What is the Pelvic Floor?

The pelvic floor muscles are located between the tailbone (coccyx) and the pubic bone within the pelvis, and support the bowel and bladder along with the uterus and vagina (in females).
Muscular bands (sphincters) encircle the urethra, vagina and anus as they pass through the pelvic floor. When the pelvic floor muscles are contracted, the internal organs are lifted and the sphincters tighten the openings of the vagina, anus and urethra. Relaxing the pelvic floor allows passage of urine and faeces.
If the muscles are weakened, the internal organs are no longer fully supported and you may not be able to control your urine, faeces or wind.
Common causes of a weakened pelvic floor include pregnancy, childbirth, prostate cancer treatment in males, obesity and the associated straining of chronic constipation.
Pelvic floor exercises are designed to improve muscle tone and prevent the need for corrective surgery.

Symptoms of a weak pelvic floor

The symptoms of a weakened pelvic floor include:
  • leaking small amounts of urine when coughing, sneezing, laughing or running
  • failing to reach the toilet in time
  • uncontrollably breaking wind from either the anus or vagina when bending over or lifting
  • reduced sensation in the vagina
  • tampons that dislodge or fall out
  • a distinct bulge at the vaginal opening
  • a sensation of heaviness in the vagina.

Causes of a weak pelvic floor

The pelvic floor can be weakened in many ways, such as by:
  • supporting the weight of the uterus during pregnancy
  • vaginal childbirth, which may overstretch the muscles
  • the pressure of obesity
  • chronic constipation and associated straining to pass motions
  • constant coughing
  • some forms of surgery that require cutting the muscles (including prostate cancer treatment in males)
  • lower levels of oestrogen after menopause.

Complications of a weakened pelvic floor

  • Weak pelvic floor muscles can also cause sexual difficulties such as reduced vaginal sensation. In severe cases, the internal organs supported by the pelvic floor, including the bladder and uterus, can slide down into the vagina. This is called a prolapse. A distinct bulge in the vagina and deep, persistent vaginal aching are common symptoms.

Familiarising yourself with the pelvic floor

Pelvic floor exercises are designed to strengthen the muscles. Each sphincter (vaginal, urethral, anal) should be exercised, so you need to familiarise yourself with these muscles in order to contract them at will. If the pelvic floor is especially weak, it may be difficult to detect any muscular contractions at first.
Suggestions on identifying your sphincters include:
  • vaginal – insert one or two fingers into your vagina and try to squeeze them
  • urethral – imagine you are passing urine and try stopping the flow in midstream (do not do this while urinating)
  • anal – pretend you are trying to stop yourself from breaking wind and squeeze tightly.

Pelvic floor exercises

You can perform pelvic floor exercises lying down, sitting or standing. Ideally, aim for five or six sessions every day while you are learning the exercises. After you have a good understanding of how to do the exercises, three sessions each day is enough.
Before you start, direct your attention to your pelvic floor muscles. Try to relax your abdominal muscles. Don’t bear down or hold your breath. Gradually squeeze all three sphincters and increase the tension until you have contracted the muscles as hard as you can. Release gently and slowly. Then perform the exercises, which include:
  • Squeeze slowly and hold as strongly as you can for 5 to 10 seconds while breathing normally. Release slowly. Repeat up to 10 times. Relax for 5 to 10 seconds between each one.
  • Perform quick, short, strong squeezes. Repeat 10 times.
  • Remember to squeeze the muscles whenever you clear your throat or cough.
It is important to perform these exercises correctly. You can consult with your doctor, physiotherapist or continence advisor to ensure proper performance. It may take weeks or months before you notice a substantial improvement. In severe cases, pelvic floor exercises aren’t enough to solve the problem and further medical treatment may be needed. Be guided by your healthcare professional.

Reducing symptoms of pelvic floor weakness

You can further improve the strength of your pelvic floor and reduce symptoms of pelvic floor weakness in many ways, including:
  • lose excess body fat
  • prevent constipation by including more fruit, vegetables, fibre and water in your daily diet
  • seek medical attention for a chronic cough.

