It is estimated that around 30% of women believe they are doing their pelvic floor exercises, when they are in fact actually bearing down or performing valsalva maneuver. This, over a long period of time, may be inching your closer to prolapse, rather than as you imagined, preventing it.
Therefore it is vitally important that pelvic floor exercises are performed correctly otherwise the time and effort will be useless or worse, counter productive!
Here are my top tips for great pelvic floor exercises:
- Posture, posture, posture!
If you do not have neutral spine and good posture, it will be impossible for your pelvic floor to fire correctly or fully. If you are performing your exercises in standing or sitting, ensure that your diaphragm is sitting evenly over your pelvis and your pelvis is untucked, honouring the natural curves of your spine. If you are lying, ensure that your pubic symphasis (the mound at the front between your legs is lined up with your hip crests, creating a level triangle.
Before starting your pelvic floor exercises, do some warm up breathing. Try to breathe deep into your belly, encouraging your ribs to flare. Notice if you are just breathing into the upper of your lungs. Again, you might have better results with some side stretches to release the inter-costal muscles that may be stopping the ribs from moving, as they should. Notice if your breathing affects your pelvic floor. As the lungs fill with air the diaphragm should descend and so too should the pelvic floor. As you exhale, both the pelvic floor should move up together. Notice if you have this symbiotic relationship.
- Over-using the obliques
The obliques are the muscles that we recruit when we want to make our waist smaller. Often fitness instructors will encourage you to switch them on with cues like “pull your belly button to spine” to encourage you to brace your core. Unfortunately, all it does is bear down on the pelvic floor. Imagine a long balloon and if you close your fingers tightly around the middle, the pressure inside the balloon is going to go force the bottom of the balloon to bulge down with gravity. Although we don’t have air inside our tummies, we do have intra-abdominal pressure.
When we activate our obliques while doing a pelvic floor contraction, the downward pressure on our pelvic floor tricks our brain into thinking we are having a strong contraction, where really we are just bearing down, negating our good work. When you perform your pelvic floor exercises, place your hands around your middle and notice if these muscles switch on or not. Sometimes some breathing exercises first and using the visual image of Homer Simpson (who NEVER uses his obliques!!) can help.
3 Steps to successful pelvic floor exercises
- Rest. The resting tone of your pelvic floor is important. Imagine doing a bicep curl starting with the elbow joint at 90 º It would not equate to a very big movement nor an effective bicep curl. And that is the same when we contract our pelvic floor. Make sure you start with your pelvic floor fully relaxed
- Close from back to front. This works best because of the way the fibres of muscle loop around the 3 openings of the anus, vagina and urethra. Start with closing your back passage (like you would to stop breaking wind), then your vagina (imagine squeezing around a penis or finger) and then your urethra (like stopping wee)
- Lift – now lift your pelvic floor, ensuring that your obliques are not switching on and doing so with an exhale can help activate the pelvic floor even more. (Note: you are able to switch on your pelvic floor with both exhale and inhale)
Holding your breath
When you are practicing your pelvic floor exercises in isolation (i.e.: not combining them with any other movement) it does not really matter if you exhale or inhale (though you may feel a greater contraction with an exhale, especially if your posture is lined up) – but often there are so many things to think about – this can be rather advanced. But what is important is that you do not hold your breath. Again this can bear down on your pelvic floor and negate your effort
Long and short holds
Just like any other muscle of the body, the pelvic floor responds best to variety to help increase strength. Practicing both long and short holds is vital for both the sprint (short twitch) and endurance (long twitch) function of the pelvic floor. One helps us to stay continent when we suddenly move, laugh or sneeze and one gives us the time to find a toilet, unbutton our clothes without wetting ourselves. Can you guess which one is for which?
Finally, one last word on pelvic floor exercises. If you have finished reading this article and feel overwhelmed with the instructions – usually just one session with a qualified Women’s Health Physiotherapist (especially if they use Real Time Ultrasound, so you can see the effects) may be all you need to get your pelvic floor contracting as it should. And you confident that you are doing it correctly!
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