Hello friends! It’s time for part three of four of our series on how to train your pelvic floor muscles. In steps one and two we learned how to identify and isolate those muscles. Step three requires that we improve the muscles, but what does that mean?
Webster’s dictionary defines improve as “to make better.” Making the pelvic floor better requires that we answer a few questions first: Where are we now? Where do we want to be? How can we get there?
Here are a few scenarios to consider:
You may be newly postpartum having urinary leakage every time you pick up your new baby, especially if they are in their car seat. This requires good power of the muscles and good coordination to turn on and engage at the right time.
You may be recovering from surgery to have your prostate removed and you are having urinary leakage constantly throughout the day. This requires good endurance of the muscles to be able to function properly while we move around throughout the entire day.
You may be struggling with chronic constipation and it seems like the harder you try, the harder it is to poop. This requires good coordination and flexibility of the muscles to be able to lengthen and open when we try to poop.
You may wonder why you are having so much pain with sitting or with intercourse. This requires the ability to control the muscles to prevent them from tensing and engaging all the time causing more pain.
The list goes on and on, but one of the reasons pelvic floor muscle training can be so complicated is because it often looks different for everyone. Keep in mind the information is this blog is not intended to be medical advice. While we are pelvic floor therapists, we are not your therapists and this information does not replace examination and treatment by a licensed healthcare provider. The scenarios we talk about are examples but are by no means all encompassing.
Now that you’ve learned to identify and isolate the pelvic floor muscles in steps one and two there are several factors that we can improve in step three:
Muscle strength: can your muscles create enough strength to do the job needed of them? This often entails a strong but quick contraction.
Muscle volume: how much muscle mass is there? In general, the more muscle volume there is the better the pelvic floor can do their job of supporting the pelvic organs.
Muscle tension/tone: how do the muscles feel are rest? Are they very tight and tense, very squishy, or somewhere in between?
Muscle endurance: can your muscles work for long periods of time without getting tired? They need to be able to function all day long to do their jobs well.
Muscle coordination: do your muscles engage or let go at the appropriate times?
It’s important that the muscles have good coordination to be effective. While a muscle can be strong, if it’s not coordinated enough it may not do it’s job properly. For example, if we are running or lifting we need the muscles to squeeze and engage as we strike the ground or lift. If the muscles squeeze and engage at the wrong times, or not at all, we still may experience symptoms like urinary incontinence even though the muscles are strong when we test them.
Once you figure out what your muscles do well (or don’t do well) here are some techniques that you can use to improve them.
Uptraining: This involves strengthening the muscles to get stronger contractions that can be held for longer periods of time. People often refer to these as Kegel exercises. Be sure to practice both quick, strong contractions and longer endurance holds. If you have pelvic pain, this is not the best first step and consider down training exercises first.
Down training: This involves working on lengthening the muscles and letting go. Different techniques like deep breathing or biofeedback can help with this. Often times with tense pelvic floor muscles or pelvic pain, the muscles have a hard time figuring out how to relax or turn off. This may also incorporating stretches to help encourage the muscles to let go.
Coordination training: Can you do two things at once? Can you talk and engage the pelvic floor at the same time? This is an important skill to learn but can often be challenging at first. Engaging the pelvic floor muscles while doing anything else can often feel like trying to rub your belly and pat your head at the same time. The two tasks by themselves might not be challenging, but the brain often struggles to do both at once. The good news is that with practice our brain and our muscles can become experts at coordinating the pelvic floor with other tasks
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Functional training: Don’t just practice pelvic floor muscles while laying in bed. It’s important to practice using these muscles with activities like exercise, chores, and more.
Technology assisted training: There are so many different options on the market these days. This can range from internal biofeedback devices, rehabilitative ultrasound imaging, electrical stimulation, and more. Many of these technologies are expensive and you may only find them in a rehab clinic, but there are some at home devices like the Elvie.
Hands-on training: This is one of the most effective ways to train your muscles. A trained pelvic physical or occupational therapist can help you figure out what your muscles need and how to do it. You can ask your provider for a referral to a pelvic floor therapist near you, or find one at www.mypfm.com/find-a-pt.
Ready to learn more about pelvic health? Here are some helpful resources:
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 BasicsOrder myPelvic Bra perineal support
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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