Pelvic Floor Exercises -why bother doing them? Article by Fiona Stewart Specialist Physiotherapist in Pelvic Floor Dysfunction

Pelvic Floor Exercises -why bother doing them?

The pelvic floor is a sling of muscles between the legs which is attached to the symphysis pubis at the front and the coccyx at the back.

Think of your pelvis as a bowl and the pelvic floor muscles (PFMs) as the bottom of the bowl. The PFM`s resemble a figure of eight round the back passage, vagina and tube to the bladder (urethra) and when these muscles are strong and healthy, bladder, bowel and prolapse problems are rare.

So, why do PFMs often become weak and not function properly?

Some of the reasons include childbirth, constipation, coughing, sport and exercise, oestrogen deficiency and weight.

Childbirth –

Vaginal deliveries and especially those involving forceps, stretch and damage the pelvic floor and especially so with larger babies. Being pregnant and the increase in weight associated with it also puts a strain on the PFMs.

Constipation –

Any regular straining to pass a bowel movement is likely over time to cause damage to the PFMs.

Coughing –

The downward pressure of a cough occurring on a regular basis, can cause PFM weakness. Those with chronic chest conditions such as asthma, bronchitis or those with a smoker`s cough, are at risk of damaging and weakening their PFMs.

Sport and Exercise –

Some sports can cause an already weak pelvic floor to weaken further. Examples may include running, squash. badminton, tennis, kick- boxing, body combat, metafit and trampolining.

Oestrogen Deficiency –

In the 5 years preceding the last period (menopause), oestrogen levels are steadily decreasing and this has a detrimental effect on PFM strength. Often, what was previously a minor problem becomes worse as women move through their 40`s, 50`s and beyond. As well as bladder, bowel and prolapse problems, bladder infections (cystitis) and vaginal dryness are much more prevalent due to the tissues being less robust because of oestrogen loss.


Carrying excess weight can impact on PFM strength especially if combined with some of the factors already mentioned. Keeping our BMI at 25 or below can ensure that weight does not become a cause of PFM weakness.

For all the reasons mentioned above, regular PFM exercises for all women on a daily basis makes sense. Those who are symptom free should carry out PFM exercises x 3/day, while those with weak muscles should aim for x 6/day.

The exact numbers of fast and slow PFM exercises that we need to do depends on how weak the muscles are. Research carried out many years ago found that, without a vaginal examination, around 50% of women were not in fact carrying out PFM exercises following instructions to do so. A Specialist Physiotherapist in Pelvic Floor Dysfunction is able to assess PFMs accurately and advise on the exact numbers of fast and slow exercises needing to be done.

So, regular daily PFM exercises for all of us are well worth the bother and are the best way of maximising our chances of maintaining good bladder and bowel control and of remaining prolapse free.

Fiona Stewart      Specialist Physiotherapist in Pelvic Floor Dysfunction

Private Practitioner, Glasgow

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