
• Persistent heavy lifting – can strain the pelvic floor by raising intra-abdominal pressure.
• Being overweight - extra weight puts more pressure on your pelvic floor muscle. You can find out whether you are an acceptable weight for your height using the BMI (Body Mass Indicator) calculator on our physiotherapy website (details on the end of this leaflet) or your GP or healthcare professional will be able to tell you.
• Having a chronic cough - every cough puts pressure on your pelvic floor muscle.

Pelvic floor muscle exercises can help strengthen your muscles so they can support your bladder and bowels properly again. This can improve bladder and bowel control and help in reducing or stopping any leakage.

Imagine you are trying to stop passing wind and at the same time trying to stop the flow of urine midstream. You should feel a sensation of ‘squeeze and lift’ as you close and draw up the back and front passages. Hold this for as many seconds as you can (up to a maximum of 10 seconds). At the end of the hold there should be a definite feeling of ‘letting go’. It is easy to use the wrong muscles instead of the pelvic floor muscles.

Try not to:

• pull in your tummy
• squeeze your legs together
• clench your buttocks
• hold your breath

There are a few ways you can check that you are doing the exercise properly:

• Place 1 or 2 fingers into the vagina and squeeze the muscles until you can feel your vagina tighten around your fingers.
• During sexual activity try to squeeze your pelvic floor muscles.
• Check with a mirror; hold a mirror so you can see the area between your legs. Squeeze the muscles - the skin between the anus and vagina should move inwards (away from the mirror).
• Stop or slow the flow of urine in the middle of passing water. This is not an exercise. You should only do this once to find the correct muscles. Make sure you completely empty your bladder after doing this.

If you are still not sure, please ask for advice from a women’s health physiotherapist or continence nurse.

It is recommended that 24 exercises are performed daily. To avoid over tiring the muscle only 8 holds should be performed at a time with at least 5 seconds rest in between each hold. Try doing 8 holds, 3 times a day. It is also important to practice the exercise in different positions.

Lying

Lie on your side. Tighten your pelvic floor muscles as if you are trying to prevent wind and stop the flow of urine. Hold the contraction as strongly as you can (a maximum contraction). In this position you may find it easier to get a feeling of lift.

You may prefer contracting the muscles lying on your back with your knees bent and your feet apart or lying on your front.

Sitting

Sit on a chair with your knees apart and tighten your pelvic floor muscles as before.

Standing

Stand with your feet apart and tighten the pelvic floor muscles as before.

You can progress these exercises by trying to hold the ‘squeeze and lift’ for longer. As the exercise gets easier you may like to try tightening the muscles when walking, as described below:

Occasionally, try lifting your pelvic floor muscles up halfway to your maximum when walking. If you find this difficult, start by getting used to holding halfway while standing before moving on to walking. Gradually increase the distance you can hold for.

It is important to be able to contract the muscles quickly, for instance when you cough or sneeze. Try and contract the muscle quickly up to a maximum of 10 times.

Try to tighten your pelvic floor muscles before sneezing, coughing etc. This will help to control and reduce leakage of urine.

It is easy to forget to do your pelvic floor exercises. Here are some suggestions to help you remember:

• Use coloured stickers or reminder notes around your house or at work.
• Do your exercises after you have emptied your bladder but remember not to stop the flow of urine mid-stream.
• Set an alarm on your electronic calendar at work or on your mobile phone.
• Do your exercises at meal times.

These are only a few suggestions you may be able to think of something more suitable to fit your own circumstances.

Drink plenty of fluid (at least 6 to 8 cups a day) but try to cut down on tea and coffee as caffeine can stimulate the bladder.

Avoid constipation and being overweight as it can put extra strain on the pelvic floor.

Contract your pelvic floor muscles when you think you may leak such as when you are lifting, coughing or laughing and hold on until the action is over.

You will probably not notice an improvement for several weeks and the pelvic floor muscle exercises will not give the best results until you have been practicing them for between 3 to 6 months. To get the most benefit from pelvic floor exercises, it is important to keep practicing them every day.

If you see little or no change in your symptoms after trying the exercises for 3 months, please ask your health professional for advice.