The pelvis is a basin containing the bladder, uterus (the womb) and the bowel. The sides of the basin are made of bone and the floor of the basin is made of muscle.

This important muscle floor is made up in layers which stretch from the front of the basin to the back of the basin. This muscle floor is more commonly known as the pelvic floor. There are openings in the pelvic floor for the urethra (front passage), the vagina (birth canal) and the rectum (back passage). The pelvic floor muscles play an important role in bladder and bowel control and sexual sensation.

Why is it important to keep the pelvic floor strong?

The pelvic floor plays an important role in maintaining urinary and faecal continence by helping to keep the outlets from the urethra and the rectum closed until it is convenient to get to a toilet. A weakened pelvic floor may not provide sufficient support for this process resulting in leaking of urine on coughing, sneezing, laughing, straining or playing sport. This is called Stress Incontinence. In some cases there will also be leakage of faeces and an inability to control the expulsion of gas from the rectum. Urge Incontinence is the urgent need to pass urine frequently and may also be associated with a weak pelvic floor. In addition, weakness may cause:

a) The uterus to move downwards through the vagina (prolapse).

b) The bladder to bulge into the front wall of the vagina (cystocele).

c) The rectum to bulge into the back wall of the vagina (rectocele).

Why the pelvic floor muscles may weaken

Pelvic floor muscles may be weakened by:

b) Continual straining to open the bowels (constipation).

c) Persistent heavy lifting.

d) High impact sporting activity.

e) A chronic cough, i.e., a smoker’s cough, chronic bronchitis or asthma.

f) Being overweight.

g) Changes in hormone levels at menopause.

h) Lack of general fitness.

Exercises for your Pelvic Floor:

2) Tighten the ring of muscle around your back passage as if you are trying to control wind. Relax it. Practice this movement several times until you are sure you are exercising the correct muscle. Do not squeeze your buttocks or thighs.

3) Now do the same thing, but this time tighten around the vagina and front passage as well, lifting upwards as you tighten. Hold for five seconds then release. You should have a definite feeling of letting go. Rest for five seconds and repeat up to ten times. (When you can comfortably do ten lifts of five seconds, progress to ten lifts of ten seconds. This may take some months).

4) Now do five to ten short fast but strong lifts.

5) Do this routine at least three times per day.

It is important that women perform a pelvic floor routine as suggested above throughout their lives. It is particularly important for women who have delivered a baby or for women with a history of constipation (in both categories the pelvic floor will have been over stretched).

Tips to help you put off the urge to go to the bathroom:

You may be suffering from urgency which is the urgent need to get to the bathroom before you have an accident and sometimes you may not make it on time. You may find that a bladder re-training programme will help you. It is possible to train your bladder so that you have more control over it resulting in less frequent trips to the bathroom. It may be useful for you to record over a couple of days every trip to the bathroom that you make and you can then set yourself goals to increase time between visits. If you encourage the bladder to hold on, the bladder will get used to holding more urine before it starts urgently telling you that you need to get to the bathroom. Therefore you will not experience as many urges and subsequently you will be going to the bathroom less often. It is best to start your training when you are at home as accidents can happen in the initial stages, when you are trying to hold on for longer. Do not be disheartened if you have more accidents in the initial stages of training as this is to be expected. It is possible to calm down an urge by taking control of the situation and there are several things that will help. Next time you have the urge, try the following steps:

2) Pull up your pelvic floor and hold on as detailed in the exercises listed earlier.

3) If you are able to sit down, cross your legs and point your toes. If you are unable to sit down you may try standing on tip toes, crossing your legs and rubbing the backs of your thighs. (These postures sets off reflexes that calm activity of the bladder)

By calming the urge using these techniques you will gradually be able to increase the time it takes you to get to the bathroom.

Commonly women get caught short as they arrive home and try to get the key in the door. The fact that they know they are only yards from the bathroom sets the bladder off into waves of urgency that are quite inappropriate. Ask your friends if they experience this – you will be surprised that you are not alone!

If you think you suffer with any degree of stress or urge incontinence and / or you think you may be in the early stages of a prolapse, cystocele, or rectocele it is important for you to discuss this with your doctor, practice nurse or your local chartered physiotherapist specialising in women’s health. Your GP may prescribe you a simple exercise routine or will refer you to physiotherapy for a more detailed assessment and individual treatment plan or to a gynaecologist. His preferred referral will depend on his / her assessment of the severity of your condition.

How can physiotherapy help?

Physiotherapy is often the first step taken to help correct pelvic floor disorders.

By means of a simple and painless vaginal examination a physiotherapist is able to establish the strength, endurance, quality and structure of the pelvic floor. By doing so a unique exercise and bladder training programme for each patient can be developed. The aim is to strengthen the pelvic floor in order to provide greater support to the bladder, bowel and vagina thus reducing symptoms. Many women may avoid the need for surgery and in others where surgery is unavoidable, a strong pelvic floor will provide the best possible chance of success in the years following surgery.

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