How do I strengthen my pelvic floor? Just doing Kegels?

The pelvic floor is composed of a group of muscles and connective tissues that create a sling to support the pelvic organs namely the bladder, uterus and bowels. A strong pelvic floor is vital to the optimal position and function of the bladder, uterus and rectum. A weakened pelvic floor can lead to incontinence, prolapse, and sexual dysfunction. Let’s delve into what pelvic floor strengthening entails.

Why Strengthening Your Pelvic Floor Matters

As previously mentioned, a weakened pelvic floor can lead to several health issues including:

• Urinary incontinence (leakage of urine when sneezing, coughing, or laughing)
• Pelvic organ prolapse (when pelvic organs, such as the bladder or uterus, descend and bulge into the vagina)
• Bowel incontinence (difficulty in controlling bowel movements or flatulence)
• Decreased sexual satisfaction (lack of sensation or inability to reach orgasm)
• Back or pelvic pain (related to weak core muscles)

Strengthening your pelvic floor has been shown to improve the above conditions and prevent worsening! This in turn will improve overall wellbeing and confidence. Let’s get started with the pelvic floor strengthening basics.

How to Identify Pelvic Floor Muscles

The pelvic floor muscles are activated when you are urinating and stop the flow of urine. Note: it is NOT recommended to actually perform this, however the act of stopping your urine is how you activate the pelvic floor. You can envision sucking a raisin through your urethra, a ping pong ball through your vagina, or a grape through your rectum. The pelvic floor muscles also contract during sexual arousal and orgasm. It is crucial that you maintain a relaxed core and ensure no contraction happens with your glutes or groin when you contract your pelvic floor.

How to Strengthen Your Pelvic Floor

Now that you know how to identify your pelvic floor muscles, let’s explore the most effective methods for strengthening them.

1. Kegel Exercises

Kegel exercises are the most well-known and effective method for strengthening the pelvic floor. Named after Dr. Arnold Kegel, who first developed the technique, these exercises involve contracting and relaxing the pelvic floor muscles.

How to do Kegel exercises:

1. Find a Comfortable Position: You can do Kegels while sitting, lying down, or standing, but it’s easiest to start lying down removing the effects of gravity.
2. Contract Your Pelvic Floor: Take a large exhale and squeeze the muscles around your urethra, vagina, and anus as if you are stopping the flow of urine or holding in gas. Hold the contraction for a few seconds
3. Relax the Muscles: Take a large inhale and release the contraction and relax for a few seconds
4. Repeat: Aim for 10-15 repetitions in a set. Start with one set per day and gradually increase to 3 sets per day.

Tip: Make sure to breathe normally while performing Kegels. Avoid holding your breath, which can create unnecessary tension in your body and can actually harm your pelvic floor.

Note: It is important that you seek the advice of a pelvic floor physiotherapist regarding your exact kegel prescription as holding for too long or too little can harm or hinder your pelvic floor

2. Pelvic Floor Exercises with Changing Position 

As your pelvic floor strength improves, you can get more creative and add resistance or different positions where you perform your kegels. Standing is a typical progression where you are working against gravity. It can be challenging to know if you are contracting well in standing, but a pelvic floor physiotherapist can actually assess your strength in standing. 

3. Bridge Pose

The bridge pose is an effective exercise for strengthening the pelvic floor, glutes, and lower back. It also helps improve core strength and stability.

1. Lie on your back with your knees bent and feet flat on the floor, about hip-width apart.
2. Exhale and slowly lift your hips towards the ceiling by engaging your pelvic floor, glutes, and core muscles.
3. Hold the position for 5 seconds, then as you inhale, slowly lower your hips back to the floor.
4. Repeat for 10-15 repetitions.

Tip: Focus on squeezing the pelvic floor and glutes together as you lift your hips, making the movement controlled and deliberate. This helps to coordinate pelvic floor contractions with release.

4. Incorporating functional movements ie: squats

Squats are a great way to strengthen the pelvic floor, especially when combined with Kegel exercises. This is especially important as you add more weight on your squat rack and to ensure your pelvic floor can support you. A deep squat engages the pelvic floor muscles and can promote better bladder control and posture.

1. Stand with your feet slightly wider than shoulder-width apart.
2. Inhale and lower your body as if you are going to sit in a chair, thing sticking your glutes outward
3. Lower down as far as you can while keeping your chest lifted and your back straight.
4. As you rise back up, exhale and engage your pelvic floor while you squeeze your glutes.
5. Repeat for 10-15 repetitions.

Tip: For added intensity, hold a dumbbell or kettlebell to your chest while squatting.

5. Pelvic Tilts

Pelvic tilts target the muscles of the lower back, abdominal core, and pelvic floor. This exercise also helps improve posture and supports proper spinal alignment.

1. Lie on your back with your knees bent and feet flat on the floor.
2. Tighten your abdominal muscles and gently tilt your pelvis upward, flattening your lower back against the floor.
3. Hold for 5-10 seconds before slowly relaxing back to the starting position.
4. Repeat for 10-15 repetitions.

6. Deep Breathing and Relaxation

It’s just as important to relax your pelvic floor muscles as it is to strengthen them. A lot of people don’t realize they hold tension in their pelvic floor. Incorporating deep breathing and relaxation techniques can help alleviate tension.

1. Lie on your back with your knees bent and feet flat on the floor.
2. Place your hands on your abdomen and inhale deeply through your nose, letting your belly rise as you expand your lungs. 
3. Each inhale imagine your pelvic floor releasing
4. Repeat for 5-10 breaths.

7. Diet and Lifestyle Changes

In addition to exercises, certain lifestyle changes can help improve the strength and function of your pelvic floor:

• Stay hydrated: Drink plenty of water throughout the day to support healthy bladder function.
• Eat fiber-rich foods: A diet high in fiber helps prevent constipation, which can strain the pelvic floor muscles.
• Maintain a healthy weight: Excess weight can put added pressure on your pelvic floor, leading to weakening over time.
• Avoid heavy lifting: Repeated heavy lifting can strain the pelvic floor muscles, especially if done incorrectly. Your pelvic floor needs to match your activity levels
• Practice good posture: Proper posture helps relieve unnecessary pressure on the pelvic floor and supports its function.

When to Seek Professional Help

If you experience difficulty doing pelvic floor exercises, persistent pelvic pain, or symptoms like incontinence or prolapse, it’s important to consult a healthcare provider. A physiotherapist with a special interest in pelvic floor can provide personalized guidance and help you address any imbalances or dysfunction in your pelvic floor.

Strengthening your pelvic floor is essential to our overall health and wellbeing, especially in the postpartum period, but also during times of increased training, menopause, etc. In this blog we wanted to give a brief overview of how to perform pelvic floor exercises and what you can expect from your exercise program after seeing a pelvic floor physiotherapist.