Pelvic floor muscle exercises (long) This leaflet aims to give an overview of pelvic floor muscles, their function, how they can be exercised and why this is so important. What are pelvic floor muscles and what do they do? The pelvic floor is made up of layers of muscles which stretch like a hammock, from the pubic bone at the front to the coccyx at the base of the spine. They form the lowest part of the abdominal cavity. The muscles of the pelvic floor support the pelvic organs - the bladder, uterus and bowel in women and the bladder and bowel in men. The urethra, vagina and rectum in women and the urethra and rectum in men pass through these muscles. The muscles loop around these orifices rather like a figure of eight, one loop encircling the urethra (and the vagina in women) and the second loop encircling the rectum. There are several of these muscles which all work together but which also have specialised types of fibres which perform different functions. Some fibres are slow acting and very strong, called slow twitch, these provide strength and endurance. A second type of fibre has less endurance and strength but is very fast acting, called fast twitch, these two types of muscle fibres are very important and enable the pelvic floor muscles to help provide: support / strength / sexual pleasure. How do the pelvic floor muscles work? The abdominal cavity is held at a slightly higher pressure than the air outside the body. This helps to pass food through the digestive system. Abdominal muscles form the front and side walls of the abdominal cavity and the diaphragm forms the ceiling, separating the abdomen from the chest. The slow twitch muscles support the floor of the abdominal cavity. When we cough, laugh, sneeze, run, jump or lift heavy weights the diaphragm flattens down with enormous force. This force is transmitted through the abdominal cavity to the pelvic floor. If the slow twitch muscles are too weak or the fast twitch muscles are too slow the result might be a leakage of urine from the bladder or a leakage of faeces or flatus (wind) from the anus. What can weaken the pelvic floor muscles? Pregnancy puts an enormous strain on pelvic floor muscles because of the influence of hormones plus the weight of the developing baby. Childbirth can cause damage to the pelvic floor muscles by prolonged pushing during labour. Damage may also be caused by trauma such as tears or episiotomies and by some types of delivery (e.g. forceps). Menopause can cause pelvic floor muscle weakness due to the changes in the hormones which effect pelvic floor muscle support. Chronic constipation and straining at stool can cause pelvic floor muscle weakness over time. Exercise / some high impact sports can cause pelvic floor muscle weakness.
Lack of exercise / immobility can cause atrophy (wasting away) of any muscle and this includes those of the pelvic floor. Obesity can cause pelvic floor muscle weakness due to the pressure of the extra weight. Trauma, accidental or during the course of some types of surgery, may cause pelvic floor weakness. This is the most common cause of pelvic floor weakness in men. Neurological damage caused by some diseases or conditions can affect the function of pelvic floor muscles. Chronic /acute cough, whether caused by smoking or by chest complaints (e.g. asthma) can damage the pelvic floor muscles by constant or intermittent pressure. Who might suffer from pelvic floor muscle weakness? Anyone from the very young to the very old can suffer from pelvic floor muscle weakness. However, women are much more likely to develop pelvic floor weakness than men - 1 in 4 women and 1 in 10 men. What are the symptoms of weak pelvic floor muscles? Urinary incontinence is the most common symptom. Typically, small amounts of urine are leaked during any stress activity, such as coughing, laughing, sneezing, running, jumping or lifting. In some cases the effect may be so severe that even rising from a sitting position can cause leakage. Poor sexual response may be a result of pelvic floor muscle weakness. Faecal incontinence / incontinence of flatus are usually caused by physical damage or bowel dysfunction e.g. irritable bowel syndrome etc. However, weak pelvic floor muscles make control or treatment more difficult. Prolapse of the bladder, uterus or rectum through its supporting structure. Why should I exercise my pelvic floor muscles? Treating and preventing stress incontinence Leakage of urine is one of the main, and most distressing, symptoms of weak pelvic floor muscles. It affects one in four women and one in ten men at some stage of their lives. Healthy pelvic floor muscles help to improve and maintain bladder and bowel control. Pelvic floor muscle exercises are widely used by continence advisors, physiotherapists, and some doctors as a first line treatment for stress incontinence. In most cases, when they are correctly taught and conscientiously carried out, pelvic muscle exercises can improve or cure the condition. This means that surgery can often be avoided. If surgery is required practicing pelvic floor muscle exercises beforehand, and continuing after surgery, speeds recovery and enhances the results of the surgery.
