What do these muscles do? 

The pelvic floor muscles help to support the pelvic organs - the bladder, uterus, and the lower part of the bowel. These muscles also support the outlets from these organs, allowing us to control starting, stopping, and slowing the flow of urine, and passing wind (gas) and bowel motions (faeces, stools, poo). The pelvic floor muscles also provide support for the muscles within the vagina which is important for maintaining muscle tone within the vagina. This assists in being able to keep tampons in place and play a part in sexual functioning in women. 

Where are they?

The pelvic floor muscles are a group of muscles that are attached to the pubic bone at the front, sit bones (ischial tuberosities) at each side and the tailbone (coccyx) at the back.

How do you exercise pelvic floor muscles? 

It is best to find a position where you can feel the muscles contract effectively. Often sitting in a firm chair, and leaning slightly forwards or standing up may be suitable. Keep your legs apart to avoid tightening the inner thigh muscles when trying to contract your pelvic floor muscles. It is also important to avoid pulling in your abdominal muscles or holding your breath as this will prevent you from contracting your pelvic floor muscles effectively. 

First tighten the muscles around the back passage (anus) as if to hold in gas, then tighten the muscles around the urethra as if you are stopping the flow of urine. Next use these muscles to try and close off the front passage (vagina). Then gently pull up the muscles inside, hold this muscle contraction for the count of three and then slowly relax. 

Rest for a moment and then repeat seven more times. 

How do I know if the muscles are working properly? 

When in the toilet start passing urine and then try and stop or cut off the flow. This action is performed by your pelvic muscles. Next empty your bladder and then do a pelvic floor muscle contraction. You may find that you now have a better awareness of how this muscle feels when you contract it.This action should not be done every time you go to the toiletand is not a pelvic floor muscle exercise. This action is used only to identify the pelvic floor muscle action. 

How many exercises should I do per day? 

Pelvic floor muscle training to increase muscle strength is more about doing the exercise well rather than doing lots of exercises.

A commonly suggested exercise program is to do two sets of 8-12 contractions, three times per day. Pelvic floor muscle training needs to be adapted to the individual, and can change over time, particularly if the muscles were quite weak before the program commenced. A pelvic floor physiotherapist can prescribe an individualised exercise program that will progressively work to increase muscle strength.

If leakage is occurring with activities such as coughing or sneezing, brace the muscles first. This is done by tightening or contracting the pelvic floor muscles before you cough, lift, sneeze, get out of a chair or do whatever else it is that makes you leak. 

Can the muscles be too strong? 

The muscles in our body work in a reciprocal way. We have muscles that bend our limbs and an opposite group of muscles that straighten them. With our pelvic floor muscles, it is important to be able to contract and relax the muscles. Overly tight pelvic floor muscles can lead to pain. This pain can be made worse by attempting to further strengthen the pelvic floor muscles. A pelvic floor physiotherapist can help to treat pelvic pain resulting from muscle strength imbalances. 

How long does it take for the muscles to get strong? 

This will depend on the strength of the pelvic floor muscles when you commence your strengthening program, however often within the first few weeks after starting an exercise program small changes in muscle strength may be noticed. 

Nearly 50% of women are not able to contract their pelvic floor muscles effectively after reading information on how to do the exercises. It may be difficult to contract pelvic floor muscles that are weakened due to damage or injury to the pelvic nerves following childbirth or pelvic surgery. Regaining muscle strength in these situations can be affected by the length of time taken for damaged nerves to heal. 

If you are unsure if the muscles are working properly it is often very helpful to have an assessment and receive professional advice from a pelvic floor physiotherapist. 

What else helps? 

In addition to training the pelvic floor muscles it is important to address factors that can strain and potentially weaken your pelvic floor muscles. 

These factors can assist in addressing pelvic floor muscle problems:

• quitting smoking to reduce coughing
• addressing constipation to avoid straining on the toilet 
• bracing the pelvic floor muscles before lifting something heavy
• aiming to achieve a body weight within the healthy weight range 
• seeking professional advice from a pelvic floor physiotherapist