Where to get help

Reference: https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/pelvic-floor August 2018

Signs of a pelvic floor problem

Common signs that can indicate a pelvic floor problem include:
  • accidentally leaking urine when you exercise, laugh, cough or sneeze
  • needing to get to the toilet in a hurry or not making it there in time
  • constantly needing to go to the toilet
  • finding it difficult to empty your bladder or bowel
  • accidentally losing control of your bladder or bowel
  • accidentally passing wind
  • a prolapse
  • in women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping
  • in men, this may be felt as a bulge in the rectum or a feeling of needing to use their bowels but not actually needing to go
  • pain in your pelvic area, or
  • painful sex.
How do pelvic floor problems occur?
Pelvic floor problems can occur when the pelvic floor muscles are stretched, weakened or too tight.
Some people have weak pelvic floor muscles from an early age, whilst others notice problems after certain life stages such as pregnancy, childbirth or menopause.
Some people have pelvic floor muscles that are too tight and cannot relax. This can be made worse by doing squeezing exercises and overworking the muscles without learning how to relax.
Pelvic floor muscle fitness is affected by a number of things. These include:
  • not keeping them active or over working them
  • being pregnant and having babies
  • a history of back pain
  • ongoing constipation and straining to empty the bowels
  • being overweight, obese or having a body mass index (BMI) over 25
  • heavy lifting (e.g. at work or the gym)
  • a chronic cough or sneeze, including those linked to asthma, smoking or hayfever
  • previous injury to the pelvic region (e.g. a fall, surgery or pelvic radiotherapy), and
  • growing older.
Although it is hidden from view, your pelvic floor muscles can be consciously controlled and therefore trained, much like your arm, leg or abdominal (tummy) muscles. Strengthening your pelvic floor muscles will help you to actively support your bladder and bowel. This improves bladder and bowel control and reduce the likelihood of accidentally leaking from your bladder or bowel Like other muscles in your body, your pelvic floor muscles will become stronger with a regular exercise program. This is important for both men and women.
To learn more about how to find and correctly exercise your pelvic floor muscles, follow the links below:
Seek help
If you experience pelvic floor (or bladder or bowel control) problems it is advisable to see a continence professional to determine the cause of your symptoms and discuss the best treatment and management options to suit your needs. This may include an individually tailored pelvic floor muscle training program to help get you back in control.
You can also call the National Continence Helpline on 1800 33 00 66 for free and confidential information and support.

The Continence Foundation of Australia – Pelvic Floor Safe Exercise App (Free)

The Continence Foundation of Australia has developed a free, safe-exercise app to enable people at risk of pelvic floor dysfunction to continue to exercise without putting additional pressure on their pelvic floor.
The Pelvic Floor First app has three customised workouts for people of all fitness levels and pelvic floor strength. The wide range of exercises have been designed by physiotherapist and fitness leader Lisa Westlake to ensure people enjoy the benefits of a total-body workout that protects their pelvic floor muscles.
App features include:📷
  • Instructional videos and audio for all workouts
  • Detailed pictures and instructions for each exercise
  • Pelvic floor muscle exercise guide
  • Ability to save favourite exercises for personalised workouts
  • Links to useful websites to learn more about your pelvic floor
The free app is based on the Continence Foundation of Australia’s Pelvic Floor First website.
The app is available through Google Play (Android) and through the App Store (iOS – note when searching for the app on an iPad select “iPhone only” from the top of the screen).
To initially download the app from the App Store or Google Play, you will require a wireless internet connection.
Internet connection required. Given the comprehensive nature of the app, with video, audio and photographic instructions, data charges may apply if you view the app online.
You can add the online version to your homescreen by following these steps: 1. visit the online version in your browser. 2. tap the icon at the bottom of your screen with an arrow pointing up out of a box. 3. when the options appear, scroll across and tap ‘add to homescreen’. 4. change shortcut name to ‘pelvic floor first’ and save. 5. your shortcut will appear on the homescreen.