You know you need to keep your hamstrings, abdominals and biceps strong and toned. But just as you exercise your other muscles, it’s important to do regular pelvic floor exercises too. Although you can’t see your pelvic floor muscles, their strength plays a key role in your bladder and bowel function, your sex life and for women, your experience of childbirth and beyond. Here's what you need to know about strengthening a weak pelvic floor.
Where exactly is my pelvic floor?
Your pelvic floor is made up of a group of muscles that lie across the base of your pelvis, stretching from the tailbone (coccyx, at the bottom of the spine) to the pubic bone at the front, and between the bones that you sit on. These muscles support and protect the pelvic organs (the bladder, bowel and uterus) when you’re standing, walking, bending, or lifting.
Together with the abdominal muscles, your pelvic floor is important for posture and to support your spine. Strong muscles prevent urine from leaking from the bladder. These muscles relax when you go for a pee or open your bowels, tightening again afterwards. Toned, healthy pelvic floor muscles can also help enhance sensation and enjoyment during sex.
You can feel your pelvic floor muscles if you try and stop the flow of urine when you go to the toilet. Or, for women, pretend to tighten your vagina around a tampon.
What causes a weak pelvic floor?
Just like any muscle, your pelvic floor will naturally weaken over time. But there are many other reasons why your pelvic floor muscles may become weak, overstretched, too tight or torn.
Some of the things that can weaken your pelvic floor include pregnancy and childbirth, especially if you had an episiotomy or tearing and the hormone changes associated with menopause. Chronic constipation, being overweight or overexercise may also play a part.
What are the signs that I have a weak pelvic floor?
Some of the signs that it would be helpful to strengthen your pelvic floor include:
- Leaking urine when you laugh, cough, sneeze, jump, run, walk, exercise or during sex
- A sudden and urgent need to pee or have a bowel movement, that may include leaking
- Going to the toilet too often (more than 8 times a day)
- Regularly getting up at night to pee
- Decreased satisfaction during sexual intercourse or painful sex
- A feeling of heaviness, as if something was bearing down, in the pelvis or abdomen
- Lower back pain
Is it normal to pee every 30 minutes?
It’s normal to empty your bladder 5-8 times a day, according to the NHS. But, if you’re peeing more frequently, particularly if it’s every 30 minutes, this suggests there may be an underlying problem like a urinary tract infection (UTI) or overactive bladder syndrome. Or, it could be a sign of diabetes, particularly if you also have other symptoms like feeling thirsty, tiredness, itching, blurred vision or cuts and wounds that are slow to heal. Talk to a doctor if you’re concerned.
What if I pee when I laugh or sneeze?
If you leak urine when your bladder is put under sudden extra pressure, you may have stress incontinence. This may happen when you laugh, sneeze, cough or exercise. Normally when you laugh or sneeze, your pelvic floor muscles contract to prevent urine from leaking. But when muscles are weak, they’re not strong enough to counteract the pressure.
Stress incontinence affects around 40% of women and is more common after the age of 40 (1 in 5 have it to some degree). The most common reason for stress incontinence in men is weak pelvic floor muscles due to treatment for prostate cancer.
Can having a stronger pelvic floor make a difference to my bladder?
Strengthening your pelvic floor muscles is helpful and effective for stress and urinary incontinence. It also helps keep your sex life healthy, increasing sensitivity, leading to stronger orgasms and helping to reduce the symptoms of erectile dysfunction in men.
Can I prevent pelvic floor or bladder problems later in life?
It’s not always possible to prevent pelvic floor or bladder problems especially if, for example, you’ve sustained damage in childbirth. But leading a healthy lifestyle can help to keep your pelvic muscles healthy. Here are some changes you can make to help prevent leaks:
- Practise daily pelvic floor exercises and keep active
- Eat a healthy diet
- Drink plenty of water as it helps to eliminate waste through the bladder and bowels (constipation strains the pelvic muscles, making them weaker)
- Lose excess weight, to reduce pressure on the pelvic floor
- Stop smoking, as it can lead to coughing, which can stress pelvic floor muscles
- Avoid lifting heavy objects. If you do lift anything, always tighten your pelvic floor muscles before and after the lift
- Avoid high-impact exercise like jumping or running if you have weak pelvic floor muscles
- Take your time and make sure you empty your bladder completely each time you go to the toilet
- If you’re about to cough or sneeze, tighten your pelvic floor muscles
What are the best pelvic floor exercises?
Pelvic floor exercises are also known as Kegel’s exercises because they were originally developed by American gynaecologist Arthur Kegel, in the 1940s, as a non-surgical way to help women control urine leaks by strengthening weak pelvic floor muscles. They also work for men.
3 daily pelvic floor exercises
Exercise 1: Sit and squeeze
- Sit comfortably and squeeze your pelvic floor muscles 10–15 times. Imagine you’re sitting on a marble and tighten your muscles as if lifting the marble
- Don’t hold your breath or tighten your stomach, bottom or thigh muscles. Instead, breathe deeply and slowly
- With practice, try holding each squeeze for a few seconds. Have a rest between each one for a second or two
- Do these pelvic floor exercises for a few minutes every day and gradually add extra squeezes each week
Exercise 2: Lie and tighten
- Lie on your back with feet flat on the floor and knees bent. Alternatively, sit in a chair with your hands on your thighs, bending forwards slightly
- Tighten your pelvic floor muscles, squeeze, lift and hold for the count of 5 or as long as you can that feels comfortable. It’s important not to overdo it when you first start to do the exercises. Over a few weeks, gradually increase the time you squeeze, lift and hold to 10 seconds
- Let go and slowly count to 5. Repeat the cycle 5 times
- Try to do the pelvic floor exercises 3 times a day. But, it’s fine if you can only manage once or twice a day to begin with. The main thing is to practise these exercises every day
Exercise 3: Quick tone-up
- Squeeze muscles and let go — repeat 10 times
- Practise this anytime, for example while you’re waiting for the kettle to boil or standing in a queue
Should I talk to a doctor?
Talk to a doctor if you start to experience urinary or faecal incontinence or if you suspect you might have pelvic organ prolapse. Your doctor will arrange for tests and examinations to determine the cause and severity of the problem and advise you on the best treatments.
Depending on your symptoms, they may refer you to a specialist physiotherapist for pelvic muscle training as a first point of call. This can be very helpful, for example in managing stress incontinence. If you suffer from urinary incontinence and pelvic floor exercises don’t help, you may need more specialist treatment such as bladder training, medication or surgery.
Likewise, if you have pelvic organ prolapse, your doctor will discuss the best options for you. These may include hormone treatment, pessaries or surgery.
Weak pelvic floor in men
Pelvic floor dysfunction affects more women than men. But it can affect men too and lead to urinary and faecal incontinence, pelvic pain and sexual dysfunction such as erectile dysfunction, premature ejaculation and reduced penile sensation.
Common causes of pelvic floor dysfunction in men include ageing, lack of exercise, surgery for prostate cancer and being overweight. Male pelvic floor function is involved in coordinating ejaculation and pelvic floor therapy has been shown to improve control (over ejaculation).
Pelvic floor muscle exercises may also be beneficial as a relevant component for erectile dysfunction. Always talk to a doctor if you have any concerns like pelvic pain, sexual dysfunction or pelvic floor weakness after surgery.
This article has been medically approved by Dr Rhianna McClymont, Livi Lead GP.