How do I do my pelvic floor exercises?
What are the pelvic floor muscles?
By means of a brief refresher, we will gladly talk you through the anatomy of these crucial muscles – this especially helps when it comes to visualisation and activation of the muscles that we will practise shortly.
The pelvic floor muscles, as the name suggests, cover the bottom of our pelvis, almost like a kite shaped hammock. They attach at the front by the pubic bone, at the back by the bottom of the spine and at the sides all the way out by the hip joints. Their four main functions are to:
support our three pelvic joints
support our pelvic organs
keep us continent
provide sexual function.
With that in mind, its safe to say that in order to keep these functions in check, these muscles deserve to be in tip top condition! One way of doing that is by practising regular pelvic floor squeezes.
Who should be doing pelvic floor muscle exercises?
In one word, everyone! As females, our pelvic floor muscles are vulnerable to becoming weakened by many everyday things. We used to tend only to hear about these muscles during/after pregnancy: this is thankfully finally on the change. Yes pregnancy and childbirth can of course weaken our pelvic floor but so can straining on the toilet, repetitive heavy lifting, chronic cough/sneeze and, to a certain extent, aging.
Why are there so many names for the same thing?!
Pelvic floors, pelvic floor muscle exercises, pelvic floor squeezes, kegels, mula bandha....... the list goes on. We have no idea why there are so many names for the same thing but just to reassure you, they are all the same and you’re not going mad!
How do you do a pelvic floor squeeze?
For a first attempt – find yourself a comfortable position (ideally relaxed sitting or even lying down) and devoid yourself of any distractions.
To do a pelvic floor squeeze in isolation you want to ensure that you are specifically targeting these muscles – when contracting these muscles you should feel a tightening and lift around your back passage and vagina. This will predominantly be an internal sensation and often it feels quite small. Physiologically the muscles work from back to front – so start by squeezing the back passage to get the best quality pelvic floor squeeze before then aiming to extend the squeeze to also include the vagina.
After consciously squeezing your pelvic floor it is imperative that you let it go fully – this should feel the opposite i.e. a lowering of your muscles. If you are not sure if your muscles have fully let go, take a big breath into your ribs and tummy – this acts like a safety net to ensure the muscles of full flexibility.
Due to the physiology of the pelvic floor muscles it is also important for optimal function to complete short and long squeezes – these are exactly the same thing apart from how long you hold the squeeze before letting go. With short ones, let go straight away. With long ones, you ideally want to get to a point where you can hold for 10 seconds.
It is normal to find this mentally taxing, at least in the beginning! Like any new skill, the more you practise, the more natural it will start to feel.
There are some self-checking methods available, to help you know if you are doing the squeezes correctly. 1. Undress from the waist down and hold a mirror to your vulva. Squeezing the pelvic floor you should see your vulva lift & move inwards. 2. Alternatively, you could try placing your hand on your vulva. When squeezing the pelvic floor you should feel your vulva lift up & away from you. 3. When having sex with a man, if you squeeze your pelvic floor he should be able to feel a tightening around his penis.
How do I know if I’m doing them wrong?
If someone else can tell you’re doing them, you’re doing them wrong! Unless someone happens to be inside your vagina or back passage, nobody should be able to tell you’re doing them (see third self-check method, above). This means keeping the rest of your body relaxed, common things to watch out for are tension in the jaw, bum muscles and legs or breath-holding.
If you see or feel a downward movement of your vulva instead of an upward movement when doing a squeeze, again, you’re doing them wrong.
If you cannot feel/see anything happening at all then it is advisable to see a women’s health physiotherapist so that a full assessment can be made of your situation. We have mapped out the referral options in this blog.
What about isolating back from front or going up like an elevator?
There are lots of different ways to visualize or cue your pelvic floor muscles into action:
imagine you are sucking up spaghetti with your vagina
imagine your vagina is a rose bud that is closing
imagine you are picking up a kidney bean with your back passage
imagine your vagina is an elevator and you are going up to the top
Anatomically it is pretty impossible to actually isolate the front of your pelvic floor from the back of your pelvic floor due to its nerve supply, though you can certainly influence where you feel the movement with certain positions.
I’ve heard pelvic floor muscle exercises are pointless: is that true?
Respectfully, we would say: no. Kegels are a valuable way to connect with and strengthen the pelvic floor muscles, which are so often given very little conscious thought. That said, they are just one part of the puzzle. LIfestyle factors (caffeine intake, fluid intake, Body Mass Index, diet, toileting posture) also play a role in keeping these muscles healthy. Ultimately, we want our pelvic floor muscles to be functional and responsive to all the demands we place on them, whether running, trampolining, CrossFitting, belly laughing uncontrollably or dancing. Daily kegels can definitely help us to achieve that.
Is it safe to do pelvic floor squeezes in pregnancy?
Yes! Pregnancy is a time where your pelvic floor muscles are under extra strain and daily practice of kegels can be beneficial. We wrote a blog which goes into this and you can access it here.