Hi friends! Welcome to part one of how to train your pelvic floor muscles. This week we are going to talk about how to find the pelvic floor.
For most people, the pelvic floor muscles work automatically and we don’t need to think about how or when to use them. However, when something goes wrong and these muscles start having difficulty doing what they need to do, we start to think a little more closely about how to work these muscles.
Let’s start by reviewing the four main functions of the pelvic floor muscles:
Support: The muscles sit at the bottom of the pelvis and create a hammock to support organs like the bladder, rectum, and uterus or prostate.
Sphincter: The muscles contract and squeeze to keep pee and poop in and relax and let go to allow pee and poop out.
Stability: The pelvic floor muscles work with other muscle groups like our back, abdominals, and diaphragm to help stabilize our core and keep our bodies moving strongly.
Sexual: The muscles are active during sex and orgasms and help with tone, sensation, and maintaining erections. While tone can improve pleasure for both partners, the pelvic floor muscles need to be able to relax at the right times so that entry and sex are painless.
When the pelvic floor muscles aren’t working properly, we can have issues with any of those functions. So how do we find the pelvic floor muscles to start training them to make sure all four functions are working well?
The pelvic floor muscles sit in the bowl of our pelvis and span from the pubic bone in the front to the tailbone in the back. The muscles are covered by skin on the outside so we can’t see them directly, but we can see and feel movement of the muscles either contracting/squeezing or relaxing/letting go. Here are 7 ways to help find the pelvic floor muscles.
#1 Place a finger on or in the anus
As the pelvic floor muscles contract and squeeze, the anus will close and help to keep poop and gas in. By placing a finger at the anal opening, when you squeeze you should feel the anus tighten and close. As the muscles relax, you should feel the anus slightly open. If you don’t feel the muscles doing the right thing at the right time–say they are tightening when you are trying to relax and let go–you may have pelvic floor dysfunction. A pelvic floor physical or occupation therapist can be a great resource to help you learn how to coordinate the muscles so that they do the right thing at the right time.
#2 Use a mirror to look
We can use a mirror to visualize the pelvic floor muscles. We can use two different reference points to see movement of the pelvic floor muscles: the anus and the perineal body. When looking at the anus, as the pelvic floor muscles squeeze you should see the anus tighten and close and it make look like it is raising towards our trunk. We can also use the perineal body as a reference. The perineal body is the area between the vaginal opening and anus in females and the scrotum and anus in males. As the pelvic floor muscles contract, this small area should rise up towards our heads and abdomen. As the muscles relax, we should see this area gently lower down towards our feet. Note for most individuals this movement is small.
#3 Fingers in “C” pushing up
You can feel a small part of the pelvic floor muscles from the outside by using your hands. While sitting, wrap your hands around your sit bones putting your hands in a “C” shape. Once you find the sit bones, bring your fingers slightly towards the middle of your body. Your fingers should feel the change between the hard surface of the sit bone and the soft tissue. The soft tissue is called the ischiorectal fossa. As you try to contract and squeeze, you should feel the muscles bulk up (like flexing your biceps). You shouldn’t feel the muscles bulge down into your hands. As you try to let the muscles go, you should feel the muscles soften.
#4 Finger on tailbone
When things are working properly, the tailbone (also called the coccyx) should move as the pelvic floor muscles contract and relax. As the muscles squeeze the tailbone tucks under, like a dog tucking their tail between their legs. As the muscles relax and let go, the tailbone extends out in the opposite direction. You can place your finger on the tailbone and feel for this movement, but note that some individuals have limited mobility in their tailbone even if the pelvic floor muscles are contracting and relaxing properly. To find the tailbone, slowly press along the skin and follow down between your buttcheeks, you will find the tailbone right before you get to the anus. Feel for the movement as you try to squeeze and relax your pelvic floor muscles.
#5 Urine stop test
As the pelvic floor muscles contract, they close off the urethra to prevent pee from being able to exit the body. When we try to pee, the muscles should relax and let go so that pee can come out. If we start to squeeze the muscles while peeing, this will stop the stream of urine because the urethra will close off. If the muscles are weak or uncoordinated it will be difficult to stop the flow of urine. Once the muscles let go, the stream of urine should start again. While this can be a good way to find the muscles, it’s important not to practice pelvic floor muscle exercises while peeing to prevent issues like urinary retention from developing
#6 Finger on or in the vagina
Similar to the anus, placing a finger at the vaginal opening can help to find the pelvic floor muscles. As the muscles squeeze and contract, the vaginal opening should get smaller and if your finger is inserted inside you may be able to feel the muscles wrap around your finger. As the muscles relax and let go, you should feel the vaginal opening lengthen. Make sure to wash your hands before placing your finger in or around the vagina or anus.
#7 Sing
Our voice can change our pelvic floor muscles because of it’s connection with other muscles like the diaphragm. When we sing words like “EEEK” to help contract and squeeze the pelvic floor muscles. Use words like “GRRR” to help the muscles relax and let go.
If your muscles aren’t responding in the ideal way, try another cue or try another option to find them. As always, Pelvic therapists are here to help you! This content is not medical advice and does not replace evaluation by a skilled healthcare provider. Most pelvic therapists are physical therapists or PT’s but there are a growing number of occupational therapists or OT’s too. To find a therapist near you ask your provider for a referral or find one at www.mypfm.com/find-a-pt.
Ready to learn more about pelvic health? Here are some helpful resources:
Find a pelvic floor PT or OT near you at www.mypfm.com/find-a-pt
Order you myPelvic Bra perineal support
Watch Netflix for Your Pelvic Floor at Pelvic Flicks
Watch our YouTube playlist on Pelvic Floor Muscle Training
Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics
Sign up for our email newsletter!
Visit our Instagram page for more on pelvic health.
For providers, check out myPFM Academy to learn more so you can better help your clients. With two membership options, you have access to courses, a growing library of patient handouts, hundreds of custom sharable images and infographics, and multilingual resources. At myPFM Academy you’ll find courses like:
Pelvic PT Evaluation of the Pelvic Floor Muscles with Dr. Samantha Richter, PT, DPT, WCS
Pelvic Floor PT and OT How-Where-What: How to Become One, Where They Work, and What They Do with Jeanice Mitchell, PT, MPT, WCS, BCB-PMD
New Structure for PFM Assessment Using ICS Terminology with Beth Shelly, PT, DPT, WCS, BCB-PMD
Written by Emily Reul, PT, DPT
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