Pelvic floor exercises and instructions

Pelvic floor exercises can help strengthen weak muscles and relax overtight muscles. These muscles hold the pelvic organs (bladder, intestines, urethra, rectum, and also the vagina, cervix, and uterus in females, and the prostate in males). People of any age can experience pelvic floor conditions that can benefit from pelvic floor exercises.

This article discusses pelvic floor exercises: what they are, how to do them, and the potential benefits and side effects.

Before starting pelvic floor exercises

Before starting pelvic floor exercises, see a doctor to make sure your symptoms are related to muscle stiffness or weakness and not an underlying health condition such as pelvic organ prolapse (when the pelvic organs fall off due to muscle weakness) or bladder problems (such as loss of bladder control).

Pelvic floor exercises, or Kegel exercises, aren\’t for everyone. Kegel exercises can help strengthen your pelvic floor, but if your muscles are tight, they can make your condition worse.

Consider seeing a physical therapist who specializes in pelvic floor therapy to make sure you\’re performing the most appropriate exercises for your condition.

Pelvic floor exercises for tight (hypertonic) muscles.

Strict (hypertonic) pelvic floor muscles can cause health problems such as bladder problems or pain during intercourse. Exercises for tight muscles focus on relaxing the pelvic floor.

Deep breathing (diaphragmatic breathing)

Diaphragmatic breathing reduces muscle tension throughout the body, including the pelvic floor. It also helps reduce pain that tight pelvic floor muscles can cause. Perform as follows:

1. Lie on your back on a solid surface.
2. Bend your knees and place your feet flat on the floor.
3. Place one hand on your chest and the other on your belly.
4. Inhale slowly through your nose, filling your belly with air. The hand on the stomach should come up while the hand on the chest stays still.
5. Purse your lips (as if blowing out candles) and slowly blow out the air.
6. Perform for five breaths.

Stretching of the adductors

If your adductors (inner thigh muscles) are very tight, prop your knees on pillows during this stretch to decrease muscle tension. Perform as follows:

1. Lie on your back on a solid surface.
2. Bend both knees and bring the soles of your feet together, with the outer edge of each foot flat on the ground.
3. Let your knees slowly drop to the sides, you should feel a stretch along your inner thighs.
4. Hold for 20-30 seconds and repeat three times.

Child\’s pose

Child\’s pose widens the pelvic bones to help stretch the pelvic floor muscles. Perform as follows:

1. Start on your hands and knees.
2. Keeping your elbows straight, sit back on your heels as you kneel.
3. Lean forward and rest your belly on your thighs.
4. Rest your forehead on the ground between your shoulders.
5. Take several deep breaths.

Happy baby pose

Use your arms to gently stretch your pelvis open to help stretch your pelvic floor muscles in Happy Child Pose. Perform as follows:

1. Lie on your back on a solid surface.
2. Bend both knees and bring your feet towards your hands.
3. Grab the outer edge of each foot with your hands.
4. Pull your knees towards your armpits and relax your knees outward.
5. Hold the position for several breaths.

If this position is too difficult, place your hands behind your knees instead.

Pelvic floor exercises for weak (hypotonic) muscles.

Excessive strain on the pelvic floor muscles from chronic coughing from smoking, pressure from chronic constipation, pregnancy, and childbirth can weaken these muscles. Additional factors such as age, weak tissue, and surgery can weaken the pelvic floor muscles.

Here are some exercises to strengthen weak pelvic floor muscles.

Kegels

Kegel exercises help strengthen the muscles that support the bladder. Perform as follows:

1. Lie on your back on a solid surface.
2. Squeeze your pelvic floor muscles, squeezing your muscles as if trying to stop the flow of urine midstream.
3. Hold for three to five seconds, then relax.
4. Repeat 10 times.

Perform Kegels at least three times a day. Once you have mastered lying Kegels, you can do them while sitting or standing.

Kegels and bridges

Increase your pelvic floor strength by combining Kegels with a hip bridge. This exercise also strengthens the abdominal and lower back muscles that support the pelvic floor. Perform as follows:

1. Lie on your back on a solid surface.
2. Bend your knees and place your feet flat on the floor.
3. Squeeze your glutes and lift your hips off the floor. Keep your shoulder blades in contact with the floor.
4. While in the bridge position, contract your pelvic floor for three seconds.
5. Relax your pelvic floor and lower your hips to the floor.
6. Repeat 10 times.

Kegels with shells

Clamshells strengthen the muscles in the hips that work with the pelvic floor muscles. Perform as follows:

1. Lie on your right side with your legs stacked on top of each other.
2. Bend your knees to about 45 degrees.
3. Contract your pelvic floor muscles and lift your top knee toward the ceiling (like a clamshell opening). Hold the position for two to three seconds.
4. Lower your leg and relax your pelvic floor.
5. Do 10 reps on each leg.

Exercise with pelvic floor dysfunction

While some exercises improve pelvic floor function, others can make it worse. A 2018 study looking at elite athletes found that 52 percent of female athletes in the study experienced urinary incontinence, with the highest rates seen in gymnasts.

Most people probably don\’t hit the gym regularly, but this study illustrates the effects of high-impact exercise on pelvic floor health.

Some examples of high impact exercises to avoid when dealing with pelvic floor dysfunction include the following:

• Heavy weight lifting
• Race
• Activities that require jumping
• High-intensity conditioning exercises (such as step aerobics)

Safe, low-impact exercise alternatives include:

As your pelvic muscles improve, you can move on to higher level activities.

Benefits of pelvic floor exercises

Pelvic floor exercises can help treat conditions and symptoms related to both tight and weak pelvic floor muscles.

For hypertonic muscles

Hypertonic (tight) pelvic floor muscles can occur due to trauma during childbirth and conditions such as irritable bowel syndrome.

Hypertonic pelvic floor muscles can cause:

• Pain during sex
• A strong urge to urinate or urinary incontinence
• Constipation
• Pelvic or abdominal pain

Relaxation exercises can reduce pain and decrease the incidence of incontinence.

For hypotonic muscles

Pelvic floor muscles can weaken after childbirth and develop following strenuous exercise such as weight lifting.

Weak pelvic floor muscles can cause:

Strengthening exercises can reduce incontinence and excessive passing of gas, as well as support internal organs. However, in severe cases, pelvic organ prolapse may require surgery.

Management of side effects of pelvic floor exercises

While pelvic floor exercises shouldn\’t increase pain, conditions that affect these muscles are often painful.

Treatments that can help reduce this pain include:

Summary

The pelvic floor muscles can be too tight (hypertonic) or too weak (hypotonic), both causing unwanted side effects such as incontinence, excessive passing of gas, and pain. Exercises can be done to stretch and strengthen these muscles, depending on the underlying problem. A physical therapist who specializes in pelvic health therapy can provide you with a personalized exercise plan.