Midlife and Menopause
How to Exercise Your Pelvic Floor
The same muscles that help hold in urine and prevent intestinal gas release are used in pelvic ﬂoor muscle training. The muscles are tightened up and in, tightened around the rectum and vagina, and moved up toward the small of the back.
To better feel the muscles contracting when ﬁrst learning to do a pelvic ﬂoor muscle contraction, it helps to lie ﬂat with feet on the ﬂoor, knees bent and slightly apart. When contracting the pelvic ﬂoor, it’s important to feel the muscles tighten inward and upward. Some women mistakenly think we are doing pelvic ﬂoor muscle training when we are actually bearing down, which won’t strengthen the muscles. To avoid bearing down, try breathing in and out gently through the mouth while contracting the muscles. (It’s difﬁcult to both push down and breathe easily at the same time.) Try to relax your abdominal, thigh, and buttocks muscles. Tightening these muscles doesn’t cause any injury, but it lessens the workout the pelvic muscles get.
A way to check if the right muscles are being contracted is to look at the vaginal area with a mirror. When your pelvic ﬂoor muscles are contracting correctly, the clitoris moves toward the vagina, and the rectal opening puckers inward. You may put your ﬁnger halfway inside your vagina and try to grip your ﬁnger with your vagina. Or if you have sex with a male partner, you can tighten the pelvic ﬂoor muscles around his penis during intercourse. Over time, he can tell if the contractions are getting stronger.
It takes time to build muscle endurance. Begin by holding each contraction for two seconds, and gradually increase the time to ten seconds. Over time, the number of seconds you will be able to hold each contraction will increase. Relax for at least ten seconds between contractions to give the muscles adequate rest.
Women who practice thirty to forty-ﬁve pelvic muscle contractions a day typically see results in six to eight weeks, but some women need to do the exercises longer before getting an effect. It takes about ﬁfteen minutes to complete the recommended thirty to forty-ﬁve contractions a day. You can divide your exercises into two or three shorter sessions throughout the day with equal effectiveness.
Setting aside time for the exercises in your daily schedule or adding them to other daily workout routines may be helpful. Research shows that people who make the exercises a planned part of their day have been more successful at actually doing them over an extended period.9 Reminders about pelvic ﬂoor muscle training also can be useful. You can post a note on the bathroom mirror or plan to do pelvic ﬂoor muscle exercises during a regularly watched TV program. Any daily event can serve as a reminder.
A sixty-two-year-old woman decided to do pelvic ﬂoor muscle training exercises ﬁve times a week:
I decided to do them at night when there were no distractions. It’s become routine and I always complete the sequence. That is my time to relax.
Once comfortable with the technique, you can practice pelvic ﬂoor muscle exercises while standing or sitting. You can do these exercises anywhere and at any time, even while waiting for an elevator or at a red light.
End of excerpt
Excerpted from Chapter 14: Uterine and Bladder Health in Our Bodies, Ourselves: Menopause © 2006 Boston Women's Health Book Collective
9. Sandra J. Hines, Julia S. Seng, Kassandra L. Messer, Trivellore E. Raghunathan, Annasis C. Diokno, and Carolyn M. Sampselle, "Factors Contributing to Adherence to Pelvic Floor Muscle Exercise Regimen to Prevent Urinary Incontinence: A Mixed-Method Analysis" (in progress). [back to text]
Excerpted from Our Bodies, Ourselves: Menopause, © 2006, Boston Women's Health Book Collective.
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