The pelvic floor is a large sling (or hammock) of muscles stretching from side to side across the floor of the pelvis. It is attached to your pubic bone in front, and to the coccyx (the tail end of the spine) behind.  It forms your "undercarriage".  The openings from your bladder (urethra), your bowels (rectum) and your womb (vagina) and all pass through your pelvic floor.

What does it do?

•  It supports your pelvic organs and abdominal contents, especially when you are standing or exerting yourself.

•  It supports the bladder to help it stay closed. It actively squeezes when you cough or sneeze to help avoid leaking. When the muscles are not working effectively you may suffer from leaking ("urinary incontinence"), and/or urgent or frequent need to pass urine.

•  It is used to control wind and when "holding on" with your bowels.

•  It has an important sexua| function, helping to increase sexua| awareness both for yourself and your partner during sexua| intercourse.

How to do pelvic floor exercises

Exercise 1

Tighten the muscles around your back passage, vagina and front passage and lift up inside as if trying to stop passing wind and urine at the same time.  It is very easy to bring other, irrelevant muscles into play, so try to isolate your pelvic floor as much as possible by

•  not pulling in your tummy,
•  not squeezing your legs together,
•  not tightening your buttocks and
•  not holding your breath.

In this way most of the effort should be coming from the pelvic floor.

Have a go!  How many seconds can you hold the pelvic floor tight for? Try holding it as long and as hard as you can. Build up to a maximum of 10 seconds. Rest for 4 seconds and then repeat the contraction as many times as you can up to a maximum of 10 contractions.

Try doing these exercises in a slow and controlled way with a rest of 4 seconds between each muscle contraction. Practise your maximum number of held contractions (up to 10) about six times each day.

Exercise 2

It is important to be able to work these muscles quickly to help them react to sudden stresses from coughing, laughing or exercise that put pressure on the bladder. So you need to practise some quick contractions, drawing in the pelvic floor and holding for just one second before releasing the muscles. Do these in a steady manner: aim for a strong muscle tightening with each contraction up to a maximum of 10 times.

Aim to do one set of slow contractions (exercise 1) followed by one set of quick contractions (exercise 2) six times each day.

Get into the habit!

Get into the habit of doing the exercises. Link doing them to some everyday activities - for example, do them after emptying your bladder or whenever you turn on a tap. Or keep a simple exercise diary (you could have an unlabelled simple tick chart on a kitchen pin board) to help you remember. Practise the exercises when you are lying, sitting and especially standing. Get into the habit of tightening your pelvic floor prior to activities that are likely to make you leak - such as getting up from a chair, coughing, sneezing or lifting.

How long should I do them for?

Pelvic floor exercises should give optimum results with regular exercise within 3 to 6 months, but you should continue them for life to safeguard against problems recurring.

You are strongly recommended to seek help from a health professional if you see little or no change in your symptoms after trying these exercises on your own for three months.

If you find it difficult to exercise your pelvic floor . . .

. . . you could consider the following techniques. There is little or no research evidence proving their effectiveness but many women have found them useful if only as ways of helping them perform their pelvic floor exercises.

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These are small weights which can be used by women to help with their pelvic floor exercises. The idea is to place the cone in the vagina and use the pelvic floor muscles to hold it there. By using it for 15-20 minutes at a time while walking around at home you will give your pelvic floor muscles some good exercise.

Some makes come as a set of cones of different weights, others as a single cone that unscrews to allow you to put in different weights. In either case you start by using the lightest weight for a short period once or twice a day, gradually increasing the weight, frequency and length of time you use them. You can buy cones directly from the manufacturers or from some branches of Boots the Chemist.  They cost from £15 upwards.

Vaginal weighted cones can be ineffective as many women find that the cone either slips out of the vagina almost immediately no matter how good the pelvic floor muscles are or else stays lodged in the vagina with no muscle work required to keep it in place.  In fact, the evidence seems to suggest that using cones does not add any benefit if you are doing your pelvic floor exercises properly - but they may help you to do the exercises properly and many women say they have been useful.

Overall it is recommended that you talk to your nurse before you try to use weighted cones.

The nurse can instruct you in their proper use - and make sure you are doing your exercises right. Phone the Continence Foundation Helpline for a start.

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This is usually used as an adjunct to pelvic floor exercises for symptoms of stress and /or urge incontinence. It requires the use of mechanical or electronic equipment to provide you with visual feedback about how your muscles are working - and hopefully improving. Biofeedback needs to be used under the supervision of a specialised practitioner, usually a specialist physiotherapist or specialist nurse. It is not directly beneficial in itself - but it does help you (if you need help) to do your pelvic floor exercises properly.

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Electrical stimulation is used in the treatment of both stress and urge incontinence, but not usually as a first line of treatment. It may be administered at a clinic (by either a specialist physiotherapist or a specialist nurse) or with the use of a small portable stimulator at home. (However, it is recommended that home treatment is supervised by a specialised health professional). It involves using a small battery-powered unit which applies an electric current to the muscles around the bladder. This current is usually passed via a small vaginal or anal probe in close contact with the pelvic floor muscles or via surface electrodes placed on the perineum (the area between the front and back passages).

It is hard to describe what electrical stimulation feels like, especially as different frequencies produce different sensations. Most individuals will describe it as a tingling rather like pins and needles, sometimes with a involuntary tightening of the pelvic floor muscles. It will not be painful.

People are usually advised to use the unit for between 20 minutes and an hour a day for about 20 days. Some people find this treatment very effective, and there is evidence that it can be as useful as pelvic floor exercises.

The unit is available on loan from some local continence services and from some physiotherapy services. (Details of your local continence service can be obtained from the Continence Foundation Helpline )

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[Revised 24 February 2001]