For the first 2 months of teaching my first Pilates class, I would psyche myself up every week to teach pelvic floor exercises and then chicken out of doing them at the last minute. I’m sure I’m not the only one and looking back I think the reason I didn’t want to talk about it was simply because I didn’t know enough about it. I was worried that if I opened the door to the world of pelvic floor, then people would ask me questions I didn’t know the answers to. They might also (God forbid!) start to tell me their pelvic floor problems and ask for advice, and as an 18 year-old newly qualified instructor, I didn’t feel qualified or mature enough to answer them.
Then something happened. I walked into my class and the first words out of my mouth were “PELVIC FLOOR…… is what we are going to concentrate on today.” Once I had said those words out loud and no-one laughed, it was fine. From that day on (and this was 15 years ago) I have always given the best explanation of pelvic floor that I can to help people get over their embarrassment and to encourage them to actually work their pelvic floor, not shy away from it.
Pelvic floor is the group of muscles connecting your pubic bone and your tail bone. Both men and women have them and they form a sling under our abdomen to keep the bladder and bowel (and for females the vagina and uterus) in place. That’s right - these muscles keep your insides in and prevent the contents of your bladder and bowel from escaping. If you are in the fortunate position of having no pelvic floor issues you can begin to appreciate how important it is to keep it that way. Even though you can’t see these muscles from the outside, you can still strengthen them in the same way that you can strengthen the muscles in your arms and legs.
The muscles in your pelvic floor allow you to control the release of urine and faeces until it is convenient for you to do so. They contract around the openings, allowing you to keep control. For men, they also assist in erectile function and ejaculation. For women they can voluntarily contract (squeeze), adding to sexual arousal. So for both sexes, strong pelvic floor muscles will save you from embarrassing toilet accidents and enhance sexual pleasure. Why wouldn’t you want to keep this magical sling of muscles in tip-top shape?
Anyone can and you wouldn’t even know it. Studies show that many athletes (runners and gymnasts in particular) can suffer from this condition. Almost 30% of women who give birth vaginally are incontinent as a result and that figure rises with the age of the mother and number of births. Obesity is a cause, as is prostate surgery in males. If you are lucky and none of these get you, then age is also a cause and unless you continue to train these muscles, like any other, they will atrophy and become weak. If you are unlucky enough to suffer from PFD, then strengthening the relevant muscles is your lifeline and cure. In some cases surgery is the only option and would still need pelvic floor exercises as part of the recovery.
A few good quality pelvic floor squeezes are worth more than lots of half hearted ones. For both sexes, training your pelvic floor involves squeezing the muscles around your anus and where you pass urine and lifting up inside. This control can be hard for people to master and hard for an instructor to teach as there is no way of knowing if your clients have done what you’ve asked. All you can do is explain, talk about where the muscles are, what it feels like (as if you are trying to stop yourself urinating and passing wind) and hope that after a few weeks they will understand and participate. I have been asked many times what the ‘best’ pelvic floor exercise is and I only have one to pick from - squeeze and lift. That’s it. I don’t have the ability to then rotate it or move it side to side. To strengthen it, you first need to locate it, learn how to squeeze it and then lift it. This can be done at different speeds and intensities and in the case of most Pilates exercises, held at 30% throughout. If going to a Pilates class is what it takes to remind you to activate your pelvic floor, then do it. You will get many other wonderful benefits. If you are happy engaging and strengthening your pelvic floor muscles, then perhaps give yourself a cue to remember such as a red traffic light or when answering the phone. Whatever your cue, try to make it something you do several times each day and just take a moment to focus, squeeze and lift. You must take time to save yourself from PFD and no-one will even know you’re doing it.
Written by Heather Oakes