Pelvic Floor Strengthening Exercises

Apr 6, 2021

 by Karina Wait

Are you someone that cringes whenever you see jump ropes programmed or shies away from movements that require strenuous core bracing like squats, deadlifts, sandbag holds, etc? Have you had kids and find it impossible to hold your bladder? If these descriptions are similar to what you're feeling or fully describe you, then it's probably time that you train your pelvic floor. For some of you, you may have already been told by your doctor that you need to strengthen your pelvic floor; hopefully, given exercises to assist? This blog will be focusing on pelvic floor strengthening exercises that can be completed in the gym; killing two birds with one stone via getting your class workout in and completing the supplementary movements. 

Before I provide some helpful strengthening exercises, let's take a little anatomy journey to the pelvis and cover what pelvic floor dysfunction is. 

Pelvic floor dysfunction is described as 'the inability to correctly relax and coordinate your pelvic floor muscles to have a bowel movement. Symptoms include constipation, straining to defecate, having urine or stool leakage and experiencing a frequent need to pee' (Cleveland Clinic, NA). However, this struggle with peeing during your workouts can also be attested to Stress Urinary Incontinence. An SUI is described as when urine leaks out with sudden pressure on the bladder and urethra, causing the sphincter muscles to open briefly. With mild SUI, pressure may be from sudden forceful activities, like exercise, sneezing, laughing or coughing (Urology, 2021).  So for those of you who avoid jumping rope because you'll pee, this fully describes your situation. But for pelvic floor dysfunction, can occur due to a traumatic accident, overuse of the pelvic muscles, advancing age, weight gain, and pelvic surgery.  For both of the above problems, treatment can be accomplished nonsurgically via physical therapy, biofeedback, medications, and relaxation techniques but this write-up will focus on exercises that you can complete in-gym. 

Urinary flow is controlled by three primary muscles: the detrusor, the internal urinary sphincter, and the external urinary sphincter. They are built specifically to control urine flow from inside to outside and just like any muscle, they can get stronger by being trained. Training can be as simple or as complicated as you'd like. But, pelvic stabilization and having the understanding of actually engaging your pelvic floor muscles is important. 

The first exercise that you may have heard of before is...

1. Kegels.

Kegels are performed by actively engaging and releasing the muscles within your pelvic floor. But for a more elaborate description, here's a write-up from Mayo Clinic. 

To get started:

• Find the right muscles. To identify your pelvic floor muscles, stop urination in midstