What is the pelvic floor?
The pelvic floor is a group of muscles and ligaments that support the bladder, bowel and uterus consisting of the levator ani, coccygeus, piriformis, obturator internus and many ligaments. These muscles and ligaments attach at the front to the pubic bone, posteriorly to the coccyx and sacrum (tail bone) and to the base of the pelvis.
What do the pelvic floor muscles do?
The muscles are used to support the pelvic organs in order to prevent urinary/faecal incontinence or prolapse of the organs. They also help with control of bladder and bowel function and help in the stabilisation of the spine. They do this by working with the respiratory and back muscles as part of the core to help regulate abdominal pressure. Ideally, as the spine is loaded (we lift something heavy) the abdominal muscles and back muscles draw in in order to support the spine and the pelvic floor muscles lift up. If this system is not working, one will usually hold their breath, not engage the pelvic floor and place excess pressure onto the bladder and bowel and these muscles. When this happens repeatedly, the ligaments and muscles can weaken leading to leakage or prolapse.
What else can cause the muscles to weaken?
· Lack of exercise/movement
· Pregnancy & Labour
· Heavy lifting
· Prolonged coughing e.g. chronic bronchitis or asthma
How do they affect the spine?
The pelvic floor attaches to the pelvis, sacrum and coccyx. It receives power from the spinal nerves originating in the lumbar spine, running through the pelvis. Therefore, correct movement and function of the pelvis and lumbar spine is vital in ensuring that the pelvic floor works optimally and recovers quickly. This means that when people focus only on pelvic floor exercises, they are forgetting that without movement of the spine, these exercises are largely ineffective.
What exercises should be avoided?
Exercises that increase the pressure within the abdomen will place more stress through the pelvic floor and therefore should be avoided or modified.
· abdominal exercises
· deep lunges
· lifting heavy weights
· dead lifts
· full push ups
· chin ups
Exercises that place downward pressure on the pelvic floor can stress these muscles.
· high impact classes
· star jumps
So, what exercises are ok?
For cardio exercise, the types of exercise listed below are great!
· low impact exercise class
For resistance work, most supported exercises will decrease the pressure placed on these muscles and ligaments.
- Any seated exercises- bicep curls, knee extensions etc.
- Dumb bell exercises on the swiss ball
- Shallow narrow squats and lunges (with or without the swiss ball)
- Wall push ups
- Use the pelvic floor muscles during exercise to support the core.
- Remember good posture when lifting to provide support for the spine through the core and pelvic floor.
- Don’t forget to breathe normally- do not hold your breath with lifting as this puts excess pressure on the pelvic floor.
- Avoid lifting heavy weights and lift weight from waist height not from the floor.
- Try to keep the feet close together as this makes it easier to activate the pelvic floor and protect these muscles and ligaments.
- Build strength in the pelvic floor gradually.
- Be careful when feeling fatigued and rest between sets to allow the pelvic floor to recover and to avoid injury.