The pelvic floor muscles are located between the tailbone (coccyx) and the pubic bone within the pelvis. They support the bowel and bladder (as well as the uterus and vagina in females).
Muscular bands (sphincters) encircle the urethra, vagina and anus as they pass through the pelvic floor. When the pelvic floor muscles are contracted, the internal organs are lifted and the sphincters tighten the openings of the vagina, anus and urethra. Relaxing the pelvic floor can allow for easy passage of urine and faeces. The pelvic floor muscles are very important in sexual function with a relaxation/ contraction combination allowing fun and pleasureable sex.
If your pelvic floor muscles are not functioning well, the internal organs will lack full support. This may stop you from being able to control your urine, faeces or wind.
Common causes of a weakened pelvic floor include pregnancy, childbirth, prostate cancer treatment in males, obesity and the associated straining of chronic constipation.
Pelvic floor exercises are designed to improve your muscle tone. In addition they improve your brain connection to these muscles. Doing these exercises may prevent the need for corrective surgery.
Symptoms of pelvic floor muscle dysfunction
The symptoms of a pelvic floor dysfunction include:
- leaking urine when coughing, sneezing, laughing or running
- failing to reach the toilet in time
- passing wind from either the anus or vagina when bending over or lifting
- reduced sensation in the vagina
- tampons that dislodge or fall out
- a distinct bulge at the vaginal opening
- a sensation of heaviness in the vagina
- a heaviness or dragging in the pelvis or back
- recurrent urinary tract infections, or recurrent thrush
- vulval pain, pain with sex, inability to orgasm.
Causes of pelvic floor muscle dysfunction
The pelvic floor can be weakened by:
- supporting the weight of the uterus during pregnancy
- vaginal childbirth, which may overstretch the muscles
- the pressure of obesity
- chronic constipation and straining to poo
- constant coughing
- some forms of surgery that require cutting the muscles (including prostate cancer treatment in males)
- lower levels of oestrogen after menopause
- pelvic floor muscle tension caused by painful periods, endometriosis.
Complications of pelvic floor muscle dysfunction
Loss of bladder control is a common symptom of a pelvic floor dysfunction. Some people experience anal incontinence, which means they can’t always control the passage of wind (gas) or faeces (poo).
Weak pelvic floor muscles can also cause sexual difficulties such as reduced vaginal sensation. If the muscles are weak but overactive (or working too hard) this can cause painful sex or vulval pain and can also cause reduced bladder control.
In some cases, the internal organs supported by the pelvic floor, including the bladder and uterus, can slide down into the vagina. This is called a prolapse. A distinct bulge in the vagina and deep vaginal aching are common symptoms.
Familiarising yourself with the pelvic floor
Pelvic floor exercises are designed to strengthen the muscles. Each section (vaginal, urethral, anal) can be exercised. You can familiarise yourself with these muscles in order to contract them at will. If the pelvic floor is especially weak, it may be difficult to detect any muscle action at first.
It is very important to feel a full release of the muscles, and these muscles are quite circular - sometimes it is good to imagine the release as being ripples in a pond – feeling the muscles release and open.
To identify your sphincters:
- vaginal – insert one or two fingers into your vagina and try to squeeze them
- urethral – imagine you are passing urine and try stopping the flow in midstream (do not do this while urinating)
- anal – pretend you are trying to stop yourself from passing wind and squeeze tightly.
Pelvic floor exercises
You can do pelvic floor exercises lying down, sitting or standing. Ideally, aim for five or six sessions every day while you are learning the exercises. After you have a good understanding of how to do the exercises, three sessions each day is enough.
Before you start, direct your attention to your pelvic floor muscles. Try to relax your abdominal muscles. Don’t hold your breath. Gradually lift and squeeze your pelvic floor muscles as if you are stopping the flow of urine or stopping wind escaping. Release gently and slowly. Then perform the exercises, which include:
- Squeeze and lift slowly making sure you can release fully each time. When you know you can lift and let go, then try to hold. Hold firmly for 5 building to 10 seconds while breathing normally. Release slowly. Repeat up to 10 times. Relax for 5 to 10 seconds between each one.
- Perform quick, short, strong squeeze and lift. Repeat 10 times. Again, make sure you can release fully each time.
- Remember to squeeze and lift the muscles whenever you clear your throat, sneeze or cough.
It is important to perform these exercises correctly. Check with your pelvic health physiotherapist, doctor or continence advisor to be sure you are doing them properly.
It may take weeks before you notice a substantial improvement, but things should change for the better within 4-5 weeks. If not seek help from a pelvic health physiotherapist or your GP. Your GP can refer you to a pelvic health physiotherapist in your area, these are normal physiotherapists who have had extra training in treating pelvic floor issues and you can see them at the same time as your GP makes a specialist referral.
Rehabilitation of symptoms of pelvic floor dysfunction
You can further improve the strength of your pelvic floor and reduce symptoms of pelvic floor weakness by:
- losing excess body fat
- preventing constipation by including more fruit, vegetables, fibre and water in your daily diet
- seeking medical attention for a chronic cough.
Where to get help