Goodbye To ‘Oops’ – How To Strengthen Your Pelvic Floor

Ever experienced an ‘oops’ moment? If you’re a woman, chances are the answer is yes, and chances are more than once.

But despite statistics showing that one in three women suffer with bladder weakness, we’re still very unlikely to talk about it.

The pelvic floor is the culprit for these leaks, but before you head for the Tena aisle, know this – pelvic floor weakness doesn’t have to be part of life. Pantyliners shouldn’t be in business, we can work on things and strengthen our pelvic floor whatever our age or situation. Over the course of our lives, these sets of muscles – situated in the pelvis – can become weakened. The pelvic floor muscles lose their tone due to a number of different triggers which result in an inability to control urination. This can be a result of pregnancy, menopause, and various surgeries. It’s just life!

However, recent research published by Innovo revealed that one in ten women and almost half of men don’t know what their pelvic floor is, or how to exercise it, and yet Google data shows that more and more people are suffering with urinary incontinence. Searches for pelvic floor-related keywords are up 22% over the past 12 months, with people specifically interested in learning more about pelvic floor ‘dysfunction’, ‘strengthening’ and ‘exercises’. 

Belle About Town spoke to Innovo’s experts – Dr Meg Arroll, a chartered psychologist and behavioural change specialist, Aoife Ni Eochaidh, a chartered physiotherapist and clinical specialist in women’s health and continence, and Marica Carleschi, a yoga instructor, and asked them to share some of the most common questions they are asked about bladder weakness.

I am still suffering bladder weakness years after having my child/children, and dread sneezing when out in public. Why is this?

Aoife: The leakage is because your pelvic floor muscles are probably not fully in the normal range of function. The thickness or bulk of the pelvic floor muscles may not be good enough to adequately support your bladder neck and keep it at the right angle to keep you dry. The strength in the muscles might not be good enough either, the fitness or endurance of the pelvic floor muscles might not be as good as needed, and most importantly, the movement internally of the pelvic floor muscles that you need to lift your bladder neck and keep it at the right position to keep you dry might not be fully working correctly. 

The muscle bulk or thickness, the strength, the fitness or endurance and the lift can all be improved with targeted (or supervised) pelvic floor muscle training. You could also use electrical stimulation, but best to be assessed by a pelvic floor physiotherapist first.

I get serious anxiety about going out due to leakage, and won’t drink when I’m out. Are there any self-help techniques that I could use? 

Meg: This is something I see all the time – where the fear over leaks becomes more problematic than the underlying issue itself, in terms of anxiety. There are so many mental exercises that you can do on top of pelvic floor strengthening. Guided imagery is such a good way to find a bit of balance again. This technique has also been shown to benefit bladder conditions and it’s something that you can do anywhere, at any time.

I dread going to places where I don’t know where the toilets are, as there have been times when I’ve been out and I’ve had a leak. Please help!

Aoife: What you are describing is called Over Active Bladder – there are two types: Over Active Bladder Dry and Over Active Bladder Wet. This is such an upsetting condition, however, it is a really common problem. What is happening is that your pelvic floor muscles are not working automatically with your bladder muscles as they should, to ensure normal filling, storing and emptying of your bladder. 

The good news is that so much can be done to treat this problem. If you can, have an appointment with a pelvic floor physiotherapist or women’s health physiotherapist as soon as possible. They will help with bladder retraining, and will include advice on fluid in-take and other tips and tricks. Drinking less than you should be drinking can unfortunately make the problem worse!

Can bladder weakness get worse around the time of my period? 

Aoife: Yes, there are monthly hormonal changes that affect us and our pelvic floor muscles. The hormone change can be sudden, and it can be that one night in the month we don’t sleep very well because of this hormonal shift. If our sleep is disturbed, our gut hormones and our digestion processes are affected too. We can become more sluggish and bloated in our tummies around this time and any sluggishness, constipation or difficulty emptying the bowel can weaken our pelvic floor muscles and put some pressure on our bladders too. From experience, those that have had birth trauma relating to third degree tears or forceps delivery, or that have had pudendal neuropathy (pelvic nerve damage) will be more affected by this monthly worsening of symptoms. It’s especially important that we keep up our pelvic floor muscle training routine at this time, at a time we feel most unlike doing it!

Why do I accidentally do a small poo when squeezing the last drops of wee out? 

Aoife: You are leaking a small poo (anal incontinence) when you are squeezing out the last of your urine because you have weak pelvic floor muscles. It is particularly common in mothers that have had a third degree tear with the birth of their child. This faecal leakage (wind or gas can also leak) can happen with physical stress from lifting, coughing, sneezing or exercise. Women that have had babies over 8lbs, those that had a long second stage of labour and those that had a forceps delivery are most frequently at risk of anal incontinence. 

Women with anal incontinence need supervised, targeted, and progressive pelvic floor muscle training, or other pelvic physiotherapy treatments like supervised bladder and bowel retraining or electrical stimulation. 

How do I get started with pelvic floor exercises? 

Aoife: First, you need to find the right muscles. One of the easiest ways to locate your muscles is when you wee. Squeeze the muscles you use to stop your urine; halfway through weeing, stop or slow down the flow. Don’t hold your breath or tense your muscles. If you can slow or stop the flow, then these are the muscles you use for the pelvic floor exercises. Then to begin the exercises: 

• Firstly, lay down on a flat surface e.g the floor or a bed. 
• Squeeze the muscles for 2 seconds, then relax for 2 seconds. 
• After 2 seconds, add 1 second each week until you’re able to squeeze for 10 seconds.
• Repeat the exercise 10 to 15 times a session. Do at least 3 sessions a day. 

You can also try the NHS’ Squeezy app. 

Q: Are there any specific exercises or sports that help strengthen the pelvic floor?

Marica: Yoga is great to do if you’re looking to strengthen your pelvic floor muscles! Here are some of the best poses you can do: 

• Mountain Pose (Tadasana)

• Chair Pose (Utkatasana) 

• Warrior II (Virabhadrasana II)

• Happy Baby (Ananda Balasana)

• Locust Pose (Salabhasana) 

• Boat Pose (Navasana)

• Yoga squat (Malasana)

• Bridge (Setu Bandha Sarvangasana) 

Interested in some more pelvic floor exercises? Check out Innovo’s invisible workouts; a series of podcasts which can help you strengthen your pelvic floor no matter where you are.