You may have heard the sentence “do your pelvic floor exercises” and not really given it much thought. Then you’re pregnant or maybe postpartum and it’s all people seem to be going on about. Why are these exercises important? Do we really need to be doing them every day? What are the symptoms of these muscles not working as they should be?
Where is my pelvic floor?
Let’s start with a bit of anatomy. The pelvic floor muscles are located in your pelvis and stretch from back to front from the coccyx to the pubic bone, and across to the sitting bones at the side. They form part of your supportive “core” alongside the deep abdominal and back muscles and the diaphragm, which work together to promote good posture and support the spine. They support organs above such as the bowel, bladder and uterus - and the baby during pregnancy. When the pelvic floor muscles work correctly, they can lift to ensure we have full control of the bladder and bowels, as well as relax to pass urine, faeces and to aid childbirth for example.
The pelvic floor muscles are active in everyday life, supporting our physical needs, working with endurance. But when they become weakened, symptoms such as leaking, pressure, pain or prolapse (for example, when the bladder descends into the vagina) could occur.
These symptoms can be very debilitating both mentally and physically so it’s really important to address them properly and get to the root cause. Gone are the days when these were just seen as “women's problems” to do with childbirth, but now more than ever fitness professionals, physios and medics are encouraging women to not accept leaking as part of their daily life throughout pregnancy and beyond.
So what can you do to work these muscles?
The simplest way to “activate” the pelvic floor muscles is to squeeze them. This should then be accompanied by a full relaxation, but not a pushing down. It’s really important to breathe fully to the belly, as it’s known there’s a strong connection between the diaphragm and the pelvic floor. You want to be able to activate the slow-twitch endurance aspect of the muscle with a sustained hold (work up to 10 seconds) as this is the muscle activation that will happen in your daily life.
In addition, work to activate the fast-twitch muscles that come into their own when quick, high impact movements are performed - anything from an intense jumpy workout, to a sudden sneeze. These muscles are strengthened with a pulse squeeze - aim for around 10, then a full relax.
It’s so important to fully relax the muscle, then take a breath to reset. As with any muscle, overuse can lead to fatigue and this won’t help it to strengthen effectively. Some women have a hypertonic pelvic floor, where they are unable to fully relax. This is equally something to be worked on with a combination of breathing and stretches that help to “soften” the muscles in the pelvis.
"The pelvic floor muscles are active in everyday life, supporting our physical needs, working with endurance"
Why does this come up during pregnancy and childbirth?
Some women may experience some symptoms such as heaviness in the pelvis, or maybe leaking during their pregnancy while others may not feel anything at all. What we know is the growing baby is definitely putting pressure on the pelvis (and abdominals and lower back) where there wouldn’t normally be, so this can impact the pelvic floor muscles.
It’s for this reason that pelvic floor exercises are encouraged from pregnancy onwards. In a vaginal birth, the pelvis widens, the muscles becoming stretched and thinner to allow the baby to pass through the birth canal. They will go back to their normal position but need exercises to strengthen them again.
With a caesarean birth, there will still have been pressure on these muscles, and if the mother goes until full term the body will start preparing for a vaginal birth and the muscles start moving.
Being strong in the pelvis after childbirth will quite literally help you get up on your feet again, supporting posture, lower back, abdomen. There is a link between postnatal depression and incontinence, which is no surprise given how important it is for our bodies to work autonomously, so it’s not something that should be ignored.
"Being strong in the pelvis after childbirth will quite literally help you get up on your feet again, supporting posture, lower back and abdomen"
What to do if you have symptoms, or you're just not sure?
In the UK you can ask your GP for a referral to a women’s health physio who will be able to assess your needs in detail. If you want to go privately and pay yourself, you can just book an appointment directly.
A physio will talk through your birth and any symptoms you may have, give you an examination (internally is best if you can) and then prescribe next steps which will likely include exercises, maybe a follow up appointment, plus there are solutions available to support a prolapse if needed. Many women feel so confident and empowered after their appointment, happy that they took an hour for themselves to get checked out.
Kegels for life?
Once you get into a good habit of doing your pelvic floor exercises (kegels) then it just takes a few minutes a day and will impact you positively your whole life. As women approach perimenopause, menopause and beyond, the muscles in the whole body lose some of their strength and mass, so it’s really important to keep training. This goes for the pelvic floor muscles as well! We have a whole life ahead of us to run, jump, do anything we want without fear of leaking or pain. It’s so worth doing the exercises for that!
Squeezy App has a ‘find a physio’ directory: https://www.squeezyapp.com/directory/