Pelvic Floor Strengthening: Part of your Daily Routine
From the Summer 2010 issue of Quality Care®, NAFC's newsletter
By Tasha Mulligan, MPT, ATC, CSCS
A consistent commitment to strengthening our pelvic floor muscles can mean the difference between bladder control and leaking urine. If you have never been instructed in a thorough pelvic floor-strengthening program, you may be wondering, "What type of exercises do I need to do to gain better control?" The answer may be more than just Kegels exercises. There are a lot of muscles that work in coordination with our pelvic floor. Some enhance the contraction of our pelvic floor and others help to stabilize our pelvis and lumbosacral spine so our pelvic floor muscles have stable anchors to pull against. With this in mind, not only do we have to perform exercises that target our pelvic floor specifically, but we also need to strengthen our deepest core stabilizers that allow an optimal contraction of our pelvic floor.
As we begin to explore a thorough pelvic floor-strengthening program, we must first discuss the cornerstone of pelvic floor exercise, the Kegel contraction. A Kegel is best instructed as squeezing the muscles used to stop the flow of urine or the passing of gas. But did you know our pelvic floor muscles do more than just "squeeze"? They also, elevate, draw up to a tighter position within our pelvic outlet. This second action of our pelvic floor muscles is often left out when outlining a pelvic floor strengthening routine. The best instruction for this action is "to visualize a string attached from your belly button down to your pelvic floor and you are attempting to pull it up." Our pelvic floor is postural muscle so endurance exercises, such as pelvic floor elevation, is as important as the quicker tightening or squeezing action of our pelvic floor muscles that help us when we cough, laugh, or sneeze, such as Kegel exercises. The combination of elevation and Kegel contractions will work all the fibers of your pelvic floor muscles. A goal of 10 endurance/elevation holds and 50 quick-squeezing Kegel contractions per day is reasonable.
The second most important muscle to work in a pelvic floor-strengthening program is our transversus abdominus (TA). This muscle, otherwise known as our lower abdominals, wraps around our abdomen like a corset that narrows as it hugs our pelvic organs within our pelvis. Drawing the belly button "up and in" activates the TA. A contraction of our TA squeezes like a cone, displacing the pressure within our abdomen up and under our lower ribs, lifting the pressure from our pelvic floor. Our TA and pelvic floor actually work in coordination, each enhancing the contraction of the other. You can feel this coordinated effort as you elevate your pelvic floor following the instructions given above. Note that as you work to pull your pelvic floor up, your belly button automatically draws in, assisting this effort. Our TA, like our pelvic floor, is also a postural muscle that we must work through longer endurance holds, drawing our belly button "up and in" and holding it there as we continue with a regular breathing pattern for 10 seconds or more, at least 10 times throughout the day. You can see this muscle work as it will cinch up your midsection, lifting your chest, and you should feel the pressure lift from your pelvic floor. It is very important to note that breathing normally throughout each exercise is a critical component of performing the exercises correctly and optimally. Breath holding is one of the most common mistakes made when trying to activate our TA. Every time we hold our breath as we reach, as we lift, even as we get up from the couch, we work against the elevation and control of our TA and pelvic floor. Breath holding locks our ribs down, forcing the pressure within our abdomen down to the weakest link, which is the soft tissue of our pelvic floor. Anytime we overwhelm our pelvic floor with increased intra-abdominal pressure, we risk the inability of our pelvic floor to control the passage of urine, feces, and/or gas.
So far, we have reviewed the important components of a pelvic floor strengthening program that include performing both actions (tightening and elevating) of our pelvic floor, we have reviewed the contraction of our transversus abdominus which displaces pressure upwards to our expanding ribs, and we have cautioned against the bad habit of holding our breath and how it works against our pelvic floor.
Now, lets finish with a quick review of the stabilizers of our pelvis and lumbo-sacral spine. These muscles help provide a stable structure of our pelvic floor muscles to pull on when tightening and elevating. So what are these important muscles that provide much needed stability? They are: the multifidi muscles of our lower back, our deepest hip rotators, and our inner thigh muscles. Your multifidi muscles can be strengthened in a standing position by rotating your pelvis slightly, giving a lift to your buns. When performing this subtle exercise, it is important to visualize your tailbone lifting with each contraction. Your pelvic floor is attached to your tailbone and will, therefore, tighten slightly with each multifidi lift.
The second exercise that will work to strengthen our inner thighs and deep hip rotators, is simply squeezing a ball or pillow between your knees while sitting and in that same seated position, and then pushing your knees apart against the resistance of your own hands placed outside of each knee. A good goal is to perform 15 repetitions per day of each of the stabilizing muscles.
With the exercises described in this article, you have been given a great start to a thorough pelvic foor rehab program. If you have difficulty with any of the exercises as instructed, you should consult with a physical therapist in your area, specializing in pelvic floor rehabilitation.
About the author:
This article was written by Tasha Mulligan, a physical therapist, athletic trainer, and certified strength and conditioning specialist. She is the co-founder of PTpartners LLC and creator of Hab It: Pelvic Floor DVD. You can read more from Tasha on her blog posts at www.hab-it.com and at www.healthcentral.com/incontinence.