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Strengthening Exercises For Your Pelvic Floor

What is the Pelvic Floor?

The pelvic floor is a skeletal muscle that makes up the base of your core. It attaches anteriorly to your pubic bone, posteriorly to your tailbone and on either side of your sit bones. The pelvic floor muscle works together with your diaphragm and transversus abdominal (TA) muscles to have a strong inner core. The diaphragm and your pelvic floor move parallel to each other. This is why breathing patterns are so important when completing pelvic floor exercises. This anatomy is the same for all people, so it applies to all genders for similar issues.

Why is the Pelvic Floor Important?

The pelvic floor is important for maintaining bowel, bladder and sexual function. It also has a close relationship with the hips and low back. Dysfunction in the pelvic floor can present as issues in any of these systems. Because it is a skeletal muscle, it can be stretched, strengthened, and motor retrained.

Why is it Important to Strengthen the Pelvic Floor?

The most appropriate population for pelvic floor strengthening is someone who is experiencing urine or fecal leakage with coughing, laughing, sneezing, running, etc. Another population includes those suffering from prolapses. It is important to note that many actually need pelvic floor lengthening prior to strengthening so it is always recommended to see a specialist prior to starting these exercises. Many of these exercises can easily be done incorrectly so supervision by a pelvic floor specialist is important. 

Types of Pelvic Floor Exercises

TA Contraction

The foundational pelvic floor exercise includes a diaphragmatic breath coupled with a TA and pelvic floor muscle contraction. To complete a correct TA contraction, imagine a zipper from your pubic bone up to the belly button that you zip from the bottom to the top.

Number of repetitions is patient dependent based on your current strength and activity tolerance. In general, 30 repetitions a day is typically needed to see an improvement. 

Kegels/Pelvic Floor Contraction

A pelvic floor contraction, also known as a kegel, is when you contract your pelvic floor like you’re trying to stop a stream of urine. Common compensations to avoid are squeezing your buttocks together and/or overuse of your upper abdominals. You also want to monitor that you are not bearing down when doing the kegel as this can lead to more complications, especially if you are suffering from a prolapse or hemorrhoids. Challenge yourself to complete this exercise in the laying down, seated, standing, and hands and knees position. Try doing both quick contractions as well as longer holds.

Once you are able to correctly complete a diaphragmatic breath with an abdominal and pelvic floor contraction, this should be applied to other exercises such as squats, deadlifts, and traditional core exercises. Remember to not hold your breath exhaling on exertion!

Pelvic Floor Stretches

As previously stated, the pelvic floor can also be stretched and often muscle length is just as important as muscle strength. Stretches such as the butterfly and happy baby are perfect for the pelvic floor.

Pelvic Tilts

Another way to improve muscle length in the pelvic floor is by doing pelvic tilts. Grab an exercise ball and rock your hips forward and backwards. Just like straightening your arm lengthens your biceps, rocking your hips backwards can lengthen your pelvic floor muscles. 

A Few Considerations

Again, it is important to note that not everyone is appropriate for a pelvic floor contraction. There are hypotonic pelvic floors where strengthening the pelvic floor is going to be the priority. There are also hypertonic pelvic floors, or tight pelvic floors. Some symptoms you may have with a hypertonic pelvic floor include pelvis or tailbone pain, pain with intercourse, constipation, urinary urgency, or inability to fully empty your bladder. When this is the case, diaphragmatic breathing and a TA contraction are still important, but leave out the kegel!

The pelvic floor, core, diaphragm, and lumbar muscles have to work together specifically and constantly.  Exercises for this region can be really complex to determine the right exercise to do and if you are doing it correctly. 

It would be best practice to consult with a pelvic floor specialist prior to starting an exercise program, and they will point you in the right direction!

Justine Lallman, PT, DPT
Justine Lallman, PT, DPT

Justine Lallman, PT, DPT is a Pelvic Health Physical Therapist at CHI Health.

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