Pelvic Floors and what to do with them
"I do what with my what?"
Pelvic floor exercises make no sense, I know.
If you want to fix your bingo wings or get big guns you usually have a vague idea about what your arm is and what you do with it. Down below? Bit trickier.
It helps if you understand the anatomy.
Pelvic floor muscles are complicated, there's loads of them and they all kind of look the same, wee gristly slabs of steak. If you are a urogynaecologist you need to know quite a lot about them, but, from a users point of view, the muscles all do the same thing and are all supplied by the same nerve, so let's consider them as a single unit.
Here they are -
The muscles fill in the hole at the bottom of your pelvis, if they weren't there your guts would fall out. And, that's their job - to support the organs which sit in there. Your bladder, bowel, vagina and uterus are all supported by your pelvic floor and the gristle that holds everything in place, your fascia.
Pelvic floor muscles do a couple of things differently from most other muscles.
Think about your bicep muscle - it originates from a tendon in your shoulder and inserts with another one in your elbow, so, if the muscle contracts it pulls the two bones it's joined to and creates movement.
Some pelvic floor muscles attach onto enormous ligaments deep in your pelvis, so if your ligaments change the muscles are affected. Loss of oestrogen at menopause affects all our soft tissue, including our ligaments - and so, as well as the joy of developing wrinkles and downward pointing boobs and bingo wings our sweet chariot can swing a bit low - and that affects the position of the organs your pelvic floor is trying to support.
Bits of pelvic floor muscles are formed into circles to create your sphincters who's job it is to keep your holes shut and keep stuff in, or when they relax, to let stuff out. These muscles are really important for your bowel and bladder function!
Sometimes, say on your birthday, or the weekend, you might like it if the muscles relaxed to allow something into your body cavities. Many women are troubled by pain on penetration, and apart from wreaking havoc in intimate relationships, these symptoms can also present challenges for using tampons, menstrual cups or having medical procedures such as smear.
An orgasm is, in part, a flickering contraction of your pelvic floor muscles - so, if they are not as strong or co ordinated as they could be, well, your sexual function could be a bit "meh" too. I KNOW! This stuff is serious.
There is some evidence that doing your pelvic floor exercises improves your orgasm. We don't have a single great quality study that shows that sorting out your pelvic floor will guarantee you toe curling, blaspheming orgasms - but, there isn't much good quality research into female sexual function at all (which I have opinions about, and that could lead to a whole rant, so, I'll shove my soap box to the side for now...). There is lots of anecdotal evidence; some not-that-well-done studies saying that good pelvic floor contractions are linked with good orgasms; and some quite-well-done studies saying that incontinence is linked with poor sexual function. Perhaps we should do a Citizen Science project and collect our own data?
Although the muscles are called "the pelvic floor" they are not fixed like a floor. They move up and down in time with your diaphragm as you breathe. Not all leaking is caused by weakness, sometimes it is that the muscles are not able to relax or co-ordinate themselves. It can be difficult to tell the difference, so, if you do the exercises and they don't work, or, if you get pelvic pain, pain on penetration or the exercises hurt then stop them and speak to your GP or pelvic physiotherapist.
It's this co-ordination of breath, pressure and pelvic floor muscles that keeps you dry when you laugh, cough, sneeze, run, jump, vomit or shout really loudly, whether that's at the kids, a partner or some random idiot who got in the way of you and your menopausal mood swing today.
These things all generate a downward pressure in your abdomen, your pelvic floor muscles have to kick in to support the neck of your bladder, or you'll pee yourself a little bit. That is called stress incontinence.
We know that pelvic floor exercises work for most women with stress incontinence. Science and stuff says so.
They help with vaginal prolapse too!
Pelvic floor exercises won't fix a prolapse, but, they will maintain it - which is important in the age of the mesh crisis - sadly, some women were injured by implants intended to help, and so that surgery has been suspended in the UK and in many other countries. Therefore, it is important we encourage women to do their pelvic floor exercises in order to manage prolapse conservatively for as long as possible.
Things which will help - don't get constipated (if you repeatedly strain to push out a wee poo you can accidentally push out your fanny too), and be the right weight for your height. Small amounts of weight loss can make big differences to prolapse and leaking symptoms.
You can read more about prolapse here.
PELVIC FLOOR CONTRACTION 101
Remember that the job of your pelvic floor is to #squeezeandlift? Fair enough, they do some other stuff too, like, resist forces from above and below, help with sexual function and what not, but, the thing to focus on here is your bumhole...
Now, think about a fart. Not any fart, this is The World's Worst Fart. This emission is so nasty that your neighbourhood, possibly the entire nation, will talk about for years to come. You are not going to humiliate yourself by letting this abomination out, you are going to squeeze and lift your bumhole tight shut and you are going to keep it tight shut for the rest of your life. Well, ok, for 10 seconds.
There's a couple of important things to remember - don't hold your breath at the same time and pay attention to where you feel the contraction, if you feel it in your butt or thighs you are cheating!
Here we go:
Take a deep breath in, sigh out.
As you sigh out, #squeezeandlift your bumhole. Hold it shut for a count of 10 seconds - but, keep breathing!
The 10 seconds is an aim, don't worry if you can only feel it work for 3 seconds. If you can contract your pelvic floor for 10 seconds there is a reduction in the urge to pee - so, it'll buy you more time if there is a queue for the loo which is longer than you anticipated. So, you are aiming to get to a hold of 10, if you start from a hold of a half a second, just keep going and see if it improves over time.
The long hold won't help if you if you laugh, cough or sneeze - because that needs a short, quick contraction of the muscles to support the neck of your bladder.
Imagine this scenario - you can feel a nasty fart, oh no!
#squeezeandlift your bumhole quick!
Oh, it's ok, it's gone away, so, relax your bumhole.
Oh no, it's back! That's going to be horrible! Squeeze your bumhole!
Oh, no, it's gone away, relax your bumhole...
Do ten in a row and make sure you properly relax the muscles between each one.
You have to do those two exercises three times a day until you are dry, and then once a day, every day until you are dry.
Hold for a count of 10, then 10 quick flicks and do one of those each x3/day -
Which gives us - 10, 10, 3
"We won't pee with a 10, 10, 3"
Well, it's not, actually, no. It's easy to do once you get the hang of it, but, remembering to do it is a challenge!
Follow me on twitter, or insta, and I'll nag you; or download squeezy; or make it a habit - like do them when you brush your teeth, when you are waiting in a queue or someone you live or work with irritates you.
The exercises take a long time to work - you need to do them consistently for 8-12 weeks to see a substantial improvement. If you do them, and they don't help; or if you do them and they hurt, or if you do them and aren't sure about exactly what you are supposed to be feeling, then speak to your GP or refer yourself to a pelvic health physio. If you are in the UK google "incontinence services" or "women's health physiotherapy" with your NHS area and the clinic details will come up.
PLEASE don't put up with it. It takes an average of seven years for women to seek help for stress incontinence. The sooner we can see you the sooner we can stop your bladder from dominating your life.
Here's your sticker for doing your exercises. Well, you got a sticker from the dentist when you were a kid, right?
Remember to follow me on social media so I can nag/gently encourage you to #DoYourPelvicFloorExercises.