Pelvic floor training
Although you cannot really see or feel your pelvic floor, you can still learn to move the muscles of the pelvic floor voluntarily, and to strengthen them through training – just as you can with your arm or leg muscles. Pelvic floor training involves both tensing and relaxing these muscles. If you feel unsure about starting out, your physiotherapist can also help you learn how to do the exercises.
What is the pelvic floor?
The pelvic floor is a muscular sheet that closes the pelvic cavity and the pelvic organs from below and is curved upward at the edges. The muscles stretch from the pubic bone at the front back to the sacrum and tailbone at the bottom of the spine, and on the sides the muscles attach to both sitting bones. Openings for the rectum, the urethra and the vagina lead through the muscular sheet.
The muscles of the pelvic floor relax during bowel movements and while urinating. This also happens in women during sexual intercourse and when giving birth. The perineum is part of the pelvic floor too. It is located between the scrotum and the anus in men, and between the vagina and the anus in women.
What does the pelvic floor do?
A strong and healthy pelvic floor is important for your health because it
- offers support for the abdominal and pelvic organs,
- supports the sphincter in the urethra and anus, and
- withstands the high pressure that results from, for example, coughing and laughing, straining during a bowel movement, and physical exertion – for instance when lifting heavy objects.
When does it make sense to do pelvic floor exercises?
Having poor posture, being overweight and sitting too much can take a toll on the pelvic floor and weaken it over time. For women, the muscles are also strained by pregnancy and birth.
Pelvic floor training can be particularly helpful for people who
- have a weak bladder
- have weak bowel muscles
- are overweight
- have problems with their posture
And, for women:
- before and after giving birth
- who have weak connective tissue caused by hormonal changes during menopause
- who have uterine prolapse
- who have had surgery in the pelvic area
And, for men:
- after surgery on the prostate
- who have potency problems
Breathing technique is very important during pelvic floor exercises because the diaphragm and the pelvic floor are closely connected to each other:
- When inhaling, the diaphragm falls and the abdominal organs are pushed down. This causes the pelvic floor to stretch out and sink downward.
- When exhaling, the diaphragm rises again, the pelvic floor muscles contract, and the pelvic floor rises again.
It is important that breathing and the movement of the diaphragm are coordinated so that the pelvic floor muscles can contract powerfully, as well as relax enough.
These exercises can help you become more aware of your breathing:
- Lie down on your back so that you are comfortable. Place your legs slightly apart with your knees bent, and rest one hand lightly on your stomach. Breathe in and out steadily. When you breathe in your stomach rises slightly, and when you breathe out your stomach falls again.
- Imagine that there is a balloon inside your belly: when you breathe in the balloon fills with air and expands in all directions, and your pelvic floor sinks. When you breathe out the air escapes from the balloon and your belly contracts while your pelvic floor rises again.
Becoming aware of your pelvic floor
Many people have difficulties with pelvic floor exercises at first because they involve muscles inside of our body that you cannot see. That is why it is important to be able to feel the muscles first in order to be able to train the pelvic floor. The following exercises can help:
- When you clench the muscle at the end of your urethra, as if you were trying to interrupt the flow of urine, you automatically tense other muscles as well: the muscles of the pelvic floor. You should not do this exercise regularly, though; it is just a way to get a feel for your pelvic floor muscles.
- You can also feel tensed pelvic floor muscles on your perineum. When lying comfortably on their back, men can feel the perineum between the scrotum and anus; women feel the tension on the perineum between the vagina and anus. The pelvic floor is tensed when you try, for instance, to pull your perineum up into your body.
When training the pelvic floor it is important to tense pelvic floor muscles on their own, without the help of the stomach or buttock muscles. This way you can avoid training the “wrong” muscles.
Different pelvic floor exercises for different people
Pelvic floor training involves tensing the pelvic floor, holding the tensed muscles for a certain amount of time and then relaxing them again. The exercises are usually repeated several times. It is important not to hold your breath while doing the exercises, but to combine the exercises with your breathing.
There are a lot of different types of exercises for training the pelvic floor. It can be strengthened just as well while standing as while sitting or lying. You can consult your doctor or physiotherapist to find out which exercises are best suited for you. Adult education centers, midwife practices and many other institutions also offer courses in pelvic floor training.
Pelvic floor tips in everyday life
Doing pelvic floor exercises can help you to specifically strengthen the muscles in that area. But there are also simple things that you can do in everyday life to avoid straining your pelvic floor muscles too much. The main goal is to avoid putting pressure on your pelvic floor.
If you are lying down and get up while keeping your upper body straight, your stomach muscles tense and this pushes your pelvic floor down. You can reduce the pressure by rolling onto your side first, propping yourself up with your arms, and then getting up.
If your back is not straight, there is less tension in your pelvic floor and the organs in your abdomen are squashed together, so they push down on the pelvic floor. You can stop this from happening by keeping your back straight while sitting and walking.
When lifting objects, there is less strain on your pelvic floor if you bend your knees first and come back up with a straight back, using the strength of your leg muscles, rather than keeping your legs straight and bending forward. It can also help to hold the object close to your body and tense your pelvic floor muscles.
If you hold your breath when lifting heavy objects, the muscles in your back, stomach and pelvic floor cannot work together as well as they could. The muscles work better together if you carry on breathing.
Coughing and sneezing
Coughing or sneezing leads to a sudden increase in pressure in your abdomen. This can put strain on your pelvic floor if your upper body is bent forward. You can reduce the strain by looking up or over your shoulder while coughing or sneezing.
Abdominal exercises like sit-ups put a lot of pressure on your abdomen. This can be a problem if you have a weak bladder, if you are pregnant, or if you have had a baby in the last few months. If any of those apply to you, you can talk to your doctor about perhaps avoiding abdominal exercises for a while, or doing lighter exercises instead.
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Pschyrembel W. Klinisches Wörterbuch. Berlin: De Gruyter; 2014.
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