Pelvic Floor Health
6 weeks to a stronger pelvic floor
What is the pelvic floor?
Every woman (and man) has a pelvic floor. It is a group of muscles and connective tissue that sit inside the pelvic cavity. These layers stretch like a hammock from the pubic bone at the front to the coccyx (tailbone) at the back. The pelvic floor muscles are normally firm and thick.
Pelvic Floor Functions
The pelvic floor has many functions, all equally important and vital to overall health. These include:
Constricting the urethra, vagina, and anal canal which helps with good bladder and bowel control.
Provide support for all internal organs. To state it literally, the pelvic floor helps keep your internal organs inside your body, primarily the bladder and anus.
The PF is part of the deep stabilizing system, including the diaphragm, multifidus, and transversus abdominis. Research shows that the multifidus and transversus abdominis are active in nearly all movements.
They respond to breathing and changes in intra-abdominal pressure, meaning your breathing pattern affects the relaxation of your PF.
Healthy pelvic floor muscles allow for stronger, longer-lasting orgasms, and weakened pelvic floor muscles may impair an individual’s ability to achieve orgasm or experience the same quality of orgasm as they did previously.
Incontinence
Incontinence is the accidental or involuntary loss of urine (urinary incontinence) or faeces (faecal incontinence). If you've ever experienced incontinence then you have experienced first-hand how incredibly important pelvic floor health is.
Many women (and men) tend to feel shame or embarrassment for their experiences of incontinence which in turn prevents them from asking for help. Or often-times many people tend to think it's a normal symptom during pregnancy, post pregnancy, or aging.
Common? YES.
Normal? NO.
Other reasons for not addressing this prevalent issue include:
Belief that surgery is the only answer.
Fear that it's her/his fault due to mis-care of their body.
Fear of being judged.
Prolapse
Pelvic organ prolapse is when 1 or more of the organs in the pelvis slips down from the normal position and bulge into the vagina or anal canal. The connective tissue that support these organs is insufficient and possibly weakened.
The different types of prolapse include:
Cystocele - prolapsed bladder
Uterine Prolapse - prolapsed uterus
Rectocoele - prolapsed rectum
To identify prolapse of either type, a health professional will ask if you’ve experienced seeing or feeling a bulge in the vagina. Consult your doctor (OBGYN or Pelvic Health Physical Therapist) if you believe you may have prolapse.
Symptoms of Pelvic Floor Dysfunction
Research has shown that pelvic floor contractions, also known as kegels, are beneficial to those who are symptomatic of pelvic floor dysfunction but also in preventing PF dysfunction. Incontinence is not the only sign of PF dysfunction. Other symptoms include:
Increased frequency of urination (8+ times per day not due to increased fluid intake.)
Pain with intercourse or penetration.
Feeling heaviness in the perineum (the area between the anus and genitals - extending either from the vaginal opening to the anus or from the scrotum to the anus.)
Feeling unable to fully and/or easily empty the bladder and/or bowel.
Difficulty inserting a tampon.
Now that you have more understanding of the importance of a healthy pelvic floor, a clear image of the pelvic floor and how supportive it is for the bladder, uterus, and rectum, and awareness to symptoms of pelvic floor dysfunction, let's get into HOW you can strengthen your pelvic floor.
Pelvic Floor Strengthening
*Disclaimer: If you have experienced incontinence of any kind, consult your doctor, OBGYN, or Pelvic Health Physical Therapist prior to starting a pelvic floor program. Kegels may not be effective for everyone. Those with a tight or overactive pelvic floor will benefit from relaxing and releasing the muscles, not contracting them. The ability to relax the pelvic floor is equally important as the ability to tighten it.
Kegels
kegels: isolated exercises for the pelvic floor muscles
So you can tighten your vagina muscles and that's a kegel, right?
Almost.
Kegels involve more than just tightening the vagina and releasing it. Reminder: connecting your breathing pattern with the movement and the ability to relax the PF is equally important as the ability to tighten it.
