What are the Pelvic Floor Muscles (PMF)?

The PFM are a number of small muscles that form a fibrous hammock that support the contents of the abdominal cavity. In order to visualize their action more clearly cup your hands in front of your body with palms upwards; then imagine that running through the center of your hands are three tubules representing the urethra, the vagina and the anus. The action of the muscles is to draw together opening and closing the tubules.

The PFM therefore have several functions. They help prevent the leakage of urine and faeces. They allow us to contract the walls of the vagina during sex and they give support to the abdomen during activity.

What Causes Pelvic Floor Muscle Weakness?

Unfortunately like any other muscle the PFM can be damaged by overuse or stretching and weakened by too little use. Factors that contribute to this process are:

Prolonged or difficult labor,

Multiple pregnancies,

History of constipation and straining,

Hormonal changes approaching menopause,

Lack of exercise and increase in general weight.

Signs and Symptoms of Weak PFMs

There are several presentations of weak PFM but for the sake of simplicity we will divide these into two categories - stress incontinence and stress detrusor.

Stress Incontinence is where due to a weakening of the muscles there is an inability of the muscles to adequately close off the urethra or the anus. This usually manifests itself with some seepage of urine or faeces. This can be relatively minor, i.e. you have a full bladder and cough and have a slight leak or can be quite restrictive with a constant seepage of urine during the day. In severe cases you may find that the uterus has herniated through the hole in the PFM and protrude into the vagina, this is referred to as a prolapsed uterus. A prolapse is characterised by a dragging feeling in the pelvis and on self examination you may be able to feel the uterus. In the case of a bladder prolapse there will be a feeling of not having completely voided and generally there is an increase in the frequency of Cystitis or thrush type infections.

Stress Detrusor refers to incontinence problems that are related to the nerve supply of the bladder and the PFM. These are characterised by a sudden urgency to urinate and can be followed by a sudden emptying of the bladder. This type of incontinence whilst thankfully being less common is also more difficult to treat and prior to any other kinds of treatment should be investigated by a Urologist or Neurologist

The majority of patients that I see in the clinic fall into the first category, they have a history of some leakage occurring after their first pregnancy that may initially resolve but which becomes progressively worse after each subsequent pregnancy or deteriorates as they approach the Menopause. Why this occurs is that there is a decrease in the level of oestrogen at this time. The function of oestrogen among many other functions is the maintenance of the elastin components of our tissue. In real terms it means that the walls of the vagina and urethra become thinner and the tubes become wider whilst the muscles, which are attempting to keep these closed become less elastic. It may even be that the first indication that there are any problems is when a woman approaches the Menopause.

Another effect of a weak PFM is the diminished ability to experience orgasm. The “wave “ that is felt during orgasm is a contraction of the Pelvic floor. Having stronger muscles can therefore heighten the sensation of orgasm. Often a first sign of weakness may be urination during orgasm where the muscle is almost caught unawares.

What Can You Do?

1. Commence PFM exercises. These exercises should be done on a regular basis just like cleaning your teeth but particular care should be taken during pregnancy and post partum.
2. Avoid constipation using a diet high in fibre and fruit. Avoid excessive weight gain by exercising regularly. Take note that present research suggests that the best form of exercise for cardiovascular fitness and fat burning is low impact, medium intensity activities such as walking. Walk at least 20 – 30 minutes each day for maximum results.
3. If you are already experiencing difficulties then seek the help of your local G.P. or health professional. There are regular continence clinics run statewide that can direct you to the appropriate clinician. There is a machine used to measure the strength of your PFMs called a Periometer as well as electrotherapeutic modalities that help strengthen the muscles by causing an involuntary contraction. Ask your Dr for a referral to the local Physiotherapist who specialises in Women’s health. I like to use the Periometer not only as a means of ascertaining how strong the muscles are but also as a biofeedback for the patient.

Pelvic Floor Exercises

The problem with PFM exercises is that often if you have weak muscles you can’t feel if you are doing the exercise correctly, which is why a Periometer is handy. However there are other ways of testing. Firstly sit on the toilet with a full bladder and attempt to stop mid stream. This is only used as a test; do not do this as an exercise as you may damage your bladder. You have just used your fast fibres.

To see how the slow fibres feel insert your two fingers into the vagina and try to squeeze your fingers or alternatively try to squeeze your partners penis during intercourse.

The exercises can be done in any position but for the novice I would suggest finding a quiet place and either lying on your back or relaxed sitting. Now close your back passage, close your front passage and then imagine your muscle pulling in and up. Imagine and elevator ascending, hold for five and then let go slowly imagining the elevator descending. Repeat this five times.

Remember these are very small muscles and they fatigue really easily. After monitoring patients and speaking to colleagues I find that there are very few women who continue to feel a contraction after a hold of five counts. If you have weak muscles you may have no sensation of lifting at all at the start. These are also like any other muscle, you would not expect to go to the gym and walk out with bulging biceps after the first session but you will find a definite change after six weeks if you persist with the programme.

The idea is little and often the exercises should be done in sets of fives. This should be repeated at least twenty times a day. They can be done at any time and anywhere. No one need have any idea of what you are doing. What I often ask patients to do to remind themselves is to go and buy a packet of stickers e.g. dots for instance. Then stick a dot on your fridge, the steering wheel, the light switch, and the bathroom mirror and every time you see a dot you do five PFM.