Key Contributor: Susie Martin, Chartered Physiotherapist
Co-Contributors: Melinda Yaman, Chartered Physiotherapist
Introduction
The pelvic floor is a group of muscles that support the bladder, bowel and, in women, the uterus. These muscles play an important role in continence, sexual function and spinal support. If these muscles are weak or dysfunctional, this can lead to a range of symptoms that can affect daily life.
Pelvic floor dysfunction can occur in both men and women. However, it is more common in women, particularly those who have had children, due to the physical effects of pregnancy and childbirth. In men, pelvic floor dysfunction is most likely following surgery for prostate cancer.
Many women can suffer for years in silence with symptoms of pelvic floor dysfunction simply because there still exists a taboo in talking about pelvic health.
Often, these symptoms can be improved through addressing some simple factors and with exercise, but because of the taboo, it can be hard to find out the right information!
Pilates can be a great tool for addressing aspects of pelvic floor dysfunction. We are passionate about putting the information out there and helping women to improve their quality of life!
Quick Summary
Pelvic floor dysfunction is an extremely common but often overlooked issue that can be greatly improved with the right knowledge and simple exercises. The most common sign of pelvic floor dysfunction is leaking urine, for example when coughing or sneezing, or not being able to make it to the bathroom in time.
What are the signs of pelvic floor dysfunction?
- A feeling of urgency and needing to use the toilet
- Leaking urine when you cough or sneeze
- Difficulty controlling bowel movements
- Discomfort in the pelvic region, including pain during intercourse
- A feeling of heaviness or pressure in the pelvic area, which could be a sign of a pelvic floor prolapse.
Signs you need to strengthen your pelvic floor
It can be difficult to know whether you need to strengthen your pelvic floor or not – but the symptoms above can give you a clue that there is a problem to address.
Not everybody with pelvic floor dysfunction has a weak pelvic floor. Some pelvic floor problems arise because the pelvic floor is overactive and here the key is to work on relaxation of the pelvic floor.
To know for sure, whether you need to strengthen your pelvic floor it is recommended to have an assessment with a pelvic specialist physiotherapist as they can assess the strength and muscle tone of your pelvic floor, through an internal examination.
How to strengthen your pelvic floor with Pilates
You can strengthen your pelvic floor directly with pelvic floor exercises – which are also known as Kegel exercises.
However, because of the anatomy of the pelvic floor, you can also strengthen the pelvic floor more indirectly through other exercises. The Pilates repertoire of exercises contains many that help to promote activity in the pelvic floor.
6 pelvic floor Pilates exercises
Breathing
Did you know that when you breathe, your pelvic floor moves with your breath? When you breathe in, the pelvic floor descends and relaxes. When you breathe out, your pelvic floor slightly contracts and lifts. Many people do not breathe well, so specific breathing practice can help you to slow your breath and get maximum benefit for your pelvic floor.
You can do this in any position, but we recommend practicing in a relaxed position such as lying on your back with your knees bent and feet flat. Place one hand on your stomach and one on your chest. Take a deep breath in, and then allow a full exhale out. Repeat for 4 breaths. As you do this, notice how much each hand moves. If your chest hand is moving as much or more than your belly hand, this may indicate that you are not getting as much breath in as you could. See if you can relax your chest more and try breathing into your belly more. This should not feel forced.
Happy baby
Happy baby pose is a yoga pose which is great for helping relax the pelvic floor. Lie on your back with your legs bent. Lift your legs up, so that your knees are close to your chest. Take hold of the outer edges of your feet, and take the knees wide. Take some deep breaths in and out. With every breath in, try to relax the pelvic floor.
Pelvic Floor Elevator
Try this exercise sitting. A perched sitting position is best, such as on a kitchen stool, as it will give you more proprioceptive feedback for your pelvic floor. Sit at the edge of your seat, with your feet wide and flat on the floor.
Try to visualise your pelvic floor muscles, which run from the pubic bone at the front, to the tailbone at the back. These muscles are used when we need to stop the flow of urine, or when we want to stop ourselves from passing wind.
