World Continence Awareness Week - Day 6 - The principles of pelvic floor training

Step 1: Technique

It's important to ensure that before you embark on a pelvic floor training programme, you are able to contract and relax the pelvic floor muscles correctly.

Weakness, trauma, disconnection, pain and a lack of pelvic floor awareness can lead to poor technique. 

A poor technique could involve the use of accessory or cheating muscles like the buttocks, abdominals or inner thighs. Or it could include gripping and overactivity of the pelvic floor that causes minimal range of movement and limited release.

It's essential to get the right technique first, and this might mean that you need to work on preparation for a programme more than the programme itself. It's a bit like decorating, the end result will be so much better if you prep the surfaces first. But the preparation phase can feel boring and frustrating! Remember, it will be worth it in the end.

Step 2: Achieving a Habit

The most common cause for failure with pelvic floor muscle training is a lack of compliance with the programme. This is the same with any muscle training; if you don't go to the gym, if you watch the exercise DVD rather than doing it, if you don't go out for that walk or run. These are all reasons for muscles to not change. 

Use it to avoid losing it! If you use a muscle, it will adapt to the demands put on it. A pelvic floor muscle training programme should aim to find the right balance between challenge and ease. The muscles need to be challenged, so that they adapt, but there needs to be enough ease for you to feel success in achieving the programme every day.

If your physio said to you, "I would like you to complete 50 squeezes every hour in the day, from 7am to 7pm", how would you feel? I'm guessing your response would be "Flip! There's no way I can fit all that in to my day". And so, compliance drops and the programme is rendered ineffective. 

If then your physio said, "I would like you to complete one squeeze per day only". You might be thinking "Easy!". So compliance is not the issue, but the muscles are not challenged enough to adapt, and so, the programme is rendered ineffective again.

We need you to be able to find the balance of being able to fit the exercises in and being able to achieve change within the muscles.

This is where the bespoke nature of physio comes into its own. A thorough assessment of the muscles, your lifestyle, your needs and goals, will all fit together in a puzzle that identifies the perfect, effective and achievable programme. with review, over time, this programme can change and adapt with you and become the refined programme that deals with your symptoms...for good!

Step 3: Finding the right position

Pelvic floor muscle training needs to be as functional as possible. The majority of ladies will have problems in upright and standing postures. But it might take some time to reach these more functional positions.

In the early stages, lying down may be the best option to access good technique and to enable full release. Then, over time, as the muscles adapt and change, the position of exercise could change too, from lying to sitting and then up into standing, even adding movement and impact at a later stage.

The starting position depends on your muscles' ability and your ability to feel the movement. Again, it's super important that you feel comfortable with the exercises.

Step 4: Maintaining Motivation

It's never easy to keep an exercise programme going over a long period of time, but with the pelvic floor muscles, it's essential. Your pelvic floor needs to be exercised regularly, for life!

Once you are in a routine, you're confident with your technique and you feel able to produce some good exercise sessions, we need to find a way to make the process sustainable.

In the early stages of rehabilitation, you'll notice major changes. In the first few weeks, you'll feel more connected to your pelvic floor and you'll start feeling more of the movement. After about 4-6 weeks, the muscles will start to physically change to adapt to the demands you've put on it. It will bulk up, move more and simply feel more effective when you squeeze it.

From 6 weeks onwards, you'll notice fewer major changes, and if you're symptom free by then, it can be a huge struggle to maintain your motivation. The hope is that by then, you'll be well into the habit of doing your pelvic floor exercises. This is where all that 'prep' work comes into its own.

Step 5: Functional training for symptomatic relief

Effectiveness of a training programme should always be seen in relation to your specific goals and dreams. If leakage is your problem and you want to be able to run 5k and remain dry, then the training programme needs to give you that achievement.

If you have fulfilled all the steps above, and you still experience symptoms and problems, it's likely that you need to step up your training to include functional rehabilitation.

With functional rehab, we need to look at your specific triggers to leakage. So, a runner who leaks when running downhill needs to add pelvic floor practice that incorporates similar positions and movements. Whereas, a weightlifter that leaks during a deadlift of her own bodyweight needs a different approach to her training. 

If sneezing and coughing are the triggers to leakage, learning to use the 'knack' or the 'squeeze when you sneeze' technique will be an essential addition to your pelvic floor programme.

Functional training is another bespoke area of physiotherapy that demonstrates the use of the principles of muscle training for a very specific area of the body.


So, if you've been squeezing, and not getting anywhere, it might be worth investing in at least one sessions with your local pelvic health physiotherapist. Get the right start and the right guidance and your continence problems could be a distant memory by the end of this year!