Why Do Physios Emphasise Pelvic Floor Exercises?

Across our Hong Kong Central and Wong Chuk Hang clinics, our physiotherapists spend a lot of time assessing, diagnosing and creating treatment plans to manage pelvic floor problems. When we first start discussing the pelvic floor, we often get feedback like “I’ve been told to do pelvic floor exercise in the past” or “yes, I’ve heard the pelvic floor is important” - but when talking further with our clients, many don’t know what the pelvic floor does, where exactly it’s located, or why pelvic floor exercises can make a big difference to your health and wellbeing.

Pelvic floor problems are more common than many people think. A study published in 2022 examining 424 pregnant women in Malaysia found that 46% had at least one symptom of pelvic floor dysfunction during their pregnancy. Over in Australia, incontinence from pelvic floor dysfunction (regardless of pregnancy status) affects 1 in 3 Australian women and 1 in 10 Australian men, with 50% of those affected being below the age of 50 years.

Here’s a closer look into your pelvic floor that explains why as physiotherapists we make your pelvic floor a priority if you have problems like incontinence or are pregnant.

What Is The Pelvic Floor?

Your pelvic floor is a hammock-like group of muscles that stretch from your pubic bone at the front of the pelvis to your tailbone. The muscles of the pelvic floor keep all of your pelvic organs supported and functioning well. This includes the bladder, bowel, and also the uterus in women.

A big role of the pelvic floor is supporting continence, which is why pelvic floor health is just as important for men as it is for women. Specifically, muscular bands called sphincters encircle the urethra, vagina and anus as they pass the pelvic floor. This means that having good pelvic floor strength means that you can control when urine or faeces are released - and having weakened pelvic floor muscles may lead to episodes of unexpected incontinence and passing gas. The pelvic floor muscles are also involved in sexual function - specifically the relaxation and contraction combination supporting pleasure during intercourse.

Consider all the movements you do throughout the day - sitting, standing, lying down, going up and down stairs - it’s your pelvic floor that keeps your pelvic organs positioned and working as they should be, without feeling any heaviness or internal movement as you go throughout your day.

Why Does The Pelvic Floor Weaken?

• Having repeated episodes of severe coughing or sneezing, particularly if you have a chronic cough or other respiratory problem
• Lifting heavy objects repeatedly
• Chronic constipation that strains the abdominal area
• Pregnancy, which places excess weight on the pelvic floor from the growing uterus
• High-impact exercise like running
• Have trauma to the pelvic region, including perineal tears during childbirth, c-sections, and an episiotomy
• Habitually poor posture - having poor postural habits like hunching the back and shoulders can lead to the chest and ribs ‘sinking’ which can lead to the pelvic area taking on excess pressure, which can lead to pelvic floor weakening

Signs Of A Weak Pelvic Floor

• Accidentally leaking urine: this may be during activities like exercise, when lifting objects, or when coughing or sneezing
• Not making it to the toilet in time, or beginning to pass urine earlier than expected when you go to use the toilet even without a sense of urgency
• Accidentally passing wind when bending over or lifting, either from the anus or vagina
• Pelvic heaviness, dragging or pain, including during sexual intercourse
• Reduced sensation in the vagina, or a distinct bulge at the vaginal opening

Ultrasound For Pelvic Floor Assessment

Here at PhysioCentral, we take an advanced approach to pelvic floor assessment. We use real-time ultrasound imaging to educate our clients on their quality of pelvic floor muscle contraction. This assessment technique has been well documented by Dr Ruth Jones of Women’s Health Physiotherapy fame. Education on pelvic floor muscles with such advanced imaging and techniques allows our clients to focus on the quality of their muscle contraction to check whether they are bearing down, or if there is overactive bladder muscle contraction, or suboptimal endurance as opposed to the traditional technique of “squeeze and lift”. With the real-time ultrasound, we can also see if the superficial abdominal muscles dominate over the pelvic floor muscles, which is commonly seen in highly athletic postnatal clients, where the deep systems are not stable enough to sustain pressure. We also communicate closely with obstetricians, gynaecologists, midwives and medical specialists to make sure our clients have a multidisciplinary approach to their problems. Our physiotherapists have studied with Diane Lee, one of the world’s leaders in Women’s Health and dedicated research scientist of the thorax, pelvic girdle and abdominal wall.

Pelvic Floor Exercises: How Important Are They?

Pelvic floor exercises are instrumental in helping maintain a strong and functional pelvic floor by intentionally engaging and activating the pelvic floor muscles. When you have a strong pelvic floor, you can have greater confidence in your pelvic floor organs being well supported, with you maintaining control of their movements.

Pelvic Floor Exercises Are Simple But Powerful

Almost everyone can benefit from pelvic floor exercises, from women in the postpartum period to men that have undergone prostate operations, to anyone experiencing any form of incontinence. Remembering that we first described the pelvic floor as a bowl-like group of muscles, activating and working the pelvic floor moves this bowl upwards and forwards as you squeeze the muscles. Your physiotherapist will prescribe an individual pelvic floor exercise plan based on the results of your assessment with us so that it is tailored to your specific needs, but here is a quick, general pelvic floor exercise you can try right now: While sitting or standing, squeeze and draw in like you’re stopping the flow of urine. Don’t try this when you’re using the toilet - just mimic the action. Keep this squeeze and contraction for 3-5 seconds. Release - you should feel your pelvic floor notably relaxing, letting go and lowering. Rest for a few seconds, then repeat up to ten times or until you feel your pelvic floor muscles fatigue.

Who Shouldn’t Do Pelvic Floor Exercises?

If you’re experiencing pelvic pain, or feel a tightness in your pelvis or pelvic organs that at times may feel like you’re sitting on a golf ball, it’s important to see your physiotherapist first before commencing pelvic floor exercises. They’ll help you diagnose the underlying causes of your pain or tightness, which may involve relaxation exercises if your pelvic floor is stuck in a place where it cannot completely function to prevent incontinence but cannot fully relax either.

Summary

• Pelvic floor problems are very common, and are commonly seen and treated by our physiotherapists. It is not a problem that you should avoid or feel embarrassed about.
• Your pelvic floor acts like a supportive hammock for the pelvic organs in both men and women.
• Pelvic floor dysfunction isn’t just caused by pregnancy - it can be from something like excessive coughing or repeatedly lifting heavy objects.
• If you’re having incontinence, this may indicate that your pelvic floor may be involved.
• PhysioCentral uses world-class ultrasound imaging to understand the quality of your pelvic floor muscle contractions, giving an extra depth of information to inform your treatment with us.
• Pelvic floor muscles are simple, but powerful.
• If you’re concerned about your pelvic floor health, always see your physiotherapist.

References

1. https://www.mdpi.com/1660-4601/19/14/8314/pdf
2. http://www.pelvicfloorfirst.org.au/
3. https://www.continence.org.au/about-us/our-work/key-statistics-incontinence