Pelvic floor muscle exercises
Pelvic floor muscle exercises (PFME) aim to strengthen the muscles surrounding the urethra and the external urethral sphincter in order to reduce or prevent urine leakage.
They are performed by both women and men, to attain and maintain urinary and faecal continence.
Pelvic floor muscle contraction raises the urethra towards the symphysis pubis, prevents urethral descent, and improves pelvic organ support. Intensive PFME leads to muscle hypertrophy, increasing external mechanical pressure on the urethra; and reinforcing bladder neck support during increases in abdominal pressure.
To undertake pelvic floor muscle exercises firstly the person must identify their pelvic floor muscles, to learn how to contract and relax them selectively (without increasing intra-abdominal pressure on the bladder or pelvic floor).
Once the person is confident they can successfully identify and contract and relax their pelvic floor muscles, a daily exercise programme is developed. This must be performed regularly over a minimum period of 12 weeks to improve the strength, co-ordination, and endurance of the muscles.
Typically, such a 12 week programme includes sets of 10 ‘sustained’ pelvic floor muscle contractions, each lasting 5 to 10 seconds with a one-to-one relaxation period in between each contraction, followed by 10 ‘fast’ pelvic floor muscles contractions. This ‘set’ should be performed three times daily, with progression to increase duration of sustained contractions (to a maximum of 10 seconds) and number of sets over the training period.
Like all training programmes it takes time to strengthen the pelvic floor muscles and improvement in urinary incontinence seldom occurs before the exercises have been performed consistently over several weeks.
These exercises may be performed while lying down, sitting, or standing.
How to identify your pelvic floor muscles
The best way to teach someone else how to do pelvic floor exercises is to first learn how to do them correctly yourself, then you can use your own expertise to teach others.
Sit comfortably with your knees slightly apart.
Now imagine you are trying to stop yourself passing wind from your bowel by squeezing the muscle around your anus. Try squeezing and lifting the muscle as if you do have wind. You should be able to feel the muscle move. Your buttocks and legs should not move at all.
You should be aware of a sensation around your anus tightening and being pulled up and away from the chair. Really try to feel the squeeze and lift.
When you relax you will feel it go down again.
Now try and imagine that you are sitting on the toilet passing urine. Picture yourself trying to stop the flow of urine. Try doing it while reading this.
You should be using the same group of muscles that you used before but don’t be surprised if you find it harder.
Do not try to stop the flow when you are actually voiding as this may, if repeated, cause problems with proper bladder emptying.
To check you are doing the exercise correctly observe yourself doing it in front of a mirror.
Exercising your pelvic floor muscles should not show on the outside: you should not hold your breath, lift your shoulders, squeeze your legs or tighten your buttocks. You may pull in your tummy slightly but not excessively.
You have to concentrate to exercise your pelvic floor muscles.
To check you are exercising the correct muscle insert one finger into your vagina and try the exercise – you should feel the muscles tighten around your finger and lift up as you contract your pelvic floor.
Some women tend to ‘push down’ or ‘bear down’ rather than pull up. If you find you are doing this try to tighten and pull up.
If you cannot work out how to this yourself you may need to see your GP to request a continence referral to see a specialist nurse or physiotherapist.
Some women have no, or very weak, pelvic floor power and find it difficult to feel their muscles contract. You can try contracting your transverse abdominal muscle, by imagining you are about to pull on tight jeans. This may help you feel your pelvic floor muscles.
If you are still not confident you may need to see your GP to request a continence referral to a specialist nurse or physiotherapist.
Using a mirror to look at your perineum can help - observe what happens to your urethra, vagina and anus when you contract your pelvic floor. Remember from the anatomy session (week 2) that if you have a grade 3 or above pelvic floor contraction you should be able to observe it.
To check you are using the correct muscles stand in front of a mirror with your feet slightly apart and try contracting your pelvic floor muscles, if you are contacting your pelvic floor muscles you should see the base of your penis move nearer your abdomen and your testicles rise.
If you place your fingers on the skin between your penis and anus and contact your pelvic floor muscles you should feel the muscle underneath your fingers tighten and lift.
Also use a mirror to look at your perineum and observe your anus. When you contract your pelvic floor, if you can see your muscles tighten and lift you have a grade 3 or above pelvic floor contraction.
If you cannot feel a contraction or it is weak, try contracting your transverse abdominal muscles. If you are still not confident you may need to see your GP to request a continence referral to see a specialist nurse or physiotherapist.
How to develop your personal pelvic floor muscle exercise programme
This is for both females and males.
When looking at the anatomy of the pelvic floor we looked at the two different muscle fibres within the pelvic floor, the fast-twitch and slow twitch fibres. When exercising the pelvic floor we need to exercise both.
Slow, sustained exercises improve the strength and endurance of your pelvic floor muscles. This allows you to hold the muscle contraction and prevent leakage for long periods of time.
Fast exercises improve the speed and reactivity of your pelvic floor muscles. This allows you to react quickly to contract your muscles and prevent leakage, for example when you sneeze or cough.
Your individualised pelvic floor exercise programme is based on your pelvic floor assessment:
The key is to tighten first and then pull up.
Concentration is required to get the best out of your pelvic floor.
Squeeze and pull up to contract your pelvic floor muscles, hold for a count of ….. (between 1 and 10) seconds. Relax for the same number of seconds as you hold for. Repeat exercises ….. times (2-10 times).
Squeeze and pull up your pelvic floor as fast and as tight as you can and relax straight away. Repeat this ….. times (up to 10)
Aim to repeat both slow and fast contractions ….. times a day (3-5 times)
‘The knack’ is a fast, hard contraction BEFORE your abdominal pressure increases eg before you cough, sneeze, stand up etc.
As part of a pelvic floor muscle exercise programme we teach people to consciously practice ‘the knack’ before they cough, sneeze or stand up . If practised often enough it will become automatic – a habit.
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