Overview

The pelvic floor is a group of muscles that hold up your organs and the structures inside your lower abdomen. It is like a taut hammock serving as support for various organs, and, like any muscle, can be contracted and relaxed. A healthy person should be able to command those movements voluntarily. It is common for these muscles to lose strength if they are not consistently activated. A weak pelvic floor becomes troublesome, especially in the presence of health issues related to the bladder, bowel, rectum, urethra and reproductive organs. Pelvic floor therapy is a set of exercises that focus on improving the function of the pelvic organs, muscles, tissues and ligaments. Consistently and correctly exercising these muscles can bring various health benefits to the nearby organs. Depending on the situation, pelvic floor therapy can be recommended as both treatment and/or precaution for conditions like cystitis, pregnancy or postpartum, surgery, age-related issues, and more. 

Anatomy of the pelvic floor

The pelvic region connects the upper part of the body to the lower. It is a musculoskeletal structure supplied by nerves and blood vessels. One of the main components of the pelvis is the pelvic floor, a muscular membrane with a net of thick muscles attached by ligaments to the nearby bones. It holds the organs in place and prevents their contents from falling out; for example, it allows for the controlled retention and expulsion of urine and stool.

Muscles involved

There are two main sets of muscles that make up the pelvic floor: 

• Ccoccygeus: also known as ischiococcygeus elevator ani: composed of the puborectalis, pubococcyx, and iliococcygeus muscles

To perform a supportive role, these muscles are coordinated in contraction and relaxation. They most commonly support organs by being involuntarily contracted at rest. But actions that recruit abdominal muscles, such as sneezing, coughing, throwing up, or lifting heavy weights, for example, can also cause the pelvic floor muscles to contract. They can be briefly relaxed during urination or defecation.¹

Main functions of the pelvic floor muscles

• Support the pelvic organs: uterus, bladder, urethra, intestines, rectum, anus, prostate
• Prevent the organs from being pushed through the pelvic bones when there is increased abdominal pressure, such as when sneezing or lifting weights
• Control urinary and bowel continence
• Contribute to sexual health
• Support for childbirth

Pelvic floor issues

It is common to have problems with being able to coordinate the contraction and relaxation of the pelvic floor muscles. Such dysfunctions may cause a wide variety of symptoms that can range from mild to severe.

Common symptoms

• Urinary and/or bowel incontinence
• Pelvic or low back pain
• Constant feeling of a full bladder
• Needing to strain to evacuate
• Not feeling fully evacuated after urination or defecation
• Constipation

Common causes

• Pregnancy and/or Postpartum
• Surgery
• Aging
• Heavy lifting
• Pelvic organ prolapse
• Chronic coughing
• Emotional disorders
• Traumatic injuries in the region

Benefits of pelvic floor physical therapy

• Improved muscle strength and control
• Pain relief
• Enhanced bladder and bowel function
• Improved sexual function

Types of pelvic floor physical therapy exercises

The exercises are simple and easy to reproduce, but before starting, you should pay attention to identifying the right muscles to activate. Pelvic floor exercises can be ineffective if this preparation is skipped. Some practical tips are recommended to get a feel for the right structures that need to be contracted

• Activate the muscles as if trying to avoid flatulence (farting)
• Pretend as if the vagina (if you have one) is tightening around a marble, trying to lift it
• Try stopping the flow of urine whilst urinating

To confirm the right muscles are being recruited, you should feel them more towards the back than in the front of the pelvic area. Getting used to these movements helps build the body’s awareness of them and understanding of how it feels to correctly perform pelvic floor exercises. 

Kegel exercises

Kegel exercises aim to improve the symptoms of people suffering from urinary incontinence. 

Step-by-step guide on how to perform kegel exercises for beginners

1. Lay on your back 
2. In preparation, you learned how to feel the pelvic muscles. Now you’ll do the learned movements to activate them. Contract your pelvic muscles for 3 to 5 seconds
3. Relax for 3 to 5 seconds
4. Repeat contracting and relaxing 10 times

Tips

• Kegel exercises should be performed at least 4 times a day, totalling up to 40 repetitions. These repetitions can be spread throughout the day, and the series of 10s doesn’t have to be done all at once
• Keep the rest of the body relaxed while exercising the pelvic muscles
• Gradually increase the time of the exercises until contractions last 10 seconds
• Variations are advised from time to time: quick flicks (short contractions and relax times, around 2 seconds each) or long holds (contractions and relax times longer than usual)
• Don’t make it a habit of doing the Kegel exercises while urinating, the practice of holding the urine stream should work only for you to better identify your pelvic muscles

Squats

Squats are known to work the glute muscles. Glute exercises often recruit pelvic floor muscles too, though, making them a good complement for pelvic floor strengthening exercises.

