The importance of the pelvic floor in preventing incontinence

Did you know that 1 in 3 women in the UK will experience urinary incontinence? And 50% of women who have had a baby will have a pelvic organ prolapse?

What is your pelvic floor?

The pelvic floor is made up of muscles, ligaments and fascia, and is the base of your pelvis. Much like a hammock, it spans from your pubic bone at the front, tailbone at the back, and sit bones laterally to support your organs above from below. There are openings for these organs: the urethra from the bladder, the vagina from the uterus, and the anus from the bowels, to pass through the pelvic floor. At each opening there are muscles known as sphincters to control passage of urine, wind and faeces, and to delay emptying until it is convenient. The pelvic floor also plays a role in stabilising the spine along with your other core muscles and has a sexual function.

How is your pelvic floor and it’s strength (or lack of it) connected to your risk of urinary incontinence?

Urinary incontinence due to pelvic floor weakness is called stress incontinence and it is extremely common in the UK. Stress incontinence is when the pelvic floor muscles and fascial support are not strong enough to support against any downward pressure such as coughing, sneezing and running, so an accident may occur.
Some of the common causes of weak pelvic floor muscles are pregnancy and vaginal birth, obesity, chronic constipation (excessive straining whilst opening your bowels), persistent heavy lifting, changes in hormonal levels during menopause, and growing older.

Can improving the strength of your PFM help to reduce your risk of incontinence and other problems such as prolapse?

Yes, improving your pelvic floor muscle strength can help prevent against incontinence and prolapse and it’s never too late to start! The first step is to identify the muscles you need to train and to make sure that you are contracting these muscles correctly.

How often do you need to exercise it?

National guidelines in the UK recommend that pelvic floor muscle training programmes should comprise at least 8 contractions performed 3 times per day. Your pelvic floor muscles are like any other muscle in the body – if you do not train them, they do not remain strong! Therefore, pelvic floor exercises are a lifelong commitment if you wish to keep it them in top shape for the rest of your life.

Could you then recommend three or four simple exercises you can do to strengthen the area – with clear step by step instructions?

Before starting your exercises, I highly recommend downloading Squeezy – an NHS app developed by pelvic health physiotherapists in the UK. It can help remind you to do your pelvic floor exercises and has great information on how to squeeze.

The four exercises below are designed to progressively challenge and strengthen your pelvic floor muscles. Once you feel confident with the first exercise, progress onto the next at your own pace.

Exercise 1: Pelvic floor strengthening in lying

1. Lying on your back with your knees bent or relaxed over a pillow.
2. Close your eyes to bring your attention to your pelvic floor region. Take a few big breaths and make sure you have fully relaxed the whole body and pelvic floor.
3. Now that you have brought your attention to your pelvic floor, tighten around your back passage, vagina and urethra as strong as possible and pull forward in the direction of your pubic bone. Your abdominal, leg and glute muscles should stay completely relaxed whilst you isolate your pelvic floor. Aim to hold this contraction for 5 – 10 seconds. When you relax your muscles you should feel a definite ‘letting go’ as the muscles drop back down. This may take a few seconds to relax fully.
4. Repeat up to ten times or until you feel your pelvic floor muscles fatigue.

Exercise progression 2: Sitting

1. Perform the same exercise above in a seated position. In an upright position you are challenging your pelvic floor further as it needs to lift against the force of gravity.

Exercise progression 3: Sit to stand

1. Begin in an upright seated position, with your pelvic floor muscles completely relaxed.
2. Inhale to prepare, leaning forward in preparation to stand up
3. As you exhale, drive through your heels and activate your pelvic floor muscles to stand up tall.
4. Inhale to return to the seat and relax the pelvic floor muscles
5. Repeat 10 – 20 times or until you feel your pelvic floor muscles fatigue.

Exercise 4: Adding weights

1. In a standing position, hold small weights in your hand, anything from 1-5 kg, with your palms facing ahead of you
2. Inhale to prepare keeping your pelvic floor muscles relaxed
3. As you exhale, keeping your upper arms stationary, lift your pelvic floor muscles as strong as possible and simultaneously curl the weights upwards.
4. Inhale to return the hands and simultaneously relax the pelvic floor muscles.
5. Repeat 10 – 20 times or until you feel your pelvic floor muscles fatigue. Have a rest then repeat for 2 – 3 sets.

How long before you might see some results?

If your technique is incorrect, sometimes just instructing the correct one can have immediate effects! However, for strength gains it takes at least six to eight weeks to notice and feel the difference in your pelvic floor (which is the same for every other muscle in your body!). The NICE guidelines recommend persisting with supervised (Ie: see your Women’s Health Physiotherapist) for at least three months duration for first line treatment of urinary incontinence.

Written by Jessica Kostos, Consultant Pelvic Health Physiotherapist at APPI clinics Wimbledon, London. Instagram: @appiclinics