As pelvic floor physiotherapists our patients commonly tell us “yes I do my pelvic floor exercises, here and there”. When probed further they often say ”I do about 3-5 contractions once a week”. When asked if they hold the contractions for long? They respond “I’m not sure, perhaps a second or two.”
Unfortunately this is where the problem lies – performing a couple of pelvic floor contractions here and there is not a sufficient training load to see improvements in your pelvic floor function. If we were to think about our pelvic floor like any other muscle in our body, for instance our bicep, performing 3-5 bicep curls with a lightweight, once a week will not improve the tone and bulk of your bicep, let alone improve its strength and endurance, the same goes for your pelvic floor!
To optimize your pelvic floor muscle function is it important to apply these three basic muscle training principles
1. Correct Technique 60% of women incorrectly contract their pelvic floor muscles when verbally cued (Thompson & O’Sullivan, 2003). Therefore it is important to have your muscles assessed by your pelvic floor physiotherapist to ensure you are contracting them correctly.
2. Sufficient load i.e. performing the correct number of reps and sets to ensure muscular fatigue, which, based on the literature is 6-12 reps, 3 sets a day or at a minimum, twice a week (Bø, 2006).
3. Specificity, which ultimately means your training program replicates the functional requirements of your pelvic floor (Marques, 2010).
To ensure your program is ‘specific’ lets first think about two primary functions of the pelvic floor.
1. To prevent leakage with cough and sneeze
During a cough and sneeze to prevent leakage the pelvic floor needs to turn on quickly and with sufficient strength. Therefore to ensure your program is ‘specific’ it must incorporate strength and speed work.
2. To prevent leakage when urgent/busting to go to the toilet.
To either prevent leakage when walking to the toilet or to delay the need go, the pelvic floor is required to hold on or contract over longer periods. Therefore the pelvic floor needs to be ‘specifically’ trained to improve its endurance
Considering the above your pelvic floor training program (PFMT) needs to include the following:
1. Strengthening exercises (Strong 80-100% effort contractions) 6-12 reps, 3 sets
2. Speed exercises (Quick contractions) 6-12 reps, 3 sets
3. Endurance exercises (long holds) 6-12 reps, 3 sets
To rehabilitate a weak pelvic floor the literature suggests 3-5 months of regular and progressive PFMT is required (Bø, 2006).
References
Bø, K. (2006). Can pelvic floor muscle training prevent and treat pelvic organ prolapse? Acta Obstetricia et Gynecologica Scandinavica, 85(3), 263-268. doi:10.1080/00016340500486800
Thompson, J., & O’Sullivan, P. (2003). Levator plate movement during voluntary pelvic floor muscle contraction in subjective with incontinence and prolapse; a cross-sectional study and review. Int Urogynecol J Pelvic Floor Dysfunct, 14(2), 84-88.
