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The pelvic floor is a funnel-shaped musculature structure that spans the bottom of the pelvis and supports the pelvic organs. These organs include the bladder, bowel, and uterus (womb) in women. The pelvic floor muscles help stabilize the core while assisting with essential bodily functions, such as urination, defecation, and sexual function. They can weaken over time due to various factors, including injury, aging, childbirth, and obesity, leading to conditions like incontinence or pelvic organ prolapse. Pelvic floor exercises, also known as Kegels, are commonly recommended to strengthen the pelvic floor muscles and improve muscle tone. These exercises involve squeezing and relaxing the muscles to build control gradually.
| Characteristics | Values |
|---|---|
| Location | The pelvic floor muscles span the bottom of the pelvis, stretching from the pubic bone to the coccyx (tailbone) and from one ischeal tuberosity (sitting bone) to the other. |
| Function | The pelvic floor muscles support the pelvic organs (bladder, bowel, and uterus in women) and help control the release of urine, faeces, and flatus. They also assist with sexual function. |
| Weakening Factors | Pregnancy, childbirth, prostate cancer treatment, obesity, constipation, heavy lifting, high-impact exercise, age, and reduced oestrogen levels can weaken pelvic floor muscles. |
| Treatment | Pelvic floor exercises (Kegels), physical therapy, and medical devices (e.g. vaginal pessary) can help strengthen pelvic floor muscles and improve control. |
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What You'll Learn
Pelvic floor exercises
The pelvic floor muscles are layers of muscle and tissue that stretch from the pubic bone at the front to the tailbone at the back, and from one sitting bone to the other. These muscles can weaken over time due to various factors, including injury, aging, pregnancy, childbirth, obesity, constipation, and surgery. Weak pelvic floor muscles can lead to conditions such as incontinence and pelvic organ prolapse.
To perform pelvic floor exercises, also known as Kegels, you should start by familiarizing yourself with the muscles. You can do this by inserting a finger into your vagina and squeezing the muscles around it. For men, this can also be done by stopping the flow of urine midstream. It is important to ensure a full release of the muscles, which can be imagined as ripples in a pond.
Once you have identified the muscles, the exercises involve routinely squeezing and relaxing them to build control. You can do these exercises in any position, such as lying down, sitting, or standing. Aim for five or six sessions a day when you are first learning the exercises, and then reduce to three sessions a day once you have mastered the technique. Each session should include:
- Squeezing and lifting slowly, ensuring a full release each time.
- Holding the squeeze for 5 to 10 seconds, gradually increasing the duration.
- Releasing slowly.
- Performing quick, short, and strong squeezes and lifts, again ensuring a full release each time.
It is important to remember to perform these exercises correctly and seek guidance from a healthcare professional if needed. It may take several weeks to notice improvements, but consistency is key to achieving optimal results and improving pelvic health.
In addition to Kegels, there are other exercises that can help strengthen the pelvic floor, such as pelvic tilts, bird-dog, bridge pose, and squats.
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Pelvic organ prolapse
The pelvic floor muscles are layers of muscle and other tissues that stretch from the pubic bone to the tailbone and support the pelvic organs. These organs include the bladder, bowel, and uterus in women, and the bladder and bowel in men. Pelvic floor muscles help control essential bodily functions like passing urine, stool, and gas, as well as sexual function.
The symptoms of POP include leaking urine or stool, pain, and a protruding organ from the vagina, which can cause feelings of isolation and embarrassment. Many women do not seek treatment until they experience serious problems with bladder, bowel, or sexual function. However, it is important to note that POP is a common condition, affecting 1 in 4 women in their 40s and 1 in 3 women in their 60s. By the time women reach their 80s, half of them will have POP.
There are several treatment options available for POP, including pelvic floor exercises, medical devices such as vaginal pessaries, physical therapy, and surgery. Pelvic floor exercises, also known as Kegels, involve squeezing and relaxing the pelvic muscles to build control. These exercises can be done lying down, sitting, or standing, and it is recommended to start with 5-6 sessions per day, eventually reducing to 3 sessions per day. It is important to perform these exercises correctly, and guidance from a healthcare provider or pelvic health physiotherapist may be necessary. Medical devices like vaginal pessaries can provide support to the pelvic organs, while physical therapy can help strengthen the pelvic floor muscles and improve their coordination. In more severe cases, surgery may be required to secure the pelvic organs into place or perform an obliterative procedure such as colpocleisis, where the vaginal walls are sewn together to prevent organs from protruding.
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Sexual function
The pelvic floor muscles are a group of muscles stretching from the pubic bone to the tailbone, supporting the pelvic organs. Pelvic floor muscles help stabilise the core while assisting with essential bodily functions, such as urination, defecation, and sexual activity.
The pelvic floor muscles play a crucial role in sexual function for both men and women. In men, these muscles are important for erectile function and ejaculation. Pelvic floor exercises, such as Kegels, can help men improve their sexual pleasure by enhancing erections and ejaculation control.
