DIY Approach to Exercising the Deep Pelvic Floor Muscles

 Starting with the technique to exercise the ‘slow twitch’ muscle fibres:

• Sit upright on a firm surface and a soft support in the hollow at the base of your back

• Relax and release. Allow your belly and pelvic floor to completely flop. 

• When you did your pelvic floor self-assessment how long could you hold on for let’s use a 5 second hold as an example

• Focus on the circle of muscle around your bum hole and tighten it as if you’re stopping yourself breaking wind, closing your back passage

• Focus on that lifting upwards and forwards movement and include your vagina and  bladder outlet .

• Be aware of that sensation of drawing your undercarriage upwards and forwards

• Hold that position for 5 seconds and then release

Can you co-ordinate your breathing pattern?

• On an ‘in’ breath allow your belly to swell like a balloon and do a belly and pelvic floor flop 

• As you breath gently out imagine you’re blowing gently on a hot drink

• As you blow out activate your deep pelvic floor muscles and hold that activation during the 5 second out breath

• Then let go slowly allowing your belly and pelvic floor to feel soft and released

• If you find that 5 seconds is too long to hold and when you ‘let go’ your muscle has already released then try a shorter hold time

• Give yourself a 5 second rest with a belly and pelvic floor flop between contractions.

Repeat this cycle 5 times

Let’s look at the technique to exercise the ‘fast twitch’ muscle fibres:

• On an ‘in’ breath allow your belly to swell like a balloon and do a belly and pelvic floor flop 

• Breathe out and lift your pelvic floor upwards and forwards as before but then release straight away

• No ‘holding on’ this time 

• Can you do 5 of these faster squeezes on that out breath

• Then relax and release  -  think floppy belly/soft pelvic floor

What about progressing this basic routine?

• Try each week adding an extra one second hold and one extra contraction at each session

• Eventually your three times a day work out consists of

• Holding onto a 10 second contraction 5 second rest 10 times 

• Followed by 10 of the faster ‘squeeze, lift, release’ with no hold 

Around a rate of one contraction per second.

Just remember there may be times when the exercises feel harder because fluctuating hormones effect your pelvic floor tissues. 

The DIY Approach to Exercising the Superficial Pelvic Floor Muscles ( FitClit Techniques and FitClit Exercises)

Here are the ‘FitClit’ techniques described in the video where we use gentle pressure and stretch to increase awareness and help activate those superficial sex muscles

It’s unlikely that you’ll experience and pain or discomfort with these gentle techniques and exercise suggestions but obviously if you do – then discontinue.

Lying on your side or on your back:

• Find your belly button

• Follow straight down to land on the central front section of your pubic bone and walk down onto the lower edge of your bony pubic arch. As you move over the edge of this arch you will land on the area just above the clitoral hood.

• Place the tip of your index and second finger firmly over each side of the clitoral hood

• Apply gentle pressure directly onto the pubic bone using both fingers (pressure stimulates the sensory nerves in the muscle attachments)

• Glide the tissues upwards and forwards keeping the pressure in place 

• It’s a small movement (gentle stretch primes a muscle to contract)

• Release the glide slightly

• Engage your pelvic floor muscles by trying to stop yourself having a wee

• You should feel the area under your fingers pull firmly down towards your vagina

• Visualise the movement as a blink, or pulling down a blind

• Hold the contraction for 5 seconds and then relax your muscle and completely release the pressure and glide for up to 10 seconds. 

• Gradually build up the programme to a 6 second hold 6 times, then a 7 second hold 7 times until you can manage a 10 second hold 10 times

• This needs to be done slowly over a period of a few weeks to avoid any delayed onset of muscle soreness 
  

FitClit Exercises in Sitting

These may be easier to fit into a typical day - with a little practice you can apply the gentle pressure and glide technique in a sitting position. Some women find this exercise easy and a great way to increase their awareness of movement in their superficial muscles – others find it a bit tricky.

Don’t spend too much time on it if it’s not helpful. Focus on the other pelvic floor exercise advice.

• Sit upright on a firm surface

• Lean forwards slightly maintaining the hollow at the base of your back. This slight forward roll of your pelvis aims to put pressure on the superficial muscles at their attachment to the clitoral hood

• Put your hands on your thighs

• Keeping your feet firmly on the floor, and your pelvis stable very gently push as if you’re trying to slide backwards slightly in the chair 

• Can you feel slight tension in your thigh muscles?

• Now be aware of the front area section of your pelvic floor as you practice your pelvic floor muscle contraction

• Hold the contraction for 5 seconds and then relax your muscle and completely release the pressure and glide for 10 seconds.

• Gradually build up the programme to a 6 second hold 6 times, then a 7 second hold 7 times until you can manage a 10 second hold 10 times.
  

Pelvic Floor Exercise Progressions  

Now progressions can be confusing. Some women want the bare bones of a pelvic floor exercise routine that will keep them dry and in touch with their undercarriage. 

Others want variety and advice about integrating pelvic floor activation into different fitness programmes, Pilates and yoga routines and more ballistic exercises.

There is no ‘one size fits all’ at this stage. It’s important to ask yourself a few questions when you’re participating in any fitness activity.

• What’s happening to my pelvic floor?

• Can I activate it and release it during the movements?

• Can I maintain a level of low-grade activity in it if necessary?

• Am I applying an unhelpful ‘bearing down’ pressure? 

It’s about having an awareness of what’s going on down below. Hopefully by this stage in the programme you will be more in tune with your pelvic floor and able to work out if it’s getting tired or needs to be challenged more.

Work your way through the suggestions for progressions and see what feels to fit where you are.

There are suggested links to websites that you may find helpful in DIY Signposting. 

How to Speak to Your GP or Health Care Professional About Pelvic Issues

Tip One

• Be prepared to talk about your symptoms, decide which ones are most ‘bothersome’ and how long they’ve been an issue in your life

• Don’t worry, you may consider your symptoms to be ‘toe curlingly’ embarrassing but honestly, a health professional will have heard them all before

Tip Two

• Complete a three-day bladder diary to take to your appointment. A diary can help the clinician see a snapshot of how your bladder behaves. It’s an ‘objective’ measurement to support the symptoms you’re describing

Tip Three

• Make a list to take along to your appointment because it’s easy to forget what you want to say. Make sure you list everything that’s on your mind - bowel problems, a feeling of ‘heaviness’ down below, discomfort during sex  

Tip Four 

An assessment with a pelvic health physiotherapist and most other health care professionals is likely to involve a physical examination. Here’s what to expect if you see a physio.

• Be prepared for the pelvic floor examination to be ‘interactive’ and take a few minutes to complete. Don’t be embarrassed – remember your therapist is likely to have examined hundreds of women and will have a wealth of experience in ‘pelvic floors’

• You should be comfortable, relaxed, have been given a clear explanation of what the internal vaginal examination will involve and know that you can opt out at any stage

• The assessment is likely to include:

  • Checking the skin condition of the vulva and vaginal area

  • Assessing for weakness of the front and back vaginal walls (prolapse) on coughing

  • Palpating the resting background tone of the pelvic floor

  • Assessing the co-ordination of the pelvic floor movement with muscles

  • Making sure your muscles can fully release and relax

  • Evaluating the power, speed and endurance of the muscles

  • Check your technique and ability to perform an effective contraction

  • Note areas of sensitivity, tension and tightness

  •  A test to see if there's a reflex contraction of your pelvic floor when you cough

So the internal examination may take five minutes or more but the information that’s gathered combined with the discussion about your symptoms means that your physiotherapist is likely to be able to give an accurate diagnosis and put together an effective treatment plan.