Pelvic floor exercises have been shown to be important and effective for treating pelvic health conditions, such as Pelvic Organ Prolapse and Incontinence.
If you have been told to exercise your pelvic floor, you may be unsure about how to connect with these muscles, in order to exercise them effectively.
Furthermore, different clinicians and practitioners may use varying ‘cues’ or visual imagery to help you to engage your pelvic floor muscles, and as these differ so greatly, they may be confusing and what may work for one person may not work for another.
Here are some examples of cues that are often used to help to encourage pelvic floor activation. Try some of them out and notice if any are easier to perform than others.
- Squeeze the muscles around your front passage as though you were stopping the flow of urine
- Imagine you are picking up a blueberry with your back passage then lift it up inside as much as possible
- Imagine a guide wire that is connected from your anus to your tummy button. Visualise that guide wire becoming tighter, drawing those two points closer together.
- Draw your sitting bones together and lift up
- Imagine you are stepping into an elevator. As the doors close, tighten the muscles around your front and back passages, as you imagine the elevator lifting up, draw the pelvic floor muscles up too.
We know from the literature that not all women will activate their pelvic floor muscles correctly and some find it very difficult to connect with them at all. Therefore despite several different cues, they may still not be working their pelvic floor correctly. Certain conditions including Pelvic Organ Prolapse and Stress Urinary Incontinence have also been linked with incorrect pelvic floor activation in women and women with these conditions often find it even harder to engage their muscles.
The best way of knowing for sure if you are activating your pelvic floor correctly is to have an internal vaginal examination by a Women’s Health Physio, or alternatively an ultrasound scan assessment of pelvic floor muscle function. However, in light of the current COVID19 outbreak, these are not services that may be readily accessible. Therefore, we must utilise the best knowledge available from research studies to help guide you to perform the best quality contractions possible, when you are practising these exercises on your own.
Common errors in pelvic floor activation that I see frequently in clinic include;
- Squeezing the buttocks or inner thigh muscles
- Bracing the tummy muscles
- Breath holding
- Bearing or pushing down into the pelvic floor instead of drawing the muscles forwards and up.
To achieve a correct pelvic floor muscle contraction, we want all areas of the pelvic floor working during a contraction [the front, middle and back] to close off the urethra and offer structural support.
A recent research study carried out by Ben Ami and Dar [2018] looked at the best cues for Pelvic Floor activation in 57 Physiotherapy students without symptoms of pelvic health dysfunction. They investigated different cues including “Squeeze around the Anus” and “Stop the flow of urine”. They found that 90% in the posterior group [“Squeeze around the anus”] achieved a correct pelvic floor activation, compared with 65% in the anterior group [“Stop the flow of urine”]. This suggests that activating the muscles from the back is more effective than working from the front. Interestingly, this study also found that cueing from the Transversus Abdominus in the lower tummy [commonly recommended in Pilates as a method for activating the pelvic floor], caused a downward movement of the pelvic floor, possibly due to alterations of pressure pushing downwards.
This is an interesting finding as the cue “Squeeze around the anus” is easy to do, most women would be able to perform that contraction without any visual imagery required and the results of this research support this with 90% of subjects achieving a correct activation from that particular verbal cue.
So give it a try next time you practice your pelvic floor exercises and see if it works for you!
For further guidance or information regarding your pelvic floor exercise program please do contact us directly for advice.
Ami N.B, Dar G [2018]. What is the most effective verbal instruction for correctly contracting the pelvic floor muscles? Neurourology and Urodynamics. 37, 2904-2910
