Am I doing my pelvic floor exercises right?

Taryn Gaudin Women’s Health Physio

Unsure if you’re doing your pelvic floor exercises right? You are not the only one! Often women feel confused if they are activating their pelvic floor muscles correctly. In this post I’ll share my top tips to knowing if you are doing your pelvic floor exercises right.

The pelvic floor muscles are a group of muscles that form a sling that creates the floor to our pelvic ring and the base of our pelvic bowl. The muscles of the pelvic floor attach from the pubic bone at the front, to the coccyx (tail bone) at the back, and to the ischial tuberosity (sit bones) on the left and right of the pelvis. There are two layers of muscles that make up the pelvic floor muscles; the deep pelvic floor muscular layer that makes up the internal muscles of the pelvic floor and the superficial layer that make up the external layer of the pelvic floor. The deep pelvic floor muscles are responsible for providing ‘lift’ to the pelvic organs and supporting the connective tissue of the pelvis. The superficial muscles help to give added closure to the vagina and the anus.

It’s important to know that the pelvic floor in its entirety is more than just muscles. It is also made up of a complex network of sphincters that open and shut to initiate and stop bladder and bowel emptying, nerves, and ligaments and fascia that provide support.

Physically the pelvic floor has a significant role in:

Maintaining continence – stopping leakage from the bladder and bowel
Sexual pleasure – orgasm
Supporting the pelvic organs – bladder, bowel, uterus in place

Activation of the pelvic floor muscles should feel like a drawing inward and upward of the pelvic floor muscles. If you feel like you are pushing down or bearing down – similar to the sensation of the pushing phase of labour or forcing a bowel motion, you are not activating the pelvic floor muscles correctly. If you are doing this bearing down action, you could be doing more harm than good. This is why it’s important to know if you are activating the pelvic floor muscles effectively.

How do I know if I am activating my pelvic floor muscles correctly?

The best way to know if you are activating the muscles of the pelvic floor correctly is to have an internal vaginal assessment conducted by a Pelvic Floor Physiotherapist. In this assessment the therapist will be able to tell you:

If you are activating the pelvic floor muscles correctly
How strong your pelvic floor contraction is
What your pelvic floor co-ordiation and endurance is like
How balanced the muscles are on the left and right
If you are able to effectively relax the muscles of the pelvic floor
What the supportive pelvic tissue is like, and if there are signs of pelvic organ prolapse

Some therapists will offer a ultrasound scan in replacement of an internal assessment. An ultrasound is far less accurate than a vaginal assessment, and is only preferred when there an internal assessment is not possible.

If you don’t have access to this pelvic floor physiotherapy, please don’t worry. There are also ways that you can check for yourself – though they are not quite as accurate.

am i doing my pelvic floor exercises right?

Stop the flow of urine

This is an effective way to see if you are contracting the muscles of the pelvic floor or bearing down. Even though you may not be able to completely stop the flow of urine, an effective pelvic floor contraction will slow the flow of urine. If you notice the flow increases, this is a good indication that you are bearing down rather than squeezing the muscles. Some people say that doing this may cause a urinary tract infection. There is no evidence to suggest this at all. This is to be done as a simple check. It is not recommended that you exercise the pelvic floor in this way for any length of time.

Look at your perineum

The perineum is the tissue between the vagina and the anus. Using a mirror you can look at the perineum as you activate the muscles of the pelvic floor. If the muscles are contracting well, the perineum will ‘tighten’, become smaller, and you will see the perineum draw inwards towards the body. If you are bearing down, the perineum will bulge, become bigger, and you will see the perineum move ‘away’ from the body.

Use a thumb or finger to feel

Inserting a finger or a thumb you can feel for the activation of the pelvic floor muscles. As you contract the pelvic floor you will feel the muscles tighten around your thumb/finger and draw upwards.If you are bearing down you will feel the muscles push downwards and will not be able to feel the tightening.

How often do I need to do my pelvic floor exercises?

How often you need to do your pelvic floor exercises is very personalised. This is why a pelvic floor assessment with a pelvic floor physiotherapist is very helpful. Along with being able to activate the muscles of the pelvic floor, it is important to be able to fully relax them swell. Often women who experience pelvic pain or pain with sex have highly toned pelvic floor muscles and find it more difficult to relax them. I will share more on how to relax the muscles of the pelvic floor in a future post.

IMPROVE YOUR TOILET POSTURE:

Sit with the knees higher than the hips, preferably by using some kind of stool/foot support. The neural pathways that help us to press up onto our toes are the same as those that help to maintain continence. Think about young children who dance on their tip-toes when they need to use the bathroom – this is one of our body’s natural ways to stop us from leaking. This is why a stool is preferred so that we don’t have to work against this natural neural pathway.
Have the knees slightly wider than the hips to allow for a gentle lean forward from the hip joint and an open outlet.
Keep the back relatively straight to avoid compression on the abdomen.
Allow the belly to soften and bulge.
Don’t push, simply allow the bowel motion to fall away naturally.

MAINTAIN ADEQUATE HYDRATION

Enure you are well hydrated so that your bowel motions are soft and easy to pass
You can tell by the colour of your urine if you are well hydrated – a pale straw coloured urine indicates good levels of hydration. Anything darker, you can drink more fluids. Anything lighter is not a problem, but you can drink less if you like.

LISTEN TO YOUR BODY DURING EXERCISE

If you are feeling prolapse symptoms either during exercise, or after exercise, it is recommended that you stop and modify that exercise in some way. In some instances you may need to take a break from a particular exercise and slowly build up to it again. Some of the most challenging exercises that women find aggravate prolapse symptoms include:

High impact exercises like running
CrossFit
Weighted exercises like gym classes or free weights, and
Strong deep core exercises like sit-ups, V-sits and some pilates style exercises