First try lifting your pelvic floor, as if you were trying to stop yourself from passing urine. Then let go of this feeling. Now try lifting the pelvic floor as if you were trying to stop yourself from passing wind. You should feel this a little further back. Then let go.
Make a note to yourself – did you feel like your buttock muscles were clenching? You should be able to keep the buttocks relaxed during this exercise. Did you feel like you were pushing down onto the pelvic floor as if you were trying to do a poo? This is the opposite of what we are trying to feel, with the pelvic floor exercise. Try again, seeing if you can get a sensation of lifting.
Once you can get this sensation of lifting, we can work on the pelvic floor elevator. Imagine a lift with 3 floors. 0 is the ground floor, where your pelvic floor is relaxed. 3 is all the way at the top where your belly button is. Try drawing your pelvic floor up to number 1, then up to number 2, then up to 3, back to 2 and down to 1 again, then finally relax. Repeat this sequence 5 times.
This is a great exercise for helping you to develop your awareness of your pelvic floor. When practicing pelvic floor exercises we need to be able to work at low levels of effort (for endurance) and high levels (for power). It would be hard to hold the pelvic floor for a long time at level 10 – we need to be able to hold with different levels of effort. We also need to be able to relax the pelvic floor with control.
Deep abdominal draw in
There is some evidence that drawing in the deep abdominal muscles can also engage the pelvic floor. This is due to connective tissue fibres that link the two muscles together.
Lie on your back with your legs bent and feet flat on the floor. In this position gently pull the lower part of your stomach in, as if you were trying to do up the zip on a tight pair of trousers. As you do this movement, you may feel a gentle tightening just at the front of your lower stomach. You should not feel like you are forcing your lower back into the floor. Now see if you can relax the muscles. Now, think back back to your pelvic floor elevator. As well as drawing in the lower part of your stomach see if you can draw the pelvic floor up at the same time. Now relax the muscles.
Inner thigh squeeze
The inner thigh muscles (know as adductors) also have connective tissue in common with the pelvic floor and so when you work on your inner thigh muscles, you also activate the pelvic floor muscles. Lying on your back with your legs bent and your feet flat, place a cushion, folded in two, between your knees.
Gently press your knees together into the cushion. As you do so, try to keep your bottom muscles relaxed. Gradually build up pressure against the cushion until you are pressing with about 50% effort. You should feel your inner thighs working. Hold for 5 seconds and repeat 5 times. Now repeat, but this time, include a pelvic floor lift.
Four point kneeling
It is important to be able to engage your pelvic floor muscles in different positions, as we need them to work during every day functional activities, rather than only train them when lying down. Four point kneeling is a great position because gravity gives us great sensory feedback for the abdominal draw in, and the position of the hips flexed, slightly stretches the pelvic floor which can also give us sensory feedback – you may find it easier to feel your pelvic floor working here.
Get onto all fours on the floor. Your knees should be hip width apart, and your hips over your knees. Your shoulders are over your wrists. Your spine should be in a ‘neutral’ position, with your lower back gently curved in. Press the floor away with your hands, to slightly lift the chest, rather than allowing the chest to sink between the shoulder blades.
In this position, draw the lower stomach in, without losing the arch in your lower back. Simultaneously draw up your pelvic floor. Hold for 5 seconds and then gently release.
Feeling inspired?
If you want to experience the Complete difference and discover the benefits of one-to-one Pilates, book a session at one of our London studios or online today.
Our physiotherapist-led Pilates studios in Chelsea, our Angel Pilates studio and our Pilates studio in City, offer a highly tailored approach to your Pilates training, whether your goal is to manage a health condition, rehabilitate from an injury or to improve your strength and fitness.
Get in touch with us via email or contact us on 0203 764 5668 for further information.
Education is key:
These blogs are designed to give information to everyone, however, it is important to remember that everyone is different! If you have not seen one of our therapists and have any questions about injuries, what you have read or whether this may be useful to you, please just ask. We are more than happy to help anyone and point you in the right direction. Our biggest belief is that education is key. The more you understand about your injury, illness and movement, the more you are likely to improve.
