Where is the pelvic floor?
If you’re scratching your head, see the diagram below.
What happens to your pelvic floor during pregnancy?
Your pelvic floor goes through a tremendous amount of strain in pregnancy. The muscles can become stretched and weak because of the continual weight. As your baby grows bigger, the amount of pressure put on it gets larger, making it harder for it to do its job of preventing incontinence, treating prolapse and improving sex.
Many women can testify to the effects of this and what happens when your pelvic area is put under stress, such as when you sneeze, laugh, cough, run, or have a few too many wines and clamber onto the kids' trampoline.
I didn't do pelvic floor exercises during pregnancy. Trampolines now fill me with fear and when I sneeze I automatically cross my legs.
"Mine never fully recovered from my first pregnancy/birth. I noticed the leaking mostly when I started running."
"My pelvic floor was pretty bad initially. I found that tampons would no longer stay put."
To give your pelvic floor muscles a fighting chance of being able to do their job after the stresses and strains of pregnancy and labour, it's good to get into the habit of doing some strengthening pelvic floor exercises – sometimes called kegel exercises – whenever you get a chance.
What are pelvic floor exercises (or kegels)?
What are kegels? Put simply, they’re exercises which strengthen your pelvic floor, and they can help during childbirth and when you're recovering afterwards. But they don’t just relate to pregnancy – they can also improve your sex life, help stop incontinence, and treat prolapse. For this reason, both men and women can do pelvic floor exercises.
But how do you do kegel exercises? Well, imagine you're having a wee and are trying to stop mid-flow. The muscles you squeeze to do this are your pelvic floor. If you've done pilates or yoga before, you'll probably be familiar with them already.
When you squeeze these muscles, you're exercising them.
How to do pelvic floor exercises
Here’s how to do kegels, step by step:
- A standard pelvic floor technique is to imagine that you're trying to stop the flow of urine when you’re urinating – tightening your muscles from the front of your pelvis and round towards your bottom. Do note the ‘imagine’, though – you can try stopping your urine once for a better idea of how to strengthen your pelvic floor, but doing this more frequently may harm the bladder.
- It might also help to imagine that you're drawing something up and into your vagina, pulling the muscles upwards.
- Keep the muscles tightened for the count of 10, then let them go and relax. Do this five times.
- Make sure that you are breathing normally and avoid tightening your legs, stomach or bottom. Just concentrate on the pelvic floor muscles.
- When you are used to this, try tightening and relaxing the muscles in succession, without holding the tension. Do this 10 to 15 times.
- A variation is to imagine the pelvic floor muscles as a lift, gradually squeezing them tighter as though they are rising from floor to floor.
"Take a deep breath and squeeze as you slowly release it. Then hold for a breath and release on the third breath as you breathe out."
"Your bum cheeks should be relaxed, as should your stomach muscles."
How long will it be before pelvic floor exercises work?
If you do kegel exercises regularly, you should begin to notice the results within a few months. Keep going and carry on doing your exercises to strengthen the pelvic floor, even when you notice them starting to work.
"I've found that now I'm in my 40s, having done them for all these years is paying off. Mine seems to be in much better shape than most people's, and I've had five babies."
When should I start doing pelvic floor exercises?
Now! Every woman, pregnant or not, can benefit from exercising these muscles. The benefits of kegels aren’t just limited to your body post-pregnancy – keeping the pelvic floor fit and healthy can help you enjoy a satisfying sex life through increased sensitivity during sex and, as a result, stronger orgasms.
Starting kegel exercises before pregnancy can also help ward off problems that can be exacerbated by pregnancy and childbirth, weight gain, or ageing.
Having strong pelvic floor muscles also helps when giving birth, as they’re useful during the second stage of labour when you need to push your baby out. If you experience a perineal tear during birth, they can also help you to heal faster.
Stopping peeing midflow can be a useful way of checking your pelvic floor muscles are getting stronger, but this shouldn't be used as muscle training as you can give yourself a urine infection.
How often should I exercise my pelvic floor?
As pelvic floor exercises can be done while you're going about your business without anyone noticing, try to do them as often as you can. Don't overdo it, and make sure you know how to relax the muscles as well as tighten them – this can help during the second stage of labour, where relaxing the muscles around your vagina may help you to avoid damaging your perineum.
Everyone should aim to make these exercises a regular activity to maintain a healthy and fully functioning set of pelvic floor muscles. Try to associate them with something else you do every day, such as during your regular commute, checking Twitter, or watching your favourite show. This way, you're more likely to remember to do them.
"I started trying to remember to do them when I was on the tube or train, and it became associative."
"Stick a note on your fridge if you have to."
What will happen if I don't exercise my pelvic floor muscles?
Pelvic floor exercises help to avoid the functional problems you may encounter during and after pregnancy and childbirth. And, as the NCT states, it “can also prevent prolapse, which is where the pelvic organs drop down into the vagina.”
The Royal College of Obstetricians and Gynaecologists cites the symptoms of pelvic prolapse as follows:
- Feeling a dragging or heaviness in your pelvic area
- Discomfort and a lack of sensation during sex
- A bulge in the front or back wall of your vagina. This bulging may extend outside the vagina.
- Trouble with continence – bladder or bowel
Your pelvic floor also has a big role to play during sex – a weakened pelvic floor can affect your ability to have an orgasm, which seems a pretty good reason to pay it some attention.
Pelvic floor exercises make a noticeable difference to the enjoyability of sex, which frankly I consider a good payoff for remembering to do them.
Do pelvic floor exercises really work?
Do kegels work – really? The short answer is that yes: generally, they should do. However, everyone’s body is different, and if you’re finding them ineffective it might be time to turn back to your doctor.
In recent years there's been some talk of the benefits of electrical stimulation for pelvic floor issues – especially if you're unable to contract the muscles on your own.
This is where a small probe is inserted into the vagina, through which an electrical current runs – with the aim of strengthening your pelvic floor muscles as you exercise them. Some women find this uncomfortable, but it is seen to help if you're having issues doing pelvic floor muscle contractions yourself.
Electrical stimulation is prescribed in some cases on the NHS. You can also buy your own device to use at home – they retail at around £50, but do talk to your doctor first.
There have also been calls to make this treatment more routinely available (as it is in other countries, such as France).
"I've got an electric one – it cost 55 quid or so and does work extremely well. It has loads of different programmes and a variable strength and pulse rate."
"The electronic ones send an electric signal to your muscles and helps them contracting. They're great for women with useless pelvic floor muscles like mine."
"Physiotherapists have vaginal equipment that electrically stimulates the inner muscles, as well as equipment that shows you the exact strength you are squeezing at – as a level of strength on the screen. The goal is both to squeeze harder and for longer."