Pelvic floor strengthening

The pelvic floor- why does it need to be strong?

I’m sure most peoples’ answer would be “so we don’t pee ourselves”- and they’re not wrong, but there is more to the story!

The answer is that our pelvic floor needs to be strong to resist the increases in intra-abdominal pressure that occur with day to day activities, so that stress incontinence (SUI), heaviness, pressure, or pain do not occur in the pelvic region.  

Intra-abdominal pressure is constant and changes with any movement we perform. Using the metric of cm H20 (averages), we know that in quiet standing we have 24 cm H20 of pressure vaginally.  In comparison, when we cough (a frequent culprit for SUI) that pressure increases to 98 cm H20!

The ability to manage these changes in intra-abdominal pressure is something that develops as we grow and are exposed to different stimuli, but factors such as injury/ trauma, obstetric history, and aging can change the way our pelvic floor functions. 

If there is a change in our pelvic health that can be attributed to weakening of the pelvic floor, pelvic floor muscle training has high evidence for effectiveness and should be a first line treatment for those with SUI and pelvic organ prolapse (POP)!

What is Pelvic Floor Muscle Training? (PFMT)

The first step in PFMT is learning how to both contract and relax the pelvic floor without compensation from other muscles (e.g the glutes, adductors, abdominals).  Physiotherapists who specialize in pelvic health undergo training to be able to best guide this learning and give feedback!

Once someone is confidently contracting and relaxing their pelvic floor, we look at the strength (graded from 0-5), endurance, and ability to contract and relax quickly.  This is because the pelvic floor needs to be dynamic to provide support during lifting, running, jumping, coughing, etc.!  These are the foundations worked on prior to moving to more functional exercises.

Functional training for the pelvic floor

The reason we encourage functional training once baseline is established is because the pelvic floor muscles are working during these exercises, and before we can manage a cough (98 cm H20) or laughing (85 cm H20)  we need to be able to manage a floor to waist lift of 15lbs/ groceries (41.6 cm H20), 30lbs/ a toddler (57.4 cm H20), and 45lbs (70.9 cm H20)!

How do we train this? Squats, deadlifts, bent over rows, overhead presses, lunges… the list goes on! Anything that puts your body under a load to increase intra-abdominal pressure that we can progress is fair game! Exercises should be tailored around movements or activities that create symptoms for you so that the pelvic floor can adapt. 

I hope this better explains why we believe so strongly in using functional resistance training for our pelvic floor strengthening!

Citations

Dumoulin, C., Cacciari, L. P., & Hay-Smith, E. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. The Cochrane database of systematic reviews, 10(10), CD005654. https://doi.org/10.1002/14651858.CD005654.pub4

Gephart, L. F., Doersch, K. M., Reyes, M., Kuehl, T. J., & Danford, J. M. (2018). Intraabdominal pressure in women during CrossFit exercises and the effect of age and parity. Proceedings (Baylor University. Medical Center), 31(3), 289–293. https://doi.org/10.1080/08998280.2018.1446888

O'Dell, K. K., Morse, A. N., Crawford, S. L., & Howard, A. (2007). Vaginal pressure during lifting, floor exercises, jogging, and use of hydraulic exercise machines. International urogynecology journal and pelvic floor dysfunction, 18(12), 1481–1489. https://doi.org/10.1007/s00192-007-0387-8