Who out there knows what I am talking about when I say the phrase “pelvic floor exercises?” In my practice, I find there are a variety of interpretations to the term, and I would like to tell you how I think of them.
Our pelvic floor consists of fourteen small stabilizing muscles that are arranged in three layers and are attached to the bones of the pelvis. Their primary role is to help support the pelvic organs (bladder, rectum, uterus), lend shape and stability to the vaginal walls, and allow us to have conscious control over the urethra and anus. They are also interconnected to the muscles of our spine and abdomen as they form the lower border of the box that is our “core.”
When our pelvic floor muscles are working together with our transverse abdominus, multifidus and diaphragm muscles, the pelvis and spine are well protected during movement. When they are weakened (as can happen after pregnancy, pelvic surgery or trauma), there is a risk of incontinence, prolapse and sexual dysfunction. However; there is a delicate balance between having a healthy, responsive pelvic floor and having one that is over trained and not able to relax. As I like to say, we’re not trying to build a six pack there, we just want your brain to be able to communicate with and control the pelvic floor when you want and need it to. When pelvic floor muscles are over-active, the muscles fatigue quickly when we actually need them to work. This itself can cause incontinence and sexual dysfunction, and can also lead to issues such as pelvic pain, overactive bladder, or constipation.
So how do we strengthen them in the right way so that they are strong enough without being too strong? Easy; by focusing on the four phases of muscle contraction: concentric contraction (when we are tightening a muscle), peak contraction (where we hold for a few breaths to build endurance), eccentric contraction (when we control the relaxation of a contraction), and full relaxation (so that the these muscles are able to move through their entire range of motion). Way back when, Dr. Kegel was on the right track by teaching his brand of pelvic floor strengthening (contract/relax, contract/relax, contract/relax, the end), but I feel it misses out on training all the different muscle fibers and utilizing the entire range of motion. The exercise I give to clients, taught to me by the incredible Paula Jaspar, is called “the Elevator.”
Start by laying on your back with a pillow under your knees for support. Take a few deep abdominal breaths and let your body really relax. Become aware of your pelvic floor and imagine that it is an elevator sitting on the ground floor of a 4 story building. If you are already accustomed to being able to consciously engage your pelvic floor muscles, go ahead and do so just enough so that you are raising the “elevator” to the 1st floor. Make sure you keep breathing naturally, and slowly lift your elevator to the 2nd floor, 3rd floor, then finally the 4th floor. When you have reached the 4th floor, you should be at your peak contraction and hold here for 3 breaths. Instead of letting your elevator plummet right down to the ground floor, gradually let it come back to the 3rd floor, then the 2nd, then the 1st and finally let it relax all the way down to the basement. When done correctly, at the basement you should almost feel a slight sense of bulging of the vagina. Return to the 1st floor and repeat the exercise 4 more times so that you have done a total of 5 repetitions. That’s it, you’re done!
To give your muscles time to recover before strengthening them again, I recommend you wait 24 hours before repeating the exercise. Aim to do the full 5 reps three to four times per week to build strength. When it starts to feel easy for you laying down, it’s time to try doing the exercise while sitting up. When that becomes easy, try doing it standing up. Lastly, when that feels easy, try doing it while squatting or walking. If you can do all 5 reps while walking, then your pelvic floor is as strong as you need it to be and you just need to maintain your strength by doing 5 full reps twice per week.
If you are like many women out there, especially after giving birth when your brain feels so disconnected from your body, you may need to start out just developing consciousness of the pelvic floor area. To re-establish this connection, try stopping the flow of urine once or twice while you are sitting down to pee. Once your brain figures out which muscles to use, go ahead and try the elevator exercise. You should only stop the flow of urine a few times and please don’t attempt to do the elevator while you are peeing as stopping urine flow once it has begun can slightly increase your risk of developing a urinary tract infection (UTI).
My Post Partum Massage page contains addition information about how massage therapy may benefit you. Feel free to contact me, or to book an appointment online so that I can help you achieve your wellness goals!