21 amazing facts about your pelvic floor
Your pelvic floor is one of the most important muscles, but how much do you know about it? Find out with these top 21 need-to-knows.
1. It's not one muscle
Your pelvic floor is not one muscle, it’s a set of them in a sheet as wide as your hips, running from the pubic bone to the tailbone. It supports the bladder, vagina, uterus and bowel, controlling urine flow and how well you hold in poo and wind, helping support your back and determining the strength of orgasm. In the 1940s an American doctor, Arnold Kegel, made pelvic floor exercises popular, so they – and the muscles – became known as Kegels. He suggested we did the exercises 300-400 times a day; now 10-20 is recommended.
2. You can see a pelvic physio
French women get a ‘vagina physio’ after childbirth. They call it ‘la rééducation périnéale’ – up to 20 sessions with a specialist who tests how strong the muscles are and ensures you do the exercises properly. ‘Supervised Kegels are far more effective than handing over a leaflet, but it’s not always possible to send every woman in the UK to a pelvic physiotherapist,’ says urogynaecologist Dr Alex Digesu from Nuada Gynaecology. But if you’re not getting results from your Kegels, or have a problem affecting your connective tissue, such as Ehlers-Danlos Syndrome or hypermobility, ask your GP for a referral to a women’s health physiotherapist.
3. The shorter your labour, the lower your risk of pelvic floor damage
'Most of the damage to the pelvic floor is done in the second stage of labour,' says obstetrician and gynaecologist Pradnya Pisal from London Gynaecology. 'This is why your medical team will try to limit your pushing until the baby's head is engaged.'
4. A weak pelvic floor is not the only reason for leaking
There are two types of urinary incontinence – stress incontinence, where you leak a little when you do things like cough or exercise, and urge incontinence, where you can’t hold your urine in before you can get to the loo. Both can develop postpregnancy but Alex says the second problem is related to pressure in the bladder, not the pelvic floor, so all the Kegels in the world won’t fix it. Instead, see your GP who can give you advice on bladder retraining.
5. Constipation and allergies can affect urinary incontinence
Straining and constant sneezing will stretch the muscles. ‘I’ve seen many women whose symptoms were aggravated by chronic constipation,’ says Pradnya. If a health problem makes you strain, cough or sneeze a lot, ask your GP or pharmacist for advice and you may find your bladder health improves too.
6. Keep exercise moderate
Exercise when pregnant is great for you and your baby, but ‘heavy, repetitive lifting or high-impact moves may lead to pelvic floor dysfunction as it raises pressure in the abdomen,’ says women’s health physiotherapist Becky Aston. Keep moving, but keep it moderate.
7. Elective C-sections lower the risk of pelvic floor problems
Elective C-sections lower the risk of pelvic floor problems, but ‘the muscles relax and weaken in pregnancy itself which can cause symptoms,’ explains Alex. An emergency C-section doesn’t give the same risk reduction. ‘The damage will start when you’re about 5cm dilated and this could be before your doctor intervenes,’ he says.
8. Don't wait until after birth to start Kegels
Not only does training them throughout your pregnancy reduce the risk of damage, but women who did this spent less than an hour in the second phase of labour, say researchers at Norway’s Trondheim University Hospital.
9. Find out how to do Kegels properly
If you're not sure how to do Kegels, it is important to ask for advice. ‘Some women bear down on the pelvic floor when they do them, which can cause the pelvic organs to prolapse,’ says Becky. To do a Kegel well, clench the muscles at the back as if trying to hold in wind, then bring in the muscles you use to hold in urine, pulling them up and forward. Hold for a count of two, breathing normally, then relax.
10. Contract your pelvic floor muscles
If you know you leak when you cough or lift your baby, contract your pelvic floor muscles just beforehand in a move called the Knack. This closes off your urethra (the tube down which urine passes) and stops the leak,’ says Becky.
11. train the pelvic floor with gizmos
Gizmos that help you train the pelvic floor are a huge trend. There are several different ones but they all work in roughly the same way. You insert a probe-like device into the vagina – it contains sensors that measure muscle activity and this then feeds back to an app on your phone showing how well you do. Alex has examined quite a few of the devices and thinks they’re a great idea. ‘They could put the end to needing physiotherapy for many women,’ he told us. Here’s our quick guide to what’s what.
12. Stop peeing midway through
One way to find your pelvic floor muscles is to stop peeing midway through. But ‘you shouldn’t do it regularly as it can lead to infections and bladder weakness,’ says women’s health expert Dr Marilyn Glenville. Do it once or twice to get a feel for things, then do the moves off the loo. ‘It can help to do them sitting on a hard chair,’ she says. ‘You can feel the muscles as they rise and fall against the chair.’
13. Pelvic floor problems run in families
If your mum or sister developed incontinence after pregnancy, then your chances of doing so increase too. It’s believed that the link is genetic and that the genes involved affect the strength of the muscles in some way.
14. Wait for the muscles to strengthen
Kegel exercises don’t work overnight to cure stress incontinence – so while you’re waiting for the muscles to strengthen, try a device called Incostress (£31.99, incoshop.co.uk). This tamponlike device is worn in the vagina and gently closes off the urethra through which urine passes, stopping leaks happening. ‘Some hospitals will now offer this on the NHS, but if not you can order it online,’ says Gaynor Morgan, who created the device to help her mother’s incontinence.
15. Your pelvic floor can be too tight
It’s not known exactly why this happens but it can cause pelvic pain, bladder problems and harder labour. This also needs specialist advice, says Gaynor.
16. Watch your weight
A series of studies has found a clear link between carrying extra pounds and a higher risk of developing pelvic floor problems. The most recent research found that over half of obese women questioned said they suffer compared to a third of women of a healthy weight. ‘Weight increases the pressure in the abdomen – a high weight and low muscle mass is a bad combination for an increased risk of pelvic floor problems,’ says Pradnya.
17. Learn the magic massage
If you're currently pregnant, you’ll be told to do perineal massage as you get into later pregnancy as it reduces the risk of tearing. But Pradnya says it also helps gently stretch the pelvic floor, lowering risk of damage here. ‘I recommend it to patients from about 34 weeks,’ she says.
18. Find a Power Plate
Find a Power Plate – because these wobbling devices aren’t just good at toning the muscles that you can see. According to a study from researchers in Iran they also help tone the pelvic floor. ‘The vibration stimulates the nerves serving the pelvic floor, making you more conscious of the area and enabling you to better connect with this vital group of muscles,’ says postnatal exercise expert Jenny Burrell. Visit powerplate.com to find your nearest studio.
19. Surgery stops leakage
If stress incontinence is really bad you can have surgery that stops leakage in up to 90 per cent of people. The most common type is TVT – tension-free vaginal tape – in which a mesh tape is placed in the abdomen to support the urethra. ‘If lifestyle changes and physiotherapy hasn’t worked, it can offer a solution,’ says Alex. But if you have another baby, the incontinence may return.
20. Increase your vitamin D intake
Several studies have shown that people with low levels of vitamin D are more prone to leakage than those who have higher levels. It’s believed that the vitamin helps keep muscles strong, so if levels fall so does their performance. Try taking a supplement such as Healthspan’s Super Strength Vitamin D3 (£11.95, healthspan.com).
21. Sex will give the pelvic floor a workout
‘It might be the last thing on your mind, but once any stitches are healed and you have your six-week check, one of the best things you can do to tone up is to get back in the saddle – so to speak – and work it,’ says Gaynor.