There are many myths and misconceptions about what your pelvic floor muscles should be doing during Pilates exercises and often when individuals are instructed to ‘activate their pelvic floor’ there is a lot of confusion surrounding what this ACTUALLY means.
When should they be relaxed? When should they be contracted? Does doing Pilates count as pelvic floor exercises? How do you do them?
Well, firstly having some more knowledge about what the ‘pelvic floor’ actually consists of is important. Having some more understanding and knowledge can then help individuals to perform exercises more effectively and be more inclined to adhere to exercises programs given by health professionals (Navarro-Brazález et al., 2021).
What makes up the ‘pelvic floor’?
The pelvic floor is made up of muscles and connective tissue that sits under the bones of the pelvis. Often this has been described to as similar to a hammock. The size of your pelvic floor muscles is similar to if you bring your index fingers together and your thumbs together to make a triangle. These muscles connect to the pubic bone (pubis), sitting bones (ischial tuberosity) and tail bone(coccyx).
Functions of the Pelvic Floor:
· to support your abdominal and pelvic organs,
· to be able to contract so you can maintain continence or relax so you can go tothe toilet
· play an important role in the preservation of urinary and anal continence
· they also have a role in sexual function (Dumoulinet al., 2019)
· Superficial layer of pelvic floor muscles in men is particularly involved in ejaculation as well as urinary and faecal continence Cohen et al. (2016).
The pelvic floor muscles are able to control these functions due to their contraction and relaxation hence why both are important to be able to perform both of these actions (Messelink et al., 2005).
Pelvic floor dysfunction (PFD) can include:
· urinary incontinence
· pelvic organ prolapse
· anal incontinence
· sexual dysfunction
These chronic conditions can all be associated with lower quality of life, and reduced physical, social, and mental well-being(Nygaard and Barber, 2008).
Risk factors associated with PFD:
· advanced age,
· number of times you have given birth
· instrumented delivery
· high body weight
· prostate surgery/ radiation
· gynaecological surgery
· The female pelvis has a wider diameter and a more circular shape than that of the male and predisposes it to subsequent pelvic floor weakness (Herschorn S., 2004).
What happens during Pilates exercises?
During Pilates a lesser pelvic floor contraction needs to happen. But this contraction must be activity and load specific. If when you do pelvic floor muscle exercises you contract at 100% then during Pilates you will contract at between 30-50%depending on the exercise (APPI, 2017).
A study comparing specific pelvic floor muscle training to pelvic floor specific Pilates sessions (Culligan et al. 2010) recognised a similar improvement in both study groups so neither were considered superior to the other however this was done with a group of ladies not reportedly experiencing pelvic floor dysfunction. Although Pilates definitely helps contribute to pelvic floor strength, there is no evidence to suggest that it is enough to simply attend Pilates sessions without doing other regular specific pelvic floor exercises on a daily basis (if no current pelvic floor dysfunction) and 3 times daily if you do experience symptoms.
How do you contract your pelvic floor?
Pelvic floor exercises can be performed in sitting and standing but if you find it particularly challenging then it is advisable to perform them lying on your back.
To contract your pelvic floor think about lifting your pelvic floor upwards and forwards from the back passage to the front passage. As you do this the bottom muscles(gluteals) need to stay relaxed and your must keep breathing.
Imagine you are passing urine and are trying to stop the stream. You will find yourself using slightly different parts of the pelvic floor muscles to the first exercise (ones nearer the front).
‘Imagine you are trying to stop wind escaping from your back passage(anus). You will have to squeeze the muscle just above the entrance to the anus. You should feel some movement in the muscle. Don't move your buttocks or legs.
You should have a sense of squeezing, pulling the back passage up and in. If you look in a mirror you may see the base of your penis retract slightly in your body and your testicles rise a little. Do not tighten your thighs or buttocks and do not hold your breath.
A correct pelvic floor muscle contraction combines the closure of sphincters, as well as a general upward lift of the muscles (think of lifting the bladder towards the belly button)
Anterior and middle sections of ‘hammock’:
“Shorten your penis” and “stop the flow of urine”
This can help with erectile function and urinary continence
Posterior section of ‘hammock’
“tighten around the anus” helps with faecal continence (Stafford et al. 2016).
Links to exercise:
Adherence to exercises:
Long-term effectiveness of conservative treatment does not seem to depend exclusively on the exercise method.
Individual adherence to a specific pelvic floor exercise program and to physiotherapist advice seems to be one of the main factors positively impacts the level of success of the treatment in the short and long term (Dumoulin et al., 2015)
Having regular prompts during Pilates and gym based classes can definitely help you to continue your own pelvic floor exercises at home. Having a good understanding of these structures and how to do these exercises can be both a treatment method for pelvic floor dysfunction but can also be done as a preventative method to reduce risk of issues later in life.
APPI (2017)Pelvic floor and Pilates [online] Available from: https://appihealthgroup.com/the-pelvic-floor-and-pilates/ [accessed on 31/5/2022].
Cohen, D,Gonzalez, J. Goldstein, I. (2016) The role of pelvic floor muscles in male sexual dysfunction and pelvic pain. Sexual medicine reviews. Jan 4 (1) p. 53-62
Culligan, P. J., Scherer, J., Dyer, K.,Priestley, J. L., Guingon-White, G., Delvecchio, D., & Vangeli, M. (2010).A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength. International urogynaecology journal, 21(4), 401-408.
Dumoulin, C.,Pazzoto Cacciari, L., Mercier, J. (2019) Keeping the pelvic floor healthy. Climacteric 2019, 22, p. 257–262.
Dumoulin, C.;Hay-Smith, J.; Frawley, H.; McClurg, D.; Alewijnse, D.; Bo, K.; Burgio, K.;Chen, S.Y.; Chiarelli, P.; Dean, S.; et al. 2014 Consensus statement of improving pelvic floor muscle training adherence: International continence society 2011 state-of-the-science seminar. Neurourol. Urodynam. 2015, 34,600–605.
Herschorn S. (2004). Female pelvic floor anatomy: the pelvic floor, supporting structures, and pelvic organs. Reviews in urology, 6 Suppl 5(Suppl 5), S2–S10.
Messelink, B., Benson, T., Berghmans, B., Bo, K., Corcos, J., Fowler,C., … & Nijeholt, G. A. (2005). Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neuro urology and urodynamics, 24(4), 374.
Milios, J.E.(2019) Therapeutic interventions for patients with prostate cancer undergoing radical prostatectomy: A focus on urinary incontinence, erectile dysfunction and Peyronie’s disease. Thesis Document University of Western Australia.
Navarro-Brazález,B.; Vergara-Pérez, F.; Prieto-Gómez, V.; Sánchez-Sánchez, B.; Yuste-Sánchez,M.J.; Torres-Lacomba, M. What Influences Women to Adhere to Pelvic Floor Exercises after Physiotherapy Treatment? A Qualitative Study for Individualized Pelvic Health Care. J. Pers. Med. 2021, 11, 1368. https://doi.org/10.3390/jpm11121368
Stafford, R. E,Ashton‐MillerJ.A, Constantinou, C, Coughlin G, Lutton N. J. and Hodges P.W. (2016) Pattern of activation of pelvic floor muscles in men differs with verbal instructions. Neurourology and urodynamics. Apr,35(4) p. 457-63.
Stein, A,Sauder, S.K, Reale, J. (2019) The Role of Physical Therapy in Sexual Health in Men and Women: Evaluation and Treatment. Sex Med Rev, 7(1) p. 46-56.