Pelvic Floor 101 - A Beginner's Guide to Pelvic Health
- Amy F
- Apr 27, 2024
- 5 min read
Updated: May 2, 2024
The number of people experiencing pelvic floor related issues is increasing. The latest statistics report that over 14 million adults in the UK have problems with bladder control and 6.5 million have bowel issues. And that’s only the people we know about. Many suffer in silence, too embarrassed to seek the help and support they need. The pelvic floor is an area we often don’t think (or talk) about, until something goes wrong then we realise just how much we take it for granted.
Ready to learn more about your pelvic health? Let’s dive in…
What is the pelvic floor?
The pelvic floor muscle group is a complex hammock-like structure made up of muscles and connective tissues (fascia) arranged in four distinct layers. It’s situated at the base of the pelvis and is attached to the walls of the pelvis from the pubic bone at the front to the coccyx (tail bone) at the back. The pelvic floor muscles work with the other deep abdominal muscles (transverse abdominus, diaphragm and multifidus) to
help stabilise the spine during movement and are often referred to as the foundation of the core.
Here's a link to a video showing how the pelvic floor and diaphragm work together during breathing.
What does the pelvic floor do?
The pelvic floor muscles support the bladder, bowel, and uterus (in women), play an essential role in maintaining continence, increases awareness and sensation during intimacy and contracts to withstand loaded pressure (coughing, sneezing, and jumping). The pelvic floor muscles also work with the diaphragm during breathing, so good posture and correct breathing mechanics are essential for function!
Now that we know where the pelvic floor is and what it does, it’s time to look at what can go wrong…
Pelvic floor dysfunction.
Pelvic floor muscle dysfunction can happen at any stage of life and for all sorts of reasons. Here are some of the main factors that contribute to pelvic floor muscle dysfunction in women:
· Posture
· Poor breathing mechanics
· Age
· Childbirth
· Menopause
· Lifestyle – jobs that require lifting
· Obesity
· Constipation
· Nerve damage
· Hysterectomy
· Lack of abdominal muscle function
· Diastasis recti
· Surgery
· Radiation treatment for certain cancers
· Injury
I remember feeling quite shocked when I saw this list during my Adore Your Floor Coach training with Adore Your Pelvic Floor back in 2018, it really hit home just how important the pelvic floor muscles are.
Here's a link to a video showing how the pelvic floor moves during chest breathing vs diaphragmatic breathing.
So now that we have a better understanding of what can cause pelvic floor muscle dysfunction, here’s a list of some of the common symptoms:
· Stress incontinence (urinary and/or faecal)
· Urgency incontinence (urinary and/or faecal)
· Overactive bladder (urgency resulting in frequent urination)
· Pain during intimacy
· Incomplete emptying (bladder and/or bowel)
· Pressure, heaviness, dragging sensation or bulging in the pelvic area
· Reduced abdominal strength and function
· Diastasis recti (separation of the abdominal muscles)
· Musculoskeletal pain in the pelvis and lower back
If you’re reading this and nodding your head, please, don’t just ignore it. It’s essential that you seek advice, and treatment. Pelvic floor muscle dysfunction rarely goes away on its own, it usually just gets worse over time.
You’ve no doubt heard or seen the adverts for female incontinence products further normalising something that is not normal. These products do have their place in the short-term management of symptoms alongside receiving treatments to restore pelvic floor function, but that’s really all they should be used for. A pad isn’t going to make the problem go away.
Issues with the pelvic floor muscles have been normalised. Sadly, there’s little encouragement to practice good pelvic floor health habits, yet learning how to correctly contract and relax the pelvic floor muscles can help manage or completely restore pelvic health! Which leads us nicely on to how to get started…
Contracting and relaxing the pelvic floor muscles
Research has shown that around 30% of women perform their pelvic floor muscle exercises incorrectly when following written instructions, therefore it’s essential to seek the guidance of a professional with specialist training in pelvic floor muscle awareness. To help you get started, here are some tips for correctly engaging and relaxing the pelvic floor muscles:
1. The pelvic floor muscles and diaphragm work together during breathing. Good breathing technique is essential, and this is the most important place to start! With chest and shoulders relaxed, place one hand on the side of the ribcage and the other hand on the abdomen below the belly button.
When you inhale you should feel the abdomen and ribcage expand and push slightly against the hands. The diaphragm contracts and the pelvic floor muscles relax.
When you exhale, you should feel the ribcage and abdomen contract and draw back from the hands. The diaphragm relaxes and the pelvic floor muscles contract. The pelvic floor muscles should be working in synchrony with the diaphragm during each breath. In general, you should try to exhale on exertion to protect the pelvic floor muscles during exercise.
2. The pelvic floor is made up of 3 areas, the back, (lower bowel and anus), the middle (vagina and perineum) and the front (bladder and urethra). It’s important to contract and relax all 3 areas. To contract the pelvic floor muscles, gently lift and squeeze all 3 areas whilst continuing to breathe normally, then release and lower the pelvic floor muscles with control.
Because the pelvic floor muscles are not visible, closing your eyes and visualising the pelvic floor muscles whilst you’re doing this can really help with ‘feeling’ what’s going on. The brain recruits the muscles it thinks it needs, so it’s important to pay attention to other muscles, such as those in the thighs and buttocks, to ensure they don’t ‘help’ to bring about a pelvic floor muscle contraction.
3. All muscles have two types of fibres, slow twitch for endurance and fast twitch for power. Around 70% of muscle fibres in the pelvic floor muscles are slow twitch, to provide continuous support for the pelvic organs. It’s important to train both the fast and slow twitch fibres, aiming for 3 sets of 10 repetitions daily for each. It’s better to do a few good contractions rather than several poorly executed ones, so start slowly and build up the repetitions and sets gradually over time as pelvic floor muscle strength and endurance increase.
Here's a link to a video of an ultrasound showing how to do a pelvic floor contraction correctly.
It’s fine to do each set at a different time of day, for example, morning, afternoon, and evening. Remember, it can take up to 16 weeks to achieve a significant improvement, so keep going!
Consistency is key, so find a time of day that works for you and stick with it. Morning is ideal, and the preferred time because the pelvic floor muscles are rested, and at their strongest. If you’re having problems remembering, the Squeezy App is a great place to start and was created by a leading WHP, Myra Robson, in the UK.
I hope that this blog has helped you understand more about the pelvic floor, and why it’s so important to look after it. If you’re struggling with any of the issues highlighted in this blog or have any questions, please reach out, I would love to help you get back on track with your pelvic health.
About Amy
Amy is a holistic therapist with training in meditation, Pilates, and pre and postnatal fitness. She has been a passionate advocate of women’s pelvic health since 2018, following her own struggles after the birth of her daughter.
She also offers the fully accredited and endorsed Adore Your Floor Programme to women on a 1:1 basis, either in-person or online. You can find more information about the programme here.
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