Pelvic Floor
Strong in the Middle
You can imagine the pelvic floor as an upside-down umbrella stretched between the pelvic bones. It supports the entire weight of the abdominal cavity.
The pelvic floor consists of muscles and fascia that stretch between the pelvic bones. The muscles are arranged in 3 layers and can be tensed in 3 directions:
- Longitudinal: from the pubic bone towards the tailbone
- Transverse: between the two sitting bones
- Circular: the anterior part encircles the vagina and urethra, the posterior part encircles the anus
Functions of the pelvic floor:
- Holding: supports the abdominal organs and closes off downward, prevents uncontrolled urine and stool loss
- Sealing: tenses with maximum force during sudden increases in pressure (sneezing, coughing, jumping)
- Opening & Relaxing: for urine and stool evacuation
However, the optimal function of the pelvic floor also depends on the surrounding organs and adjacent muscles (abdominal muscles, back muscles, diaphragm, lumbar spine).
Weak Pelvic Floor?
Pelvic floor weakness is more common than one might think. It is estimated that one in three women has a pelvic floor weakness.
Signs of a weak pelvic floor:
- Bladder weakness: urine loss when coughing, sneezing, or exercising
- Constant urge to urinate
- Feelings of incomplete emptying of the bladder or bowel
- Residual urine (incomplete bladder emptying)
- Recurring urinary tract infections
- Bladder pain, urethral pain
- Irritable bladder
- Prolapse of the pelvic organs (pelvic organ prolapse)
- Pain/Discomfort/Lack of sensation during sex or orgasm
Benefits of an active pelvic floor:
- Prevention and relief of prolapse issues
- Controlled passage of urine and stool
- Healthy bladder function (important in susceptibility to UTIs)
- Healthy, upright posture (fewer back issues)
- Increased sensation during sex
Therapists
Even though you can do many pelvic floor activation exercises at home, it's always a good idea (especially if you have issues) to seek professional support first.
There are physiotherapists with additional qualifications in pelvic floor therapy.
Osteopaths are also able to detect and treat tension, functional, and mobility disorders of the abdominal organs with their hands.
Exercises for Home
It is best to consult a physiotherapy service that can address your individual situation. Following home exercises were recommended to me:
Perform each exercise in 3 sets of 10-15 repetitions. Train in different positions: lying on your back, lying on your side, sitting, on all fours, on a gym ball.
Before training, empty your bladder. Stop exercises immediately if pain occurs.
Breathing Technique
Place your hands on your lower abdomen, breathe deeply into your belly through your nose, after a short pause, exhale loudly and forcefully with a "pffff".
- Longitudinal: While exhaling with "pffff", pull the pubic bone up towards the navel and back towards the tailbone.
- Transverse: While exhaling with "pffff", draw the sitting bones towards each other to the center.
- Circular: While exhaling with "pffff", tighten the vagina, and during inhalation, "release" it. Repeat the same exercise with the anal sphincter.
Tense the entire pelvic floor quickly and briefly while pronouncing the short, hard sounds "p", "t", "k". Repeat until the muscles are tired.
Maximum Strength ExercisesDaily: While exhaling with "pffff", maximally tense the pelvic floor, tighten 3 times, then slowly relax. Repeat 3 times, with a 3-minute break in between.
Additionally, exercises for the abdominal and back muscles are recommended. Be cautious after pregnancy. If the abdominal muscles are still too separated (rectus diastasis), the straight abdominal muscles should not be trained.
Bladder Discomfort without Diagnosis
Particularly with bladder problems without a medical diagnosis, this is often related to tension. The pelvic floor must be able to both tense and relax.
If the pelvic floor develops a persistently increased pressure, it is referred to as a hypertonus in the pelvic floor. Very often, the connective tissue/fascia of the skin and subcutaneous tissue is also tense and hardened with bladder discomfort.
Urology usually does not look for a relationship between bladder problems, muscles, and connective tissue/fascia. However, functional bladder problems almost always involve tension.
Hypertonic Pelvic Floor
Women with a hypertonic pelvic floor often experience unclear and periodic – non-cyclical – pain in the lower abdomen or abdominal area. During sexual intercourse, sneezing, coughing, and generally while sitting. In short: with everything that exerts "downward pressure".
Treatment is usually symptomatic:
- Direct manual therapeutic treatment of the deep abdominal muscles, buttocks muscles/sitting bones, and leg muscles
- Heat application in the area of the lower and middle thoracic spine to dampen the sympathetic nervous system and activate the parasympathetic nervous system (the "rest nerve")
- Increasing foot baths
- Foot sole massage with spiky balls
A Peek Behind the Scenes
Until pregnancy and childbirth, I hardly dealt with this muscle group. It was only during postnatal therapy and my prolapse issues that this topic came into focus. I can confirm from my own experience that a bladder prolapse can cause extreme problems. I had the urge to empty my bladder every few minutes, especially while walking. Lying down made my symptoms better. Fortunately, I didn't have any bladder infections, although it felt like a UTI in terms of symptoms.
My salvation at that time was the insertion of a pessary by the gynaecologist. My first ring pessary stayed in the vagina for about 8 weeks and kept my pelvic organs where they should be after childbirth. It was a relief in an instant! As a new mum, you rock the baby a lot, go for walks with the pram, and generally don't have time to do intensive physiotherapy every day.
After that, I used pessaries that I could insert myself in the morning and remove in the evening. I tried:
- Ring pessary: the classic
- Cube pessary: when a lot of support is needed
- Restifem: very comfortable to use
I was happiest with the Restifem (there are only 2 sizes, and you can order it yourself). I no longer use a pessary because the pelvic floor has recovered very well through physiotherapy and the pessary.
For higher grade prolapses, based on a friend's experience, I can additionally recommend: Acticore home trainer and accompanying physiotherapy with a specialist (e.g. pelvic floor clinics).