Next up: Learn all the steps to complete kegels correctly for optimal repetitions and results.
Follow the Steps
Step #1: Let's start with alignment and its importance to the overall benefit of a kegel. Alignment is how the joints and bones stack up to create your posture. The top of the pelvis shouldn't be tilted too far forward, nor should it be tilted too far back. For optimal pelvic floor contractions, you will want to get your rib cage stacked right in the middle with the rib cage sitting directly on top of the pelvis.
Follow these tips to get into proper alignment:
Create a tall upper body, imagining the crown of your head is being pulled by a string directly above you pulling you toward the ceiling.
Allow a gentle, natural arch of the back as the spine naturally curves. (If you have a more prominent arch, try tucking your ribs to your pelvis slightly.)
Stack your rib cage directly over your pelvis, preventing the ribs from flaring outward.
Step #2: Certainly you already know how to breathe, but this next step will teach you how to do so with your kegel exercises. This will be referred to as the Connection Breath
While in proper alignment from Step #1:
Sit tall on a chair, again stacking your ribs on top of your pelvis and pull the flesh away from your sit bones so that you feel your sit bones on the hard surface.
Place one hand on your abdomen and the other hand on your rib cage.
On the inhale breath, breathe into your hands imagining that you are inflating your pelvic floor with air, taking note of how the PF is deflating downward.
On the exhale breath, note your hands descend as the rib cage and pelvic floor deflate imagining the pelvic floor deflating upward.
*Note: Step #3 & 4 can take multiple repetitions before being able to FEEL the pelvic floor deflate downward on the inhale and upward on the exhale. Take your time with these steps.
Step #3: Time to kegel! Steps 1 and 2 will help you connect your pelvic floor to your core for optimal kegels. For many people, the breathing pattern is backward of what they would assume, so pay close attention.
On the inhale breath - imagine you are inflating or expanding your pelvic floor as if filling your vagina with air.
Inhale = Relax the muscles
On the exhale breath - release the air from the vagina and imagine you are picking your pelvic floor up.
Exhale = contract the muscles/kegel
The kegel exercise or the tightening of the muscles happens on the exhale breath. This is the connection breath - you are connecting your pelvic floor up through your core to your diaphragm creating the optimal contraction.
Tips to help:
Imagine you have to pee very badly, but aren't near the restroom and have to hold your bladder. Flowing through your breaths: on the inhale, you are at the toilet and can relax the bladder while on the exhale you aren't near the toilet and must hold your bladder full.
Imagine you're about to blow out the candles on your birthday cake, as you breathe in you are relaxing the pelvic floor downward, and as you exhale to blow the candles out, you are contracting the pelvic floor up.
Testing Your Pelvic Floor Strength
It's always a recommendation to consult with your OBGYN or Pelvic Floor Physical Therapist prior to beginning any new program, including a pelvic floor program. Many people are not able to get to a physical therapist or simply don't want to. This next tip will give you helpful and easy at-home tips to test your own pelvic floor strength.
Before beginning your daily pelvic floor exercises, make sure to test your pelvic floor function for a baseline so you are able to track the progress you make over the coming weeks/months.
Here are a few quick ways to test your pelvic floor:
Insert 1 finger into your vagina, about 3/4 of the way in while standing in the shower. Focus on contracting your pelvic floor muscles together. You should feel a squeeze around your finger.
Sit on your hand so you can feel the pressure of the perineum on your hand. When you complete a pelvic floor contraction you should feel the perineum lift up and away from your hand. Then as you relax the muscles you should feel the perineum return back to your hand.
Where to begin with your pelvic floor strengthening program
First, it is important to have an understanding of what the pelvic floor muscles are, why they are important and signs of dysfunction.
Next, it is important to practice the connection breath and relaxation of the pelvic floor. Once you feel as though you have good ability to relax the pelvic floor and perform the connection breath, the next step is to add the kegel or pelvic floor contractions.
Follow the weekly guides with pictures and links to video explanations (below). You will be able to print tracking sheets for each week's exercises and recommended sets/reps for that week.
Remember that these exercises, when done consistently and over time, have the ability to strengthen your pelvic floor muscles and decrease occurrences of incontinence or signs/symptoms of pelvic floor dysfunction.
[Again, it is highly recommended to consult your OBGYN or a Pelvic Floor Physical Therapist prior to beginning any pelvic floor program.]
Week 1
In the first week, you will practice proper alignment and connection breathing exercises. It is equally important to be able to relax your pelvic floor as it is to contract it.
Use the tracker form (linked at bottom) to track your progress over these first 7 days. The focus here is to create the habit of taking time to complete your pelvic floor exercises while learning how to incorporate the connect breath for optimal relaxation and contraction.
2 sets of 8 reps - 2-3 X daily
Watch week 1 video below
Week 2
In the second week, you will take time to practice pelvic floor contractions with the connection breath. Use the tracker form (linked at bottom) to track your progress over these next 7 days. Keep in mind the relaxation portion of the kegel is equally as important as the contraction.
Inhale = relax the pelvic floor
Exhale = contract the muscles
2 sets of 8 reps (each exhale rep held for 4-6 seconds - 2-3 X daily
Watch instructional video below
Now that you have more practice and confidence in your ability to relax and contract the pelvic floor with the connection breath, you will incorporate the kegel with another exercise.
Over time you will be able to naturally contract the pelvic floor during other movements as well as exercises within your workout routine. We are going to explore some of the best core strengthening exercises while incorporating the kegel (+ connection breath) in weeks 3-6 and beyond.
Use the tracker form (linked at bottom) to track your completion and progress with the following exercises.
Knee Openings with Kegels
Lying in a neutral position with knees bent, focus on relaxing your body and muscles prior to beginning.
You will alternate sides with the following repetitions.
One the inhale breath, slowly move one knee outward but make sure to keep your pelvis in neutral position (if you feel your pelvis move, you've opened your knee too far.)
On the exhale breath, move your knee back to the starting position while simultaneously contracting your pelvic floor muscles for the entire exhale (up to 6 seconds).
Make sure to relax all muscles between each repetition.
2 sets of 8 reps - 2-3 X daily
Glute Bridges with Kegels
Lying in a neutral position with knees bent, arms at sides with palms face up, focus on relaxing your body and muscles prior to beginning.
Inhale to prepare, relaxing the pelvic floor muscles.
On the exhale breath, curl your tailbone off the floor as you squeeze your glutes and drive your hips up while simultaneously contracting the pelvic floor muscles.
Lower hips back down to the floor.
Make sure to relax all muscles between each repetition.
2 sets of 8 reps - 2-3 X daily
Deadbugs with Kegels
Lying in neutral position, raise your legs to form a 90 degree angle at the knees (as if your feet were resting on a chair) and reach your arms straight up for the ceiling.
On the inhale, extend the opposite arm and leg out while maintaining the neutral pelvis position with your lower back driven into the floor - relax the pelvic floor muscles.
On the exhale, pull your arm and leg back to the starting position while simultaneously contracting the pelvic floor muscles.
2 sets of 8 reps per side - 2-3 X daily
Alternate sides if desired, but take your time.
Birddogs with Kegels
Start in the tabletop position with your wrists right under your shoulders and your knees right under your hips, maintaining a natural curve in your spine.
On the inhale, extend the opposite arm and leg out, making sure to keep your pelvis in neutral and not shifting your weight - relax the pelvic floor muscles.
On the exhale, return your arm and leg back to the starting position while simultaneously contracting the pelvic floor muscles (see video for a progression).
2 sets of 8 reps per side - 2-3 X daily
Alternate sides if desired, but take your time.
