Many women have little idea of their pelvic floormuscle (PFM) lifting action and this may lead them to substitute the wrong muscles e.g. to use buttock, thigh and upper abdominal muscles when they are reminded ‘don’t forget your pelvic floor exercises’. Practicising the wrong action may aggravate existing problems or prompt you to give up in frustration. All movements in our body are mapped into our brain’s frontal cortex and the more we practice an action, the more quickly the controlling area in our brain lights up, making the action easier to repeat. Learning a new skill or action firstly requires recognition of what the action feels like and then repeating the correct action until it becomes well mapped into our frontal cortex.
To help you identify the correct action, I have included my FIVE WAY CHECK to help you discover if your pubococcygeus (PC) muscle is working (this muscle closes urethral sphincters and firms vaginal walls). This is step one of the Find It, Control It, Train It, 3 step programme to learn your PFM action so you know which muscles to strengthen. Practice slowly and gently to find the inner lifting action, then you can lift and strengthen more firmly once you have recognized and are confidently repeating the PFM lift.
5 Way Test for Pelvic Floor Muscle Activity
This extract from Hold It Sister shares with you the five ways you can check for the correct action of your pubococcygeus muscle (PC muscle). This muscle is critical for effective pelvic floor training. As we all learn differently, I have provided five strategies, find which works best for you. I have also included a training strategy after each item to help you improve.
1. Mirror, Mirror
Sit on the edge of a chair and angle a mirror to gain a good view of your pelvic floor. Open your legs and part the labial lips. Observe what happens when you lift your PC (while breathing out). You should see a central drawing up and the labia closing. Try keeping your butt and waist relaxed.
Do this again and focus on a slow closing and lifting of the urethral and vaginal openings, rather than letting the anal sphincter do all the work. Observe the floor relaxation when letting go.
Now watch what happens to the pelvic floor when you cough strongly. If it bulges out, your PC is either weak or too slow to respond. This may also happen during lifting or exercise. If your floor ‘holds’ when coughing, your muscles have sufficient strength and they tightened at the right time. Failing to correct the faulty pattern will lead to incontinence and pelvic organ prolapse.
Strategy: Become aware of tightening and lifting the pelvic floor when you cough or lift. Go back to learning the PC lift and repeat this action when standing, walking, coughing and lifting. While this may be difficult initially, keep practicing until it becomes a normal reaction.
2. Tampon Tug
Swell a tampon with warm water and insert vaginally. Again, observe and feel what happens when you try to keep the tampon in place while slowly pulling on the strings. If the tampon holds and you need to pull more firmly, this shows your PC is tightening. If the tampon pulls out easily, then the muscle lacks effective strength.
Strategy: Reinsert the tampon and as you gently pull on the string, close vaginally and hold the tampon in place for 5 seconds. Relax and repeat 5 to 8 times. Progress by repeating in standing (relax your waist and bend your knees).
3. Hold it Sister
Try to slow and stop the flow of urine when your bladder is emptying. This is not an exercise, but a way to help you identify the sensation of using your PC muscle. Only try this occasionally, as your bladder should empty continuously.
Strategy: Try this action no more than once a week as a gauge of your control.
4. Feel For Yourself
Insert your first and second fingers about an inch into your vagina. Repeat the PC lifting and draw up vaginally. If you feel a tightening and slight draw up on your fingers, you are doing well; this is the correct action. If nothing happens or the lift is weak, it may be you do not understand the exercise or the muscle is weak.
If inserting your fingers is difficult or painful, it may indicate your PF muscles are too tight.
Strategy: If there is no muscle action or the insertion is painful, visit a physiotherapist who specializes in treating PF muscles and discuss your findings.
5. The Right Vibe
Vibration gives increased sensory input to muscles. Many women have discovered the benefits of using a vibrator to reach orgasm. Less known is that vibration increases a muscle’s ability to contract, increasing strength. Insert the vibrator vaginally (with lubricant), feel the vibration then slowly tighten your PC around the vibrator. If your PC is working correctly, you will feel a more definite closing action around the vibrator.
Strategy: Repeat PC tightening and relaxation, holding for 5 to 10 seconds then relax before repeating. If your PC fatigues (the closing becomes weak) take a break or you will start to substitute other muscles.
The purpose of these activities is to learn the local action of the PC muscle in your pelvic floor. It does not stop here however. To develop a truly effective pelvic floor, you must now use what you have learned in different exercise combinations. Practicing the following exercises will start to build effective control of your pelvic floor during daily activity, lifting and exercising.
Avoid rushing this early ‘Find It’ stage and take time to learn the correct PC action before progressing onto the ‘Control It’ phase of the program.Text provided by Mary O’Dwyer Australia’s leading physiotherapist. Her book Hold it Sister is becoming the number 1 best selling pelvic floor book in Waterstones. Hold it Sister book available at Waterstones, WH Smith www.holditsister.com www.incostress.com
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