The lower part of the pelvis, its floor, is made up of a complex network of muscles and tissues that stretch, like a hammock, from the tail bone at the back to the pubic bone at the front. The pelvic floor muscles hold your uterus, bladder, rectum and vagina in place. Pelvic floor muscles provide support for your pelvis and spine, help to start and stop the flow of urine and pass gas and stool. Our pelvic floor muscles also help with our sexual responses and to achieve orgasm. The pelvic floor is best known by women because they’re the muscles targeted with a Kegel exercise.
Pelvic floor symptoms or complaints can include:
- general discomfort
- a feeling of heaviness in the vagina or rectum
- pressure or a tugging feeling in the pelvic area
- low back or groin pain when standing or lifting
- difficulty emptying bladder or bowels
- leaking of urine, stool, or gas with coughing, sneezing or other activities
- pain with sex
- a bulge at or around the vaginal opening.
Maintaining a Healthy Pelvic Floor: It’s critical for every woman, post-partum or otherwise, to understand the importance of keeping the pelvic floor in good shape. In addition to exercises we can do at home to maintain healthy pelvic floor function for mild cases of weakness, we can also seek physical therapy to improve symptoms and possibly avoid or delay the need for other medical interventions. Even women who ultimately do need surgery can often benefit significantly from targeted Pelvic Floor Muscle Exercise (PFME) and physical therapy both before and after a procedure. Seeing a Physical Therapist who specializes in pelvic floor dysfunction can help with various treatments such as biofeedback and electrical stimulation as well as a plan to address muscle weaknesses which may include Kegel exercises or bladder and bowel training.
Find the Pelvic Floor Muscles: In order to strengthen weakness in the pelvic floor we must first find the right muscles! This can be difficult for some women but there are various ways to figure out which muscles are involved in the pelvic floor. Try some of the following:
- In any position that is comfortable, try to squeeze and lift the muscles around your vagina and anus up and in. A helpful hint is to imagine you’re trying to hold in gas. You should not feel belly, butt or thighs tighten when you try to contract your pelvic floor.
- You may also want to try to visualize bringing your tail bone and pubic bone together. Though this will not actually happen, it may help you start a pelvic floor contraction.
- Insert one or two fingers into the vagina and try to squeeze around them – the muscles you’re feeling coming in and around your fingers are part of your pelvic floor and this inner squeeze should feel the opposite of bearing down for a bowel movement.
- If the contraction is done right, the muscles that encircle the urethra (bladder tube), vagina, and rectum should feel closed as if stopping the flow of urine or passing of stool.
- No outward sign of effort should be apparent with a pelvic floor muscle contraction. In other words, doing them should be invisible to others.
- Try using a hand-held mirror when you contract your pelvic floor muscles. You may see some minor up and in movement in and around the vagina.
- Try to stop your flow of urine then let it flow again. This shouldn’t be done as an exercise but can help identify the pelvic floor muscles. If you can’t stop the flow of urine, your pelvic floor muscles are especially weak.
- You should feel your pelvic floor muscles squeezing up and in while abdominal muscles sink inward. You should not feel your belly bulge outward.
The suggestions above can help you to find and exercise your pelvic floor muscles. Exercising these muscles is critical and should be started immediately after childbirth. They will help your recovery from your pregnancy and delivery and can help for a lifetime by avoiding problems in the future. You may also want to have a Physical Therapy evaluation to determine what you need to work on and to get one-on-one instruction for your own recovery. If you are unable to locate these muscles or have little or no ability to contract them, talking to your primary care doctor, see a physical therapist, a urogynecologist, or other specialist is a good next step.
A good plan: When you squeeze and hold your pelvic floor muscles, try to hold for a count of 5 and try counting out loud or maintaining a conversation so that you continue to breathe while doing them. Work up to holding for 10 seconds with a 5-10 second relaxation of the muscles in between. Letting go to let the muscles relax between contractions is also very important. Try to repeat this exercise at least 5 times a day.
With a newborn, it can be helpful to try to remember to do them by attaching a reminder to another activity like feeding or changing the baby or washing your hands. In other words, each time you feed or change the baby, let it be a reminder to do your pelvic floor exercise!
Lifelong Maintenance: Remember that maintaining a healthy pelvic floor is not only important immediately after childbirth. Keeping a fit pelvic floor can help avoid aches and ailments in the future and improve your sexual response and orgasm. We recommend keeping pelvic floor exercise as part of our daily lives. Some ways to do this forever:
- Every time you finish emptying your bladder do a few “quick twitch” contractions: a fast up and in squeeze of pelvic floor muscles.
- While in the shower, do squeezes shooting to hold them for 6-10 seconds and continue until your shower is done.
- During sexual intercourse, practice contracting your pelvic floor muscles. This will not only help maintain the strength of your pelvic floor, it will enhance your sexual experience as well.