Specialists recommend that all young women should learn to do pelvic floor muscle exercises to help prevent incontinence in later life. Sexual response Well developed pelvic floor muscles provide greater internal movement and stamina. So, as well as improving a woman s sexual response, her partner can benefit too. Pre-pregnancy For many women, the first time the pelvic floor muscles are at risk is during pregnancy and childbirth. In the early stages of pregnancy, the hormone relaxin is produced. This has a softening effect on fibrous tissue, which allows it to stretch. Relaxin also softens the fibres in pelvic muscles. This effect added to the extra weight tends to weaken the pelvic floor muscles. If pelvic floor muscle exercises were begun before pregnancy this would help avoid weakness later. Post natal During delivery pelvic floor muscles can become stretched and damaged. Tears, episiotomy or a forceps delivery may add to any damage. It is very important to exercise the pelvic floor muscles after delivery and to continue lifelong. It can take 6-12 months to regain pre pregnancy pelvic floor muscle strength. It is often assumed that only vaginal deliveries weaken the pelvic floor muscles. As already mentioned, weight and hormonal effects must also be considered. Bowel problems Learning to do pelvic muscle exercises will help in treatment and control. Men only Men sometimes develop stress incontinence after surgery e.g. following prostatectomy. Learning to perform pelvic floor exercises can help regain control. They can also help to achieve firmer erections. How can I find my pelvic floor muscles? The pelvic floor muscles are not visible and are not always easy to locate. It is important that you identify them so that you are sure you are exercising the correct muscles. 1. Some women and men find it easiest to identify the pelvic floor muscles around the anus first. Imagine you have severe diarrhoea and that the nearest toilet is 200 yards away. Tighten and squeeze the muscles upward. 2. Another way of locating the pelvic floor muscles is when passing urine. Halfway through, try and stop the flow by contracting the muscles. You may be able to feel the muscles squeeze. If the muscles are weak you may only be able to slow the flow, not stop it completely NB The stop-test is not an exercise. It should never be used more than once a week. If this test is used regularly as an exercise it may make the bladder unstable or cause a backflow of urine to the kidneys. 1) For women, another method is by self-examination. Whilst lying or sitting in a comfortable position insert one or two fingers into the vagina and squeeze the muscles. You should be able to feel the muscles contract around your finger.
Another variation of this method is to practice this with your partner. He will be able to tell you if you are contracting the correct muscles. 2) (For women) Place the tips of two fingers just behind the vagina. 3) Imagine a sharp pin is about to stab this spot. Try to draw the muscles up and away from the pin. You should be able to feel your muscles tightening and lifting away from your fingers. 4) (For men) Place the tips of two fingers just behind the scrotum. Imagine a sharp pin is about to stab this spot. Try to draw the muscles up and away from the pin. You should be able to feel your muscles tightening and lifting away from your fingers. In addition you may be able to see your penis lift slightly. What if I can t find my pelvic floor muscles? If you have tried the above methods and are unable to find your pelvic floor muscles or you would like further help or you wish to comment about this information please contact continence care on 01634 719252. Pelvic floor muscle exercises programme Getting started Sit or lie comfortably with your knees slightly apart and your toes turned out. Remember how you found your pelvic floor muscles in the previous exercise? Do the exercise again. While you are contracting your pelvic floor muscles do not hold your breath, squeeze your buttocks, lift your shoulders or tense your abdomen. Training for endurance Each muscle contraction should be held for as long as possible (at least 2 seconds). Then rest for an equal number of seconds. This action should be repeated as many times as possible and held for as many seconds as possible. Training for strength Contract the pelvic floor muscles as with the endurance exercise, but this time repeat as many as you can as quickly as you can and do not rest in between. When you have done all these exercises write down the results in a notebook or diary. It should look something like this: Each slow contraction held for----number of seconds -------- number of slow contractions -------- number of seconds in between each contraction -------- number of fast contractions This will give you your base line on which you can build and improve. How often should I exercise? You should aim to repeat this set of exercises about 5 times a day. Although they can be done at any time, you may find early morning is best. This is because the pelvic muscles tire like any other muscles. It may also help you to remember to keep up your exercises by doing them at set times e.g. when you make a drink or wash up or when on the toilet after emptying your bladder. You will need to set yourself a schedule.
Your aim now is to increase the number and strength of both your slow and fast contractions as you improve your pelvic muscle strength. It is important to exercise enough to improve but not so that the muscles ache or overtire. How soon should I notice a difference? This will depend on how weak or damaged your pelvic floor muscles are and if you have any incontinence and on how severe it is. However, if you are exercising correctly and regularly, you should notice a difference in about 6 weeks. Remember, once you start to improve you need to keep going. These exercises are for life. What if the exercises are not working? If after a few weeks you have not seen any improvement it may be that you are not doing the exercises correctly. It may be that another treatment could help you more (there are several) The cause of any incontinence may be an unstable bladder rather than a weakness in your pelvic floor. The muscles may be too damaged and may need to be repaired. It is always important to have the cause of any incontinence checked and to make sure you are performing the exercises correctly. Other sources of information are: The Bladder and Bowel Foundation SATRA Innovation Park, Rockingham Road, Kettering, Northants NN16 9JH Tel: 01536 533255 Email : info@bladderandbowelfoundation.org Website : www.bladderandbowel foundation.org PromoCon (Continence Products) Disabled Living, St Chad s Street, Manchester, M8 8QA. Tel: 0161 834 2001 Fax: 0161 214 5961 Email : promocon2001@disabledliving.co.uk Website : www.promocon2001.co.uk Who to contact if you have any questions about this information: Continence Care, Lordswood Healthy Living Centre, Sultan Road, Lordswood, Chatham, Kent ME5 8TJ Tel: 01634 337475 Customer care Please send any comments about Medway Community Healthcare services to: Customer care coordinator, Medway Community Healthcare MCH House, Bailey Drive, Gillingham, Kent, ME8 0WG t: 01634 334650 medwaycustomercare@nhs.net All contact will be treated confidentially. Sharing your information Your information will only be disclosed to those who have a genuine need to know and who agree to keep your information confidential. For your direct care we often share information with NHS hospitals and clinics, GPs and social care. Leaflet reference: MCH307