Step-by-step guide on how to perform squats

1. Standing, place your feet shoulder-width apart. Exhale, activating your core and the pelvic muscles
2. Inhale, relaxing the pelvic muscles, while bending your knees. Lower your hips, your butt should aim for an invisible chair, as if you’re going to sit down 
3. Return to a standing position while exhaling and engaging your pelvic muscles again

Bridge exercise

The bridge exercise is a common practice in yoga or pilates, usually aiming to activate the glutes. While performing it, the pelvic floor muscles are also activated. 

Step-by-step guide on how to perform the bridge

1. Lie on your back
2. Bend your knees while keeping your feet on the ground
3. Keep your hands to your side, palms facing down
4. Raise your hips. Take your bottom off the floor, squeezing it, while still maintaining the foot position
5. Stop lifting your hips before you feel your back arching
6. Hold the position at the top for a breath or 2
7. Slowly return to the positions in step 3
8. Perform it 8 to 12 times

Bird dog exercise

The bird dog exercise focuses on core strength, recruiting pelvic floor muscles as well. 

Step-by-step guide on how to perform the bird dog

1. Kneel down, resting your hands on the floor, in a tabletop position
2. Your knees should be aligned with your hips, while your wrists should be aligned with your shoulders
3. Activating your core and, mindfully, your pelvic floor muscles, extend your right arm in front of you, parallel to the floor. Your right arm should now be aligned with your torso. While your right arm is still up, lift and extend your left leg, also bringing it parallel to the floor and aligned with your torso
4. Hold the position for 3 to 5 breaths
5. Slowly return to the tabletop position
6. Do the same with the left arm and right leg
7. Repeat, alternating sides, around 8 times

Relaxation and stretching exercises

Performing conscious relaxations and stretches is important to achieve a more complete training of your pelvic floor muscles. Breathing and stretching are the main components for relaxing your muscles.

Deep breathing

1. Find a comfortable position that enables you to fully relax your body
2. Inhale while calmly counting to 4. Expand the belly, imagine it being full of air
3. Exhale while calmly counting to 6. Imagine all the air in your belly being gently released
4. Repeat this process 10 times

Happy baby

1. Lie on your back
2. Reach for the back of your knees or your ankles, whichever feels more comfortable according to your flexibility
3. Bend your knees towards your chest while drawing your feet apart
4. Hold this position for up to 30 seconds. You should feel the pelvic floor muscle tension being released
5. Repeat 2 or 3 times

Child’s pose

1. Come onto your hands and knees
2. Your big toes should meet behind you
3. Your knees can be either close together or separated wider than shoulder-width, depending on your flexibility and how it feels more comfortable for you
4. Gently send your hips back, towards your feet
5. Your arms should stretch forward, while you’re facing down to the floor and lower your chest
6. You should feel your inner thighs and pelvic muscles releasing tension

Tips for effective pelvic floor exercise practice

• Kegel Exercises are the foundation for the other strengthening exercises 
• Attention to the proper technique and posture is important
• Breath control is also important, and can help with mindfulness too
• Consistency and frequency: Incorporate these exercises as a daily routine for the highest impact

When to seek professional guidance for pelvic floor therapy

• Persistent pain in the pelvic region
• Difficulty performing daily activities
• Lack of improvement from medication treatment only
• Urinary or bowel incontinence

Summary

The pelvic region is connected to organs like the bladder, bowel, urethra, and rectum. It contains a muscular floor that acts as support for these organs, and its strength can have a great impact on the proper functioning of these organs. Like any muscle, the muscular net that makes up the pelvic floor can contract or relax. These structures can lose strength over time or after issues related to pregnancy, postpartum, surgery, heavy lifting, or traumatic injuries. Good maintenance of the pelvic floor muscles can prevent or improve urinary or bowel control, pelvic pain, local inflammation, organ prolapse and sex life. Pelvic floor therapy can be done at home through easy and mindful steps. The proper movements and muscle recruitment should be done frequently and consistently, becoming a practice incorporated into daily life for maximal effect.