Physiotherapy - Pelvic Floor Exercises for Women

This leaflet will provide you with information about Pelvic Floor Exercises.

Many women experience pelvic floor problems at some time in their life.

The most common problems are urinary leaking and pelvic organ prolapse, but your pelvic floor also affects bowel control and sexual function.

The Pelvic Floor muscles

The pelvic floor consists of layers of muscles and ligaments that stretch from the pubic bone to the end of the spine, like a sling.

Your Pelvic Floor muscles:

1. Keep your bladder, womb and bowel in the correct position - preventing prolapse
2. Tightly close your bladder and bowel openings to prevent incontinence
3. Help with sexual function and sensation

When you go to the toilet, your pelvic floor muscles relax and afterwards they tighten to restore control. They actively squeeze when you cough, sneeze or laugh to prevent leaking.

If you have any problems completing the exercises or understanding this leaflet you should ask your doctor, nurse, continence advisor or specialist pelvic health physiotherapist for advice.

Problems with Pelvic Floor may include:

• Stress incontinence - leaking urine with activity or increased abdominal pressure (such as laughing, lifting, coughing, sneezing, running, jumping or other sporting activity)
• Urgency - a sudden urgent need to rush to the toilet
• Urge incontinence - urgency and leaking on the way to the toilet
• Frequency - a need to go to the toilet frequently during the day/night
• Faecal urgency and incontinence - an urgent need to empty your bowels and leakage of stools or wind from the back passage
• Prolapse - a feeling of something coming down inside the vagina or an aching dragging sensation
• Sexual dysfunction - decreased feeling during sexual intercourse, sexual pain or difficulty achieving orgasm

It is possible to have a combination of these symptoms.

Causes of Pelvic Floor Problems

• Pregnancy
• Childbirth – especially perineal trauma, forceps or ventouse deliveries
• Menopause
• Chronic cough or chest problems
• Constipation
• Being overweight
• Post surgery – i.e. hysterectomy
• Repeated heavy lifting or poor lifting technique
• High impact exercise
• Other medical or neurological problems

Many people think these symptoms are part of the natural aging process, but they can happen to women at any time of life and you can help to minimise these.

Pelvic floor muscles can be strengthened just like any other weak or damaged muscle. They need to be exercised regularly to work effectively.

How to Exercise your Pelvic Floor muscles

• Sit or lie comfortably
• Imagine that you are trying to stop yourself passing wind from your back passage. Now imagine you are trying to stop the stream of urine at the same time. You need to think of squeezing tightly inside your vagina. You should feel your muscles lift up and squeeze tight.

You need to practice long squeezes to build up endurance and short squeezes to be able to react quickly

1.    Long Squeezes

• Pull up the pelvic floor muscles as tight as you can for 10 seconds
• Rest for 4 seconds
• Repeat 10 times

2.    Short Strong Squeezes

• Pull up and squeeze for 1 second and then relax
• Repeat 10 times

Complete 3 times a day.

You may find it easier to start your exercises when you are sitting or lying down. As your muscles improve, aim to do your exercises when standing.
 
Try to avoid excessively pulling in your stomach, squeezing your legs together, tightening your buttocks or holding your breath to ensure only your pelvic floor is working. A feeling of gentle tightening in your lower abdomen is normal.

As you improve you will notice that you can hold your squeeze for longer and do more repetitions in comparison to when you started.

Personalised Exercise Programme

1.    Long Squeezes:

• Pull up and hold as tightly as you can for _____ seconds
• Rest for 4 seconds.
• Repeat _____ times

2.    Short strong squeezes

• Pull up and squeeze for 1 second and relax.
• Repeat _____ times.

Complete long and short squeezes    times a day.
Position yourself in lying sitting standing.

‘The Knack’ – Always squeeze your pelvic floor muscles before you do anything that may put them under pressure, such as lifting, coughing or sneezing.

Remembering to Exercise

It is easy to forget your pelvic floor exercises. Make sure your exercises are part of your daily routine – just like brushing your teeth or taking your medication.

You should continue with the exercises for the rest of your life.

• Use coloured stickers or reminder notes around the house or at work
• Use triggers such as boiling the kettle or waiting at traffic lights
• Use the advert breaks between television programmes
• Set an alarm on your phone or watch
• Download the ‘Squeezy’ App on your smart phone which alerts you and counts you through your programme.

Pelvic floor exercises are a secret exercise. No one should know you are doing them if you are doing them correctly.

Pelvic floor exercises are not a quick fix. It is important you continue with your exercises even if you feel they are not helping. It can take 3 to 6 months to notice an improvement in your symptoms.

Tips to help improve your symptoms

1. Use a small mirror to look at the area between your legs. The skin between the vagina and your back passage should move upwards and inwards as you squeeze. If you see any bulging or opening at the vagina when you do the exercise then STOP. This could cause more problems.
2. Feel inside your vagina with your thumb or finger. Tighten the pelvic floor muscles and you should feel the squeeze around your thumb or finger.
3. If you are sexually active, you could try and squeeze your muscles during sexual intercourse. Ask your partner if they can feel the squeeze.
4. Being overweight puts extra strain on your pelvic floor muscles. Your symptoms may improve if you lose weight.
5. Avoid constipation – Straining to empty your bowels can weaken your pelvic floor.
6. Drink at least 8 cups of fluid a day. Avoid caffeine, fizzy drinks, citrus juices and alcohol. These drinks irritate the bladder and you may need to urinate more frequently.
7. Only go to the toilet if your bladder is full. Avoid going ‘just in case’.
8. Try to give up smoking – this affects your pelvic floor function as the associated cough can worsen symptoms. Ask your GP, health professional or local smoking cessation service for help.
9. If you take part in any regular exercise in your day to day life, discuss this with your Physiotherapist. It may be necessary to adapt or change some of your exercises for a period of time. This is because you may be placing your pelvic floor muscles under unnecessary strain.

Further Information

www.thepogp.co.uk
www.bladderandbowel.org
www.bbuk.org.uk - Tel 0161 214 4591
www.bladderhealthuk.org - Tel 0121 702 0820
www.nhs.uk