Pelvic Floor Muscles

The pelvic floor muscles are tightly slung between the tailbone (coccyx) and the pubic bone, and support the bowel, bladder, uterus and vagina. Muscular bands (sphincters) encircle the urethra, vagina and anus as they pass through the pelvic floor. When the pelvic floor muscles are contracted, the internal organs are lifted and the sphincters tighten the openings of the vagina, anus and urethra. Relaxing the pelvic floor allows passage of urine and faeces.

If the pc muscles are weakened, the internal organs are no longer fully supported and you may not be able to control your urine. Common causes of a weakened pelvic floor include childbirth, obesity and the associated straining of chronic constipation. Pelvic floor exercises are designed to improve muscle tone and prevent the need for corrective surgery.

Symptoms
The symptoms of a weakened pelvic floor include:

Leaking small amounts of urine when coughing, sneezing, laughing or running
Failing to reach the toilet in time
Uncontrollably breaking wind from either the anus or vagina when bending over or lifting
Reduced sensation in the vagina
Backache
Tampons that dislodge or fall out
A distinct swelling at the vaginal opening
A sensation of heaviness in the vagina.
Common causes
The pelvic floor can be weakened in many ways, including:
The weight of the uterus during pregnancy
Vaginal childbirth, which overstretches the muscles
The pressure of obesity
Chronic constipation and associated straining to pass motions
Constant coughing
Some forms of surgery that require cutting the muscles
Lower levels of oestrogen after menopause.
Complications of a weakened pelvic floor
Loss of bladder control is a common symptom of a weakened pelvic floor. Some people experience bowel incontinence, which means they can’t always control the passage of wind or faeces. Weak pelvic floor muscles can also cause sexual difficulties such as reduced vaginal sensation. In severe cases, the internal organs supported by the pelvic floor, including the bladder and uterus, can slide down into the vagina. This is called a prolapse. A distinct bulge in the vagina and deep, persistent vaginal aching are common symptoms.

Familiarising yourself with the pelvic floor
Pelvic floor exercises are designed to strengthen the muscles. Each sphincter (vaginal, urethral, anal) should be exercised, so you need to familiarise yourself with these muscles in order to contract them at will. If the pelvic floor is especially weak, it may be difficult to detect any muscular contractions at first.

Suggestions on identifying your sphincters include:
Vaginal – insert one or two fingers into your vagina and try to squeeze them.
Urethral – when you are urinating, try stopping the flow in midstream. This should only be done to identify the sphincters. Do not do it on a regular basis.
Anal – pretend you are trying to stop yourself from breaking wind and squeeze tightly.

Kegel exercises
You can perform these exercises lying down, sitting or standing. Ideally, aim for five or six sessions every day while you are learning the exercises. After you have a good understanding of how to do the exercises, three sessions each day is enough.

Before you start, direct your attention to your pelvic floor muscles. Try to relax your abdominal muscles. Don’t bear down or hold your breath. Gradually squeeze all three sphincters and increase the tension until you have contracted the muscles as hard as you can. Release gently and slowly. Then perform the exercises, which include:
Squeeze slowly and hold as strongly as you can for 5 to 10 seconds while breathing normally. Release slowly. Repeat 10 times. Relax for 5 to 10 seconds between each one.
Perform quick, short, strong squeezes. Repeat 10 times.
Remember to squeeze the muscles whenever you clear your throat or cough.
Professional help
It is important to perform these exercises correctly. You can consult with your doctor, physiotherapist or continence advisor to ensure proper performance. It may take weeks or months before you notice a substantial improvement. In severe cases, pelvic floor exercises aren’t enough to solve the problem and surgery may be needed. Be guided by your health care professional.

Other considerations
You can further improve the strength of your pelvic floor in many ways, including:
Lose excess body fat
Cure constipation by including more fruit, vegetables, fibre and water in your daily diet
Seek medical attention for a chronic cough.
Where to get help
Australian Physiotherapy Association Tel. (03) 9092 0888
National Continence Helpline Tel. 1800 33 00 66
Victorian Continence Resource Centre Tel. (03) 9816 8266
Family Planning Victoria Tel. 1800 013 952 or (03) 9257 0100 www.fpv.org.au
Family planning clinic
Your doctor or other health care professional

Things to remember
The pelvic floor muscles support the bladder, uterus and bowel.
The pelvic floor can be weakened by pregnancy, childbirth, obesity and the straining of chronic constipation.
Pelvic floor exercises are designed to improve muscle strength.