What is the pelvic floor and why does it become weak?
The pelvic floor is a complex layer of muscles and ligaments which stretches like a hammock from the pubic bone (at the front) to the tail end of the backbone (the coccyx, see the diagram).
The pelvic floor has several functions:
- It supports your pelvic and abdominal organs, especially when you are standing or straining
- It helps the opening of the bladder to stay closed when you cough, sneeze or strain
- It is used to control leakage of wind or motions from your lower bowel
- It helps to increase sexual awareness by tightening during intercourse
The pelvic floor can become weak because of childbirth, prolonged straining to empty your bowels, lack of exercise and the menopause, or simply as a result of ageing. A weak pelvic floor gives you less control so that you may leak urine when you exercise, cough, lift or sneeze.
How can exercising the pelvic floor muscles help?
Exercising the pelvic floor muscles can strengthen them so that, once again, they provide the support you need. This will improve your bladder control and improve (or even stop) leakage of urine. Like any other muscles in the body, the more you use and exercise them, the stronger they become.
How do I find the pelvic floor muscles?
It is not always easy to identify your pelvic floor muscles. Exercising them should not show at all “on the outside”.
Here is what to do:
Sit comfortably with your knees slightly apart. Imagine that you are trying to stop yourself from passing wind from the bowel. To do this, you must squeeze the muscle around the back passage. Try lifting and squeezing the muscle as if you have wind; you should be able to feel the muscle move and your buttocks or legs should not move at all. You should notice that the skin around your back passage tightens up and creates the sensation of lifting you from your chair.
Imagine that you are sitting on the toilet to pass urine and try to stop yourself from producing a stream of urine. You should be using the same group of muscles that you used before, but you will find this a little more difficult (do not try to stop the urinary stream when you are actually passing water, because this may cause problems with bladder emptying).
Try to tighten the muscles around your back passage and vagina, lifting up inside as if you are trying to stop passing wind and urine at the same time. Try to avoid tensing your abdomen, squeezing your legs together, tightening your buttocks or holding your breath. If you can master this, most of the muscle contraction should be coming from the pelvic floor.
How do I practise the exercises?
You need to develop two types of muscle activity, slow and fast.
To practice slow contractions, do the exercises above and try to hold the pelvic floor tight for up to ten seconds. Rest for four seconds and then repeat the contraction as many times as you can, up to a maximum of ten contractions.
To practice quick contractions, which will protect you against leakage during coughing, laughing or exercise, draw the pelvic floor rapidly upwards and hold this for one second. Repeat up to a maximum of ten times.
Aim to do one set of slow contractions followed by one set of fast contractions six times a day.
This patient information leaflet provides input from specialists, the British Association of Urological Surgeons, the Department of Health and evidence based sources as a supplement to any advice you may already have been given by your GP. Alternative treatments can be discussed in more detail with your Urologist or Specialist Nurse.
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Bladder cancer nurse practitioner (haematuria, chemotherapy and BCG)
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Urology nurse practitioner (stoma care)
Urology nurse practitioner (stone disease)
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