Pelvic Floor Muscle Training for Women

WHAT ARE THE PELVIC FLOOR MUSCLES?

The floor of the pelvis is made up of layers of muscle and other tissues. These layers stretch like a hammock from the tailbone at the back, to the pubic bone at the front.

A woman’s pelvic floor muscles support her bladder, uterus (womb) and bowel (colon). The urethra (urine tube), the vagina, and the rectum (back passage) all pass through the pelvic floor muscles. Pelvic floor muscles help control your bladder and bowel. They may also help sexual function.

It is vital to keep your pelvic floor muscles strong.

Pelvic floor muscles can be made weaker by:

• not keeping them active
• being pregnant 
• giving birth 
• growing older.

SHOULD I DO PELVIC FLOOR MUSCLE TRAINING?

When the pelvic floor muscles have to support heavy loads they may not be strong enough.

Heavy loads press down on the pelvic floor muscles when you:

• are pregnant
• are overweight
• push and strain to use your bowels if you are constipated 
• carry heavy weights
• have a cough that goes on for a long time such as with asthma, bronchitis or a chronic cough.

Women who wet themselves when they cough, sneeze or are active have stress incontinence. They will find pelvic floor muscle training can help improve this problem.

For pregnant women, pelvic floor muscle training will help the body support the growing baby. Pelvic floor muscle training will also reduce the chance of having a bladder or bowel problem after birth. Healthy muscles before the baby is born return to normal more easily after birth.

After the birth of your baby, begin pelvic floor muscle training as soon as you are ready. Always brace your pelvic floor muscles. To brace means to squeeze up your pelvic floor muscles and hold before you cough, sneeze or lift the baby. This is called having ‘the knack’.

As women grow older, the pelvic floor muscles need to stay strong. After menopause, hormone changes can affect bladder control. As well as this, the pelvic floor muscles change and may get weak. A pelvic floor muscle training program can help to lessen the effects of menopause on pelvic organ support and bladder control.

A pelvic floor muscle training program may also help women who have an urgent need to pass urine often.

WHAT ARE MY PELVIC FLOOR MUSCLES?

The first thing to do is to find out which muscles you need to train. Here are two things you can try:

1. Sit or lie down with the muscles of your thighs, buttocks and stomach relaxed. Squeeze the ring of muscle around the anus (back passage) as if you are trying to stop passing wind. Now relax this muscle. Squeeze and let go a couple of times to be sure you have found the right muscles. Remember, do not squeeze your buttocks.
2. Try to stop the stream of urine when sitting on the toilet to empty your bladder. Then start your stream again. You can do this to learn which muscles are the right ones to use — but do this only once a week. Your bladder may not empty the way it should if you stop and start your stream too often. You need active pelvic floor muscles to be able to stop your urine flow.

If you do not feel a distinct ‘squeeze and lift’ of your pelvic floor muscles when you try to squeeze, ask for help from a continence physiotherapist or continence nurse advisor. They will help you to get your pelvic floor muscles working the right way.

Even women with very weak pelvic floor muscles can be helped by pelvic floor muscle training.

HOW DO I DO PELVIC FLOOR MUSCLE TRAINING?

Now that you can feel the pelvic floor muscles working, you can:

• squeeze and draw in the muscles around your anus (back passage) and vagina at the same time. Lift them up inside. Feel a sense of lift each time you squeeze your pelvic floor muscles. Hold them strong and tight as you count to eight. Then, let them go and relax. You should have a distinct feeling of letting go
• repeat the squeeze and lift and letting go. It is best to rest for about eight seconds in between each lift up of the muscles. If you can’t hold for the count of eight, just hold for as long as you can
• repeat this squeeze and lift as many times as you can. Aim to do between eight to twelve squeezes each set
• try to do three sets of eight to twelve squeezes each, with a rest in between. A training program is three sets of up to eight to twelve squeezes
• do your whole training program each day. Try to do sets while lying down, sitting or standing.

While doing pelvic floor muscle training:

• do not hold your breath
• only squeeze and lift
• do not tighten your buttocks 
• keep your thighs relaxed.

DO YOUR PELVIC FLOOR MUSCLE TRAINING THE RIGHT WAY

Fewer strong squeezes are better than a lot of half-hearted ones. Ask for help from your continence physiotherapist or continence nurse advisor if you are not sure you are doing the squeezes right.

Seek help if you do not see a change in your symptoms after three months.

MAKE pelvic fllor muscle TRAINING PART OF YOUR DAILY LIFE

Once you have learnt how to do pelvic floor muscle squeezes, do them often. Every day is best. Give each set of squeezes your full focus. Make a regular time to do your pelvic floor muscle squeezes. This might be after going to the toilet, when having a drink or when lying in bed.

Other things you can do to help your pelvic floor muscles:

• Use ‘the knack’. This is when you brace your pelvic floor muscles by squeezing up and holding each time before you cough, sneeze or lift anything.
• Always share the lifting of heavy loads.
• Eat two pieces of fruit and five serves of vegetables daily.
• Drink fluid every day. Fluid is everything you drink. Fluid includes milk, juice and soup. The best fluid to drink is water.
• Avoid constipation.
• Don’t strain when using your bowels or emptying your bladder.
• If you have hay fever, asthma or bronchitis see your doctor. Your doctor may help to ease sneezing and coughing.
• Keep your weight within the right range for your height and age.

SEEK HELP

You are not alone. Poor bladder and bowel control can be cured or better managed with the right treatment. If you do nothing, it might get worse.

Phone expert advisors on the National Continence Helpline for free:

• advice
• resources
• information about local services.

1800 33 00 66* (8am–8pm Monday to Friday AEST)

To arrange for an interpreter through the Translating and Interpreting Service (TIS National), phone 13 14 50 Monday to Friday and ask for the National Continence Helpline. Information in other languages is also available from continence.org.au/other-languages

For more information: continence.org.au, pelvicfloorfirst.org.au, health.gov.au/bladder-bowel

* Calls from mobiles are charged at applicable rates.