Pelvic Floor Muscle Training

Pelvic floor muscle training focuses on increasing awareness and strength of the pelvic floor supports. The goals of pelvic muscle training are threefold:

  • To strengthen the contraction of the muscle around the urethra and bladder neck;
  • To regain the ability to unconsciously contract these muscles (eg. Prior to a sudden unexpected sneeze);
  • And to better activate these muscles voluntarily prior to straining or other increases in abdominal pressure.

As an added benefit, the increased awareness of these muscles may lead to increased pleasure during sexual activity

  1. Understanding the Anatomy

    These drawings show the hammock-like layer of muscles called the pelvic floor, which supports the organs in the pelvis, namely, the bladder and urethra (and prostate in a man), the vagina and uterus (in a woman), and the rectum. When these muscles are weakened or damaged, the position and function of the organs can change. These pictures also demonstrate how the pelvic floor muscles are closely linked to the external sphincter, or valve muscle, which helps control urine flow

  2. Methods of Pelvic Floor Muscle Training

    There are many techniques of improving pelvic floor tone and strength, and our pelvic physiotherapist can help develop a program that is best suited to your needs. The most commonly employed include:

    • Kegel exercises
    • Biofeedback
    • Devices (eg. Weighted cones)
    • Electrical stimulation
  3. Kegel Exercises

    Kegel exercises can be done anywhere anytime, and require no assistance or props, once you are doing them correctly. The keys to succeeding with Kegel exercises are to learn to identify the muscles properly, and to stay motivated and perform them regularly. Working with a trained therapist is the best way to ensure success.

    To identify your pelvic floor muscles, try squeezing around 2 fingers placed in the vagina or rectum, or imagine contracting the muscles that would stop your urine flow. DO NOT, however, perform the exercises during urination – this is just a method to help you understand the muscles involved. Another way to identify the pelvic floor muscles is to imagine the muscles you would need to use to fight off the urge to pass gas.

    If you have doubts about your ability to identify these muscles, it is best to consult our pelvic physiotherapist; otherwise, you may be wasting your time. It is a fact that some women simply cannot identify these muscles properly.

    How to do them:

    1. First empty your bladder.
    2. Contract slowly for a count of 1-2-3-4-5, and then relax for same count
    3. Now repeat this but with quicker contractions to work the fast-twitch muscle fibres
    4. It is equally important to RELAX the muscle for the same time after each contraction
    5. One set of exercises consists of five slow, followed by five quick contractions
    6. Start by doing 10 sets, three to five times per day, then
    7. Increase the number of sets by five every week, until you can do 10 sets 10 times per day

    Start in a reclined position (head on pillow, knees bent, legs slightly apart), then seated (upright on straight-backed chair, feet flat on floor, knees slightly apart), and finally standing (lean on back of chair or counter, hips flexed, knees slightly bent, toes pointed outward) as you become more comfortable with them. Remember, you must practice daily to make the exercise a habit. Make them part of another daily routine, like brushing your teeth, talking on the phone, or sitting in the car at a red light.

    You should begin to notice improvements in 8 weeks or so. You must continue to perform these exercises lifelong to maintain pelvic muscle strength and tone

    Along with regular exercises, contract your pelvic muscles when needed to control bladder symptoms, such as to suppress a sudden urge to urinate and keep it suppressed while walking to the bathroom, or to prevent leakage prior to a cough, sneeze, golf swing, etc.


  4. Biofeedback

    Biofeedback is a type of therapy usually performed by a pelvic physiotherapist or nurse. The goal of biofeedback is to enhance the effectiveness of pelvic muscle training. Biofeedback uses sensory signals to give feedback as to the effectiveness of an attempted contraction or relaxation of muscles. These signals may be auditory, visual, verbal, or tactile.

    There are several situations where biofeedback may be of great use:

    • To enhance pelvic muscle training for overactive bladder and urinary incontinence.
    • To improve pelvic floor relaxation during urination.
    • For the treatment of pelvic pain secondary to excess muscle tension.

    Biofeedback also allows one to quantify muscle strength, which gives important information about where you are starting from and how your therapy is progressing.

    Typical methods of biofeedback include:

    • Placing fingers in vagina or rectum to gauge pressure.
    • Use of a probe in the vagina or rectum, which is connected to a meter or electrical signal device called an EMG.
    • Skin patches connected to a similar signalling device.

    Weighted vaginal cones are another type of biofeedback tool. They are progressively shaped narrower and heavier so that the heaviest one is also the narrowest and thus the most difficult to retain. Patients place the heaviest cone they can retain by actively contracting their pelvic muscles in the vagina and attempt to retain it for at least 10 minutes. Once each weight is mastered, the next heaviest one is used. This needs to be done at least twice a day over a long period of time, just like bodybuilding, to be effective. These are obviously not for everyone, but can be an effective method of pelvic muscle strengthening that can be done at home with minimal supervision.

  5. Electrical Stimulation

    Pelvic floor electrical stimulation (PFES) is available at some centres. It can be a helpful assist to pelvic muscle exercises, but does not replace them. This treatment involves the application of a low-grade electrical current to the pelvic muscles. This serves to:

    • Stimulate muscle activity and further strengthen them.
    • Inhibit bladder contractions (thereby reducing symptoms of bladder urgency).
    • Improve pelvic muscle relaxation.

    PFES is usually taught by a dedicated therapist, and is continued at home.

  6. Relaxing the Pelvic Muscles

    It is important to remember that just as we need to learn to actively contract our pelvic muscles to help combat overactive bladder symptoms and incontinence, we must also focus on relaxing those same muscles while urinating. Poor relaxation of the pelvic floor during urination can worsen many bladder symptoms, and can lead to retention of urine and bladder infections. Pelvic floor relaxation should be the first step to initiate urination, and this relaxation must be maintained through the entire void. To do this, take plenty of time, relax, and breathe slowly while urinating, and try not to strain if it can be avoided.