Your pelvic floor muscles sit in a hammock underneath your pelvic organs – bladder, womb and the lower part of your bowels. Healthy pelvic floor muscles are important for bladder function, bowel function and sexual function.
Pregnancy and childbirth can put a strain on the pelvic floor muscles. By the end of pregnancy, your pelvic floor is supporting roughly twice the weight of your baby. Your baby is being carried along with your (now bigger) womb, the fluid around your baby, and your placenta.
Pelvic floor exercise is recommended during pregnancy and after the birth to help avoid problems during this time.
It is also important to get into good habits exercising these muscles, as any problems or weakness will typically get much worse as we get older. Menopause brings changes which can make pelvic floor problems worse.
Up to one third of women will experience some problems with their pelvic floor muscles at some point. Symptoms of pelvic floor weakness include:
- Leaking of urine, particularly when coughing, sneezing, laughing or exercising
- A sudden need to go to the toilet, or going very often
- Leaking of stool (poo) or wind
- Difficulty getting clean after a bowel movement
- Feeling of something 'coming down' in the vagina
- Lack of sensation during sexual activity
The good news is that by choosing to work out your pelvic floor you can build up strength, avoid problems and stay healthy and active into later life. With a strong pelvic floor you can:
- Get active playing with your children without worrying about leaks
- Laugh at those funny parenting moments without worrying about leaks
- Have more sensation during sexual activity
The muscles you need to squeeze to exercise your pelvic floor are the same ones you would use to hold in urine if you were in a queue for a toilet, and to hold in wind. When you try to exercise these muscles for the first time, you may find it easiest to lie on your back with your knees bent. With a stronger pelvic floor, you can exercise them in a sitting, or even a standing position too.
With clean hands, you can feel inside your vagina with a thumb or finger to check whether you can feel a squeeze. The pelvic floor contraction should feel different from when you tense up your buttocks or your stomach muscles.
If you are not confident that you are able to do pelvic floor squeezes, talk to your midwife.
As with any muscle, to build strength you will need to repeat the exercise until the muscle gets tired, and then do this regularly to build up how much you can do over a number of weeks and months. For pelvic floor strength, exercise three times a day is recommended. It takes around five minutes each time. Ideally, you would be able to do 10 squeezes, holding each for the count of 10 and relaxing your pelvic floor completely in between. You would then do 10 quick squeeze and release patterns.
Effective pelvic floor strengthening is a commitment, but well worth it. It needs to be built into a routine, and this is difficult when looking after a baby and perhaps other children. You may wish to set yourself reminders. You might consider downloading the NHS Squeezy app to provide reminders and an exercise guide. However, it is worth it to avoid problems and enjoy the advantages of a strong pelvic floor.
Do not suffer in silence. Pelvic floor problems are very common and can be improved with the right support. Maternity services are working to ensure that it is easier for you to see a specialist women’s health physiotherapist when this is needed. A women's health physiotherapist can support you to exercise your pelvic floor effectively, and also identify when further treatment or surgery may be needed. Speak to your midwife or GP.