For women, voluntary contractions or relaxations of the pelvic floor muscles contribute to sexual sensation, arousal, and orgasm intensity. During intercourse, the contraction of these muscles can provide additional pleasure for both partners. Additionally, strong pelvic floor muscles can support the baby during pregnancy and aid in the birthing process.
Weak or tight pelvic floor muscles can lead to painful intercourse and sexual difficulties. Conditions such as vaginismus, where the vaginal muscles remain involuntarily contracted, can be treated through pelvic floor physical therapy.
Kegel exercises are an effective way to strengthen the pelvic floor muscles and improve sexual function. These exercises involve routinely squeezing and relaxing the pelvic muscles to build control. By strengthening these muscles, individuals can enhance their sexual experiences and improve their overall pelvic health.
It is important to note that excessive Kegel exercises or performing them incorrectly can cause the pelvic floor muscles to become overly tight, which may lead to discomfort or pain. Therefore, it is advisable to consult a healthcare professional or pelvic health physiotherapist to ensure proper form and avoid potential issues.
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Urinary incontinence
The pelvic floor muscles are layers of muscle and other tissue that span the bottom of the pelvis. They support the pelvic organs, including the bladder, bowel, and uterus (womb) in women. These muscles help to control the release of urine, faeces, and flatus, and they assist with sexual function.
- Pregnancy and childbirth: Women who have had multiple births, assisted births, or large babies are at a higher risk of pelvic floor muscle damage, which can lead to incontinence.
- Ageing: Pelvic floor muscles can weaken over time due to the normal ageing process, leading to a loss of control over the bladder.
- Obesity: Being overweight can increase the risk of urine leakage and place greater stress on the pelvic floor, causing weakness.
- Constipation: Ongoing or repeated straining on the toilet associated with constipation can weaken pelvic floor muscles and lead to incontinence.
- Surgery: Procedures such as hysterectomy, prostate surgery, or radiotherapy treatment can weaken the pelvic floor muscles and affect bladder control.
- Heavy lifting: Activities that involve heavy lifting, such as certain exercises or work-related tasks, can increase stress on the pelvic floor and potentially lead to incontinence.
- High-impact exercise: Participating in high-impact exercises, where both feet are off the ground at the same time (e.g., running, jumping), can increase the risk of urine leakage, especially for women.
- Coughing: An ongoing cough, due to conditions like asthma or bronchitis, can increase the risk of urinary incontinence.
To manage and treat urinary incontinence, pelvic floor exercises, also known as Kegels, are commonly recommended. These exercises involve routinely squeezing and relaxing the pelvic floor muscles to improve muscle tone and control. Biofeedback, physical therapy, and medications may also be used to treat incontinence and improve pelvic floor muscle function. It is important to consult with a healthcare professional to determine the most appropriate treatment plan for urinary incontinence.
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Constipation
The pelvic floor muscles are layers of muscle and other tissue that stretch from the pubic bone at the front to the tailbone at the back, and from one sitting bone to the other. They support the pelvic organs, such as the bladder and bowel, and the uterus in women. These muscles help control the release of urine, faeces, and flatus, and assist with sexual function.
There are several ways to manage constipation:
- Drink 8 to 10 glasses of decaffeinated fluid each day. Caffeine intake can contribute to dehydration and worsen constipation.
- Follow a regular exercise program. Walking and abdominal exercises can help improve intestinal muscle tone.
- Respond to the urge to have a bowel movement. Relax and let your body take the time it needs. Ignoring the urge could prolong the problem.
- Take a high-fibre supplement if recommended by your doctor.
- Try constipation massage techniques to aid the transit of stool through the colon. A pelvic health physiotherapist can teach you these techniques.
- Biofeedback therapy may be helpful in retraining the pelvic floor muscles to allow for easier passage of stool.
- Stimulant laxatives encourage bowel movements through increased muscle contractions in the intestine. However, they should not be taken for prolonged periods as they can cause cramping, irritation, and rarely, nausea and vomiting.
- Hyperosmotic laxatives work by drawing water into the bowel, softening the stool and sending the signal to empty.
- Enemas fill the colon with fluid, softening the stool and stimulating a bowel movement.
It is important to address the cause of constipation and learn good toilet habits. For example, sitting on a toilet is not the optimal position for opening our bowels. We can recreate squatting, which is the natural position, by using a small step or stool under the feet and leaning forward with arms resting on the thighs. This can help the pelvic floor lengthen and relax.
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Frequently asked questions
The pelvic floor is a funnel-shaped musculature structure. The pelvic floor muscles support the pelvic organs (bladder and bowel, and uterus in women). They help stabilise your core while assisting with essential bodily functions, like pooping, peeing and having sex.
Common signs and symptoms of having weakened pelvic floor muscles include struggling to control when you pee, poop or pass gas (incontinence). Other symptoms include leaking urine when coughing, sneezing, laughing or running.
Common causes of a weakened pelvic floor include pregnancy, childbirth, prostate cancer treatment in males, obesity, heavy lifting, high-impact exercise, and the associated straining of chronic constipation.
Pelvic floor exercises, or Kegels, are commonly used to strengthen pelvic floor muscles. Kegels require routinely squeezing and relaxing your pelvic muscles to slowly build control.
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