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Analysis

How to… teach pelvic floor muscle exercises

21 May, 2009

How to… teach pelvic floor muscle exercises

University Hospital of North Staffordshire and Staffordshire University’s Sue Tohill and Christine Kettle describe teaching pelvic floor muscle exercises.

University Hospital of North Staffordshire and Staffordshire University’s Sue Tohill and Christine Kettle describe teaching pelvic floor muscle exercises.

Midwives magazine: June/July 2009


The pelvic floor consists of layers of muscles and soft tissue that fill the pelvic outlet and provide support for the bladder, uterus and bowels, which lie in the cavity above. Due to physiological changes during pregnancy and childbirth, the pelvic floor muscles (PFM) can become stretched and damaged, which may lead to urinary problems such as stress incontinence and prolapse of the organs. Despite the benefits of pelvic floor muscle exercises (PFME) in helping to strengthen the muscles and prevent urinary incontinence, many women have no idea of where their pelvic floor muscles are or how to carry out PFME. It is important that women are given information regarding what PFME are, why they should perform them and how to do them correctly.


Teaching women about the pelvic floor

Before teaching PFME, women should be given an explanation of the anatomy, muscle location and function of the pelvic floor (Wallace, 1994).


Locating the PFM

- Advise women to sit or lie down with knees slightly apart
- Ask the woman to ‘lift and squeeze’ at the front as if stopping the flow of urine and around the back as if stopping the passage of wind, without tightening the abdominal muscles, squeezing legs together, tightening buttocks or holding breath
- Ask if they can feel the muscles around their vagina and front and back passages tighten and lift
- This is called a ‘pelvic floor contraction’.
Women can check that they are using the correct muscles by:
- Slowing down the flow of urine – no more than once a week
- Self examination – insert one to two fingers into their vagina, tighten the PFM’s and feel the contraction.

Once women are confident in locating the correct muscles, there are two types of PFME that should be carried out daily:

Exercise 1 – Slow contractions

- ‘Lift and squeeze’ perform a pelvic contraction and hold for at least two seconds, increasing as the PFM strengthen up to a maximum of
ten seconds
- Release the contraction and rest for an equal number of seconds between holds
- Repeat the contraction at least three times a day increasing to a maximum of ten.
Women should do at least eight pelvic contractions, three times a day (National Institute for Health and Clinical Excellence, 2006).


Exercise 2 - Fast contractions

- ‘Lift and squeeze’ more firmly,
hold for one second and release
- Rest for one second
- This is called ‘quick contraction’
- Repeat the contraction the same number of times as exercise one
- This exercise will help the muscles react quickly when coughing, sneezing, exercising and lifting.


Other advice for women

- Squeeze and hold PFM before coughing, sneezing or lifting
- Avoid constipation
- Maintain a sensible body weight
- Only go to the toilet when the bladder is full
- Report any problems
- Perform PFME every day for life.

Remember to ask women if they are carrying out PFME at every antenatal and postnatal appointment and reinforce the importance and benefits of doing them.


References

National Institute for Health and Clinical Excellence. (2006) Urinary incontinence: the management of urinary incontinence in women. Nice Clinical Guideline 40. NICE: London.

Wallace K. (1994) Female pelvic floor functions, dysfunctions and behavioural approaches to treatment. The Athletic Woman 13(2): 459-81.
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