What is your pelvic floor?
“Your pelvic floor is a group of muscles that lie across the bottom of your pelvis, like a hammock. They attach from your tailbone to your pubic bone and to your sits bones along the sides; They are the ‘bottom of your bowl,’ so to speak,” explained Dr. Melissa McElroy PT, DPT, WCS, Clinic Director, of ProRehab Physical Therapy’s Springhurst Clinic. Your pelvic floor has three main functions, and it’s the same for all genders:
- Postural support
- It assists in maintaining continence (preventing leaks) or allowing for evacuation (urinating or having a bowel movement).
- Sexual function
Pelvic Floor Weakness
For two main reasons, your pelvic floor can weaken or develop issues over time. First, like any muscle group, your pelvic floor muscles can weaken and atrophy over time if not allowed to function fully. For your pelvic floor muscles, allowing them to function fully means
- Having proper bowel and bladder habits
- Ensure the muscles get the proper blood flow and oxygen to function optimally by avoiding sitting all day.
- Engaging in physical activities
- Maintaining sexual activity.
Secondly, your pelvic floor might weaken or develop issues because of hormonal depletion in the tissues. “In general, as we age the production of reproductive hormones such as estrogen decreases. There is a significant amount of hormone receptors in the vulvovaginal tissues around your pelvic floor, and if they aren’t stimulated by estrogen, then the tissues can begin to lose their elasticity, their pliability, and their durability, thus creating a potential weakness through an inability to stretch properly,” explained Dr. McElroy. “This is an extremely common occurrence in those in the perimenopause to postmenopausal years, and often the underlying cause of pain with penetrative intercourse and urinary symptoms as we age.”
Pelvic Floor Exercises
“More often than not, belly breathing is the first exercise I will give to my patients,” McElroy says. She explains that pregnancy, trauma and the societal pressure to “suck in” means that most women aren’t breathing all the way into their diaphragms, which must be fixed before moving on to more intensive exercises.
“Proper control starts with proper breathing,” McElroy explains. “Your pelvic floor and your diaphragm should sync and work in the same rhythm. Once this proper function and coordination is restored, then and only then will other exercises to target the pelvic floor really work.” So, we’ll start there.
Belly Breathing
- Your pelvic floor and your diaphragm should sync and work in the same rhythm.
- As you inhale through your nose, your diaphragm should move down into your abdomen, allowing for abdominal expansion (Think: Belly breathing).
- As your abdomen expands, your pelvic floor should elongate to allow pressure change.
- Then, as you exhale, your pelvic floor should recoil a bit, and your diaphragm should return to its resting state, like a piston system.
Once belly breathing has been mastered, you can move on to other exercises.
Fog the Mirror
- Lie on your back with your knees bent and feet flat on the mat.
- Inhale through your nose and “breathe into the belly.”
- Exhale as if you were “fogging a mirror” and gently contract the pelvic floor muscles, like you’re cutting off the urine flow.
- Remember to continue breathing throughout.
- Hold for 5 seconds, working up to 10sec, for 30 reps.
Once confidence is built while lying on your back, progress to sitting, side-lying, quadruped, and standing.
Elevator
To perform this exercise, picture your pelvic floor muscles as an elevator in a three-story building.
- Sit on a therapy ball or desired chair.
- Initiate by taking an inhale with belly expansion,
- As you exhale, slowly lift and activate the pelvic floor slightly to the “1st floor.”
- Then, as you continue to exhale, engage a little more to get to the “2nd floor.”
- Continue to exhale and engage a little more to get to the “3rd floor.”
- Release.
- Perform on repeat for 3 minutes.
“As you progress with this exercise you can work on slowly releasing the muscles to pause ’at each floor’ on the way back down. As you begin lifting/tightening the pelvic floor, this sensation should begin at the front of the vagina, near the clitoris, and then transition to the back of the vagina, or near the vaginal/anal openings. This helps activate both superficial and deeper muscles of the pelvic floor,” explained Dr. McElroy.
Quadrupled Hover
- Inhale, exhale, and engage the pelvic floor.
- Start on your hands and knees directly under your shoulders and hips.
- Keep your back flat as if you were making a box shape with your body.
- Curl your toes under, then inhale, exhale, and engage the pelvic floor as you raise your knees 1 inch off the ground and hold the position.
- Hold for 5 seconds for 10 to 20 reps.
Clamshell
- Lie on your side with your knees bent and head supported.
- Breathe in (deep belly breath) and exhale.
- As you exhale engage the pelvic floor and lift your upper knee without moving your pelvis or lifting the foot.
- Hold for 5 seconds.
- Lower your knee and repeat for 20 reps.
Tip: You can add a resistance band just above the knees to increase the difficulty level of this exercise.
Schedule an Appointment
“Often it’s a big jump to go from getting the breath coordination correct to going to functional tasks, and it may require a few steps in between,” said Dr. McElroy. If you’re currently experiencing any pelvic floor pain or have general questions about the pelvic floor, schedule an appointment with a ProRehab Physical Therapy pelvic floor therapist. To read the full article, please follow this link: Experts Reveal the Pelvic Floor Physical Therapy Exercises That Block Bladder Leaks.