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Exercising the pelvic floor

Many symptoms tend to get better with time and exercise. It’s often recommended to try regular pelvic floor exercises three times per day for 3-6 months. Wait out the first year to see how the problems are affected by it. To maximize and get the most out of your pelvic floor exercise, do them when you are fully engaged, i.e., not while cooking or when you’re in the car.

Identification squeeze

In order to find your pelvic floor muscles, it can be good to lie down in a comfortable position, either on your back or your side. Try to enter a relaxed state where the body is in harmony; take a deep breath. Try to squeeze around the rectum as if you are resisting passing gas, and at the same time, try to squeeze around the vagina and urethra. Try to imagine that you are holding back urine; this is a good approach to activate the right muscles.

The feeling should be that your openings are closed and possibly that you also feel a lift of the muscles inside the body. You should hold this squeeze for about 2 seconds, then release it and completely “open up.” Repeat this 5-10 times. Don’t forget to practice completely relaxing the pelvic floor between each squeeze. This is just as important as the squeeze itself. If it feels challenging, take a deep breath and clear your mind to find a helpful focus.

Strength squeeze

Once you have identified the right muscles and found the right technique, you can start increasing the force of your squeezes. These exercises are called kegel exercises, and you are supposed to use maximum pressure to hold the tension for about 5-8 seconds. You should repeat this 3-10 each workout. If it’s challenging and you can only hold max force for about 3 seconds, that’s fine. This will be your starting point, and the goal is to move up to 8 seconds gradually. When doing this, you should relax all external muscles such as glutes, thighs, and abdomen. Don’t forget to practice completely relaxing the pelvic floor between each squeeze.

Endurance squeeze

Endurance squeezes means that you are trying to keep the squeeze for longer but with less force. Bring in about half of your full power, enough for you to be able to talk and breathe normally. Hold the endurance squeeze for 10-20 seconds and gradually increase it to hit 2 minutes. Repeat this 1-2 times each training session.

Functional squeeze

Suppose you are bothered by leakage, feeling heavy when coughing, sneezing or lifting heavy, for example. In that case, you can learn to consciously perform a strength squeeze as a precaution to counteract the increased abdominal pressure that will occur. This can help you avoid the mentioned problems.

Positioning

Suppose you want to experiment with the difficulty level of your training, then you can try different positions. Lying positions are relieved from the law of gravity and are therefore often easier. Four-legged positions, sitting or standing, are more difficult as it gets heavier. Play around and see what feels best for you, and don’t be afraid of raising the bar to make your workouts more challenging as long as it feels ok.

General training for pelvic floor symptoms

Here, individual advice is often needed based on your particular problem and your pelvic floor. Try to adapt your general training so that the pelvic floor signals are as mild as possible. Ideally, training should take place without, for example, feeling heavy or experiencing urine leakage.

Try the following to see if you can continue exercising but without symptoms:

  • Don’t hold your breath when exercising - breath as you squeeze
  • Don’t tighten your stomach unless you have to. Stomach tension increases the pressure down towards the pelvic floor.
  • Lower workload / Lower intensity / Lower weights.
  • Reduce the training or add extra rest days.
  • Change positions - laying and sitting will relieve tension on the pelvic floor compared to standing.
  • Strengthen the muscles around the pelvis (legs, back abdomen, glutes) to relieve the load on the pelvic floor.
  • If running or walking increases your symptoms, try cycling or standing on a cross-trainer instead.
  • Try aids such as tampons or menstrual cups during exercise for increased support from within. Be aware of any chafing or possible discomfort.
  • Adapt the training to the menstrual cycle if you feel that it affects you.

Contact a physiotherapist if you have tried the tips above and still experience symptoms or issues when conducting your pelvic floor exercises. They have competence within women’s health and will help you examine your pelvic floor.

Sources: - Bø et al. Second Edition 2015. Evidence-based Physical Therapy for the Pelvic Floor.
- Regberg Lundborg. Balkong Förlag 2017. Gravidkraft - Hälsa genom rörelse och träning - Lind, Rotstein, Fernando, Olsson. Gothia fortbildning 2020. Bäckenbotten och förlossningsskador - Handbok för barnmorskor
- Bäckenbottenutbildning med ursprung i ”Säker förlossningsvård” 2021. backenbottenutbildning.se
- Goom et al. 2019. Returning to running postnatal - guideline for medical, health and fitness professionals managing this population. - Faubion et al. 2012. Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction