The 'How' & The 'Why' of Pelvic Floor Exercises
By Brigid Godwin www.unitybumpsandbabies.co.uk
Come on, hands up who knows that they should be doing their pelvic floor, but just can't be bothered? Yup, I know that one alright! Unlike going to the gym you don't even get to see the results of your efforts, but there are lots of reasons why you need to embrace this secret work and make it part of your daily routine. Men can also do pelvic floor work - it can help with back ache and helps them to keep their erection.
To point out the basics, women have 3 holes down there with gravity getting behind some big organs creating pressure and eventually weakness. If these muscles become lax due to the pressure, this could set you up for all sorts of problems later in life; diminished sexual enjoyment, back ache, weak or leaky bladder or worse still uterine and / or bowel prolapse. If you are pregnant then there are even more reasons why you need to make friends with your nether regions!
What is your pelvic floor? It is a group of muscles that are weaved together and act like a hammock at the base of the pelvis helping to support the reproductive and digestive organs. The bowel, vagina and urethra all pass through the pelvic floor so the tone of the pelvic floor affects these passages. As women, doing your pelvic floor exercises are important during any phase of your life but its especially important to do them regularly during pregnancy and the postnatal period. There are a number of reasons why;
1) As mentioned earlier gravity takes it toll on the pelvic floor for all women, but during pregnancy you also have to consider the added weight of a growing baby PLUS the softening of all the ligaments and tendons in the body. This weakness may result in stress incontinence (where a small amount of urine leaks when you sneeze or cough). Keeping the muscles strong help you to retain control! Plus if the muscles stay strong then they can help the uterus find it's position back in the pelvis after birth.
2) Pelvic floor exercises help with circulation to the area which can help prevent haemorrhoids. Good circulation and pre-conditioned muscles will also help you to recover more quickly after delivery especially if there has been any tissue damage.
3) Pelvic floor work helps you to create strong neural pathways. If you have an epidural, you may find that having that strong connection already established helps you to bear down in the area that you can’t feel and perhaps increase the possibility of having an unassisted second stage.
4) Back ache is only too common during pregnancy and the postnatal period. A strong pelvic floor is crucial for helping to prevent back ache as these muscles form part of the all important core. As the pelvic joints become more unstable due to increased levels or relaxin, having a strong pelvic floor can help to keep the area stable.
5) Strength is important, but so is learning how to release, especially if you have a very strong / tight pelvic floor maybe as the result of lots of cycling, running, horse riding, singing, yoga or playing a wind instrument. Other things that may affect the tone of the pelvic floor could be a history of sexual abuse or if you are holding a lot of fear around childbirth or mothering. So focusing more on the release that comes with the exhale is a really helpful practice as is visualising the breath moving down and out of this area saying the word ‘soften’ or ‘release’ in your mind as you do so. Imagery such as the petals of tightly packed flower opening gradually, breath by breath can also be very powerful.
You can do your exercises at any time in the day but you may find its useful making it a regular part of your routine so you don’t forget to do them. When you brush your teeth, when you are driving or in bed at the end of the day. Aim for 3 times a day during pregnancy (doing a selection from below). You're aim is to be able to hold for a count of 5 breaths. From week 36 you may find it too hard to hold so just do the repetitions without the holds. If you are in the postnatal period then you do the SQUEEZE WITH THE EXHALE and do several each time you feed your baby until you can hold for a count of 10 breaths then ease back to a maintenance level of 10 - 15 squeezes once a day with holds for a couple of seconds at the top.
Try them in different positions such as standing, sitting or lying down or a combination of all of these. Make sure that you are not squeezing your buttocks or thighs during the pelvic floor work and check your shoulders and forehead don’t scrunch up as you concentrate. It’s fine if the lower belly draws back a little while you squeeze. Putting a small smile on your face may help you create a positive and relaxed experience.
It’s a good idea to check that you can feel the difference between the 3 different areas you are trying to control.
