Exercises for women to strengthen the pelvic floor muscles

The purpose of this leaflet is to introduce the patient to pelvic floor muscle strengthening exercises.

More than 50% of women who have given birth have problems with urination and uterine collapse (prolapse) in old age, usually caused by weakness of the pelvic floor muscles.

Strong pelvic floor muscles help improve bladder, bowel and sexual function, and keep internal organs in their anatomically correct position. These muscle problems can be caused by pregnancy, childbirth, chronic constipation, obesity, smoking, menopause and neurological problems.

The weakness of the pelvic floor muscles is usually signalled by leakage of urine during coughing and sneezing, air from the vagina, the need to urinate too frequently and at night, vaginal pain and pain during sexual intercourse. In order to prevent urinary incontinence and subsidence of organs, and to alleviate the condition, it is very important to learn to tighten the pelvic floor muscles correctly.

Pelvic floor muscles are located in the pelvic floor between the pubic and coccyx bones. Their task is to keep the organs located in the pelvis (uterus, bladder, intestines) in the correct position, and the opening of the bladder and bowel closed, to prevent involuntary leakage and to be able to relax at the right moment to empty them.

Figure 1: Anatomy of the pelvic floor. The Continence Foundation of Australia

Reproduced with permission from the Continence Foundation of Australia

Pelvic floor muscles need to be trained, just like all other muscles in your body.

How to tighten the pelvic floor muscles?

Lie on your back, with your feet bent from your knees, and your feet against the ground. Try to tighten the pelvic floor muscles as if you were stopping the flow of urine or holding stomach gas, pulling these muscles up and in at the same time.

You may feel tension when you contract your muscles. Do not hold your breath, but breathe deeply through your nose as you release your muscles, and exhale slowly through your mouth as you tighten your muscles. At the same time, the abdominal muscles may also tighten a little, but this is normal.

Try to keep your buttock and leg muscles free of tension. After each tightening of the pelvic floor muscles, let them relax completely.

What to watch when tightening the pelvic floor muscles?

1. Muscles should be tightened when exhaling, not by holding your breath!

2. The gluteal muscles must not be tightened at the same time, but must be kept relaxed!

3. Don’t strain while holding your breath.

Three basic ways to check if you’re tightening your pelvic floor muscles correctly 

1. Use a mirror to look between your legs, then tighten your pelvic floor muscles. Watch if the vagina moves inwards, away from the mirror. If you notice that the vagina is moving towards the mirror, stop the exercise immediately and contact a physiotherapist who specializes in pelvic floor muscle training.

2. Put your thumb or index finger in your vagina. As you tighten your pelvic floor muscles, you should feel the vagina tighten around your finger.

3. Tighten the pelvic floor muscles during sexual intercourse and ask your partner if he feels pressure.

Performing pelvic floor muscle exercises

1. Tighten the pelvic floor muscles and try to hold them tight while counting seconds. Then relax the pelvic floor muscles and keep them free of tension for the same number of seconds. How many seconds can you keep your muscles tight? How many times can you repeat this effort?

2. Tighten the pelvic floor muscles quickly: One to two seconds of effort and four to five seconds of relaxation. How many short repetitions can you do before you feel muscle fatigue? The pelvic floor muscles should always be relaxed before a new effort is made.

Make a goal of 10 long efforts, holding each effort for 10 seconds, and each effort must alternate with 10 seconds of relaxation. Then make 10 short efforts, each effort must alternate with a short relaxation.

You can start with a shorter time and fewer repetitions. Practice at least three times a day. At first it is easier to do the exercise on your back, then do it while sitting and finally while standing – standing is the most difficult position to perform the exercise. You should notice results after 3–6 months. Later, you can continue to practice once a day to maintain the result.

Tighten your pelvic floor muscles each time before coughing, sneezing and lifting weights, to prevent leaks and reduce the pressure of the abdominal muscles on the pelvic floor.

To prevent constipation, avoid carbonated and caffeine-containing beverages. Drink at least 1.5 litres of water per day. During bowel emptying, put your feet on a small bench to be in the push position, which makes bowel emptying easier. When constipation occurs, the pressure on the pelvic floor muscles increases as the intestine is emptied.

Eat a healthy diet and be physically active, moving for at least 150 minutes a week.

Try to make pelvic floor muscle training a daily habit. In order not to forget this, for example, put a reminder on your phone. Also do exercises while waiting for public transport or when queuing in the shop.

N.B.: Stopping the flow of urine during urination is allowed only as a control exercise after three months from the start of the exercises. This should not be done every time you urinate, as it may start to prevent the bladder from emptying.

If you have any pain or questions during pelvic floor muscle training, contact a physiotherapist who specialises in pelvic floor muscle training.

You can register for a physiotherapist’s appointment by calling 666 1900.

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Approved by the decision of the Care Quality Commission of Aktsiaselts Ida-Tallinna Keskhaigla on 27.11.2024 (protocol no. 16-24)