It’s interesting how many patients have come to me recently saying: “Oh I read that we are NOT supposed to be doing pelvic floor exercises,” or “I heard that pelvic floor exercises do not work.” So let’s take a deeper look at why this is the new narrative.
What are Pelvic Floor Exercises?
If you are familiar with this topic, feel free to skip this section, but for those of you who aren’t: let’s quickly discuss it.
The pelvic floor is a very interesting concept that is often confused with the core. Though these two systems work synergistically, they are two independent entities and can be trained as such. The pelvic floor muscles refer to a collection of small, intricate muscles that line the base of the pelvis – everything from the pubic bone, downwards through the saddle area and to the tailbone and base of the pelvis. It is essentially the ‘floor’ of our abdomen, which is where the name comes from. Like most muscles from the core, including our diaphragm (which, for interest’s sake, is the ceiling of the abdomen) these muscles are under involuntary control. This means that your body can decide to use it automatically without you even realizing that it is working. You don’t consciously move your diaphragm for every breath you take, do you? Though you could if you wanted to! That is exactly how the PFM works as well. They are working constantly, but if you wanted to use them intentionally, you could. What makes this difficult is that we are not used to doing so, but with the help of a good Pilates teacher or Physio, you can learn to control it if you want to.
Incontinence, pregnancy, and sexual function
Why are Pelvic Floor Exercises always the first thing that comes up when we do a Google search for these topics? (Ok, maybe not that last one!) The PFM plays a big role here because when it comes to what happens inside the pelvis, this is the only part we can control. As if it wasn’t complicated enough, the pelvic floor also has a very intricate feature: it has three holes/openings right in the middle of it (although, only two for males). These holes in the pelvic floor are what allow for the urethra (through which we urinate), the vagina, and the anus to find their openings.
The fibers of the pelvic floor muscles are arranged around these openings in such a way as to allow them to function as valves that can open and close these openings. Do you know how you can hold it even when you desperately need to pee? It is the pelvic floor that does that for you. So evidently, when you cannot hold it when you need to – perhaps it is because your pelvic floor is not doing its work properly! Also, to say it
without actually saying it: a strong Pelvic Floor contraction can tighten any opening in the pelvis…(insert suggestive emoji here).
When it comes to pregnancy, there are two reasons why the pelvic floor takes strain here. Firstly, as the baby grows, the weight is carried mostly by the pelvic floor which is essentially working very hard for a long period. If you were to have a natural vaginal delivery, these muscles must be able to stretch a lot to allow for the baby to move through it. Basically, after pregnancy and delivery, that pelvic floor is tired and stretched! Though this is exactly what it was designed to do, there is a little bit of help we can provide to get it happy again.
Stress Urinary Incontinence and the PFM
Stress Urinary Incontinence is when you leak a bit of urine when you cough, sneeze, laugh, run, or jump (or any form of strenuous movement). The reason why this happens is that when we sneeze, for example, the pressure inside our abdomen increases. The responsibility of the PFM here is to contract tightly to close the openings of the urethra, vagina, and anus so that when the pressure inside the abdomen increases, the PFM can resist it and keep everything inside. Think of blowing up a balloon and squeezing the neck shut so that the air stays inside.
Stress Urinary Incontinence is what happens when the PFM does not contract strong enough or early enough to resist the increase in pressure. This is where PFM training comes into play: we can teach you how to make sure that it contracts on time, with enough strength, and for long enough so that this does not happen.
So why would we NOT do Pelvic Floor Exercises?
As with any conversation in our industry, we always go through periods of debate. Currently, the narrative is moving a little more towards: do NOT do pelvic floor exercises, or that they do not work. So let’s discuss why this would be true.
As with any muscle in the body, the PFM can be weak, they can be strong but they can also be tight – and not in a good way. In the same way that after a long day of working in the office, your shoulders can be very tight and sore, your PFM can be too. This is a little harder for us to realize, because some of the symptoms of a tight pelvic floor look very similar to a weak pelvic floor, the primary of which is Stress Urinary Incontinence.
The best example I’ve heard is this: imagine your shoulders are so tight that they are constantly shrugging up toward your ears. Now someone tells you to shrug your shoulders. You can try, but if they are very tight, your shoulders are already sitting at their highest position. No matter how hard you try, you cannot move them more. It is in this way that a tight pelvic floor cannot and will not contract adequately to resist an increase in pressure when you sneeze. You can then do as many pelvic floor exercises
as you want, but the truth is that they will never move (i.e. “you cannot control them”) and they will not resolve the incontinence (i.e. “they will not work”).
Alright, so what do I do then?
This is where professional help comes in. We are in the golden age of booming Women’s Health developments, with new qualified professionals popping up left and right. A Women’s Health therapist or a Pelvic physio will be able to assess for you to determine if your PFM is weak, tight, or unhappy in any way and they will be able to guide you through the process of fixing it.
Sometimes pelvic floor exercises are the answer, sometimes they are not, but there is someone who has the right answer for you.
Quick Tips
Pelvic floor exercises can be done for:
- Women
- Men
- Transgender individuals
- Pregnant patients
- Post-natal patients
- Athletes
- Office workers
- Basically… everyone.
Pelvic floor exercises can help with:
- Stress Urinary Incontinence
- Pelvic organ Prolapse
- Sexual function
- Pregnancy
- Post-natal rehab
- Sports and exercise (eg. Weightlifting or sprinting)
- Pelvic floor dysfunction
- Prevention