Start off with the back section first, towards the tailbone. Squeeze your anus as though trying to hold back wind (check the buttocks don’t squeeze at the same time). It’s very difficult to completely isolate all the areas so expect them all to join in to some degree. You are just making sure you have consciously control of each section.
Next the middle section. Either by inserting your fingers or imagining you are squeezing on a tampon, squeeze the vagina. This is a deep squeeze moving all the way up to the neck of the womb. Some women find sucking their thumb at the same time helps to lift this area.
Lastly squeeze the front section by imagining you are trying to stop yourself from doing a pee. If you notice it’s particularly difficult to get access to any one area then spend longer on that section until your control improves.
Stay connected to your breathing throughout. Don’t feel you have to do all the exercises below in one sitting, they are just there for some variety but it is important to always do a combination of both the quick and slow exercises as they both work different muscles fibres.
Exercise 1 - Quick squeezes
Take a couple of nice deep breaths relaxing your face and your shoulders. Put a small smile on your face to keep things light. Just keep breathing easily and normally.
If you are pregnant you do the squeeze with the inhale. Otherwise you squeeze with the exhale. All the directions that follow are for pregnancy.
With your next inhale squeeze your anal sphincter, vagina and urethra, hold for 2 seconds then release quickly. You are gathering IN AND UP like pulling up purse strings. Rest for a couple of seconds then repeat until you tire. Its a quick on / quick off action. You will most likely find that you will be able to increase your reps at first but that may get more difficult in the last few weeks of your pregnancy.
Excercise 2 - Slow squeezes
The breathing in the slow squeezes is different to the Quick Squeezes.
Take a couple of deep breaths relaxing your face and your shoulders and remember your little smile!
As you inhale through your nose lift all sections of your pelvic floor slowly for a count of 4. Remember you are pulling IN AND UP. Hold the squeeze for a count of 4 breaths (it’s important to not hold your breath while pregnant.) Then with your next exhale through your mouth through softly pursed lips, SLOWLY release. This part is DOWN AND OUTWARDS. Pause for a couple of moments and then repeat until you tire, aiming for about 5 repetitions in a row. The quality of your squeeze is more important than the quantity.
From 36 weeks try a longer release, so squeeze and hold for 4 then release for 6 or 8 so you are getting used to the sensation of letting go. Please note you are NOT bearing down at this point, just releasing effort, moving DOWN AND OUT.
Exercise 3 - The Elevator
Just for variety, this is a staggered squeeze up, with a staggered breath in and then a slow release down and out.
Inhale and exhale deeply a couple of times. Then begin at the end of an exhale when your pelvic floor is nice and soft. Then as you breathe in to one third of your capacity, squeeze up your pelvic floor to one third of your full strength - so landing on the first floor in your pelvic elevator. Pause for just a moment, then repeat to two thirds of breath and lift to the second floor, pause and then repeat to the top. Hold for 2 seconds then SLOWLY blowing the breath out through softly pursed lips SLOWLY release the pelvic floor in one smooth decent. Rest for a few seconds then repeat twice more.
This is a really good exercise for increasing your lung capacity. If you get dizzy doing this one then only repeat it once or miss it out.
Exercise 4 - The Zip
Starting off at the end of an exhale when your pelvic floor is soft. Then as you start to inhale begin to squeeze around your tail bone and ‘zip up’ all the way through your vagina and finish on the pubic bone. Pause for a moment at the top of your inhale then SLOWLY breath out through softly pursed lips as you unzip from the pubic bone to the tail bone. Repeat up to 5 times.
Additional references:
The Forth Trimester- Kimberly Ann Johnson 2017
Preparing for Birth With Yoga - Janet Balaskas 1994
Yoga For Pregnancy - Francoise Barbira Freedman and Doriel Hall 2001
NHS UK - https://www.nhs.uk/Planners/pregnancycareplanner/Documents/BandBF_pelvic_floor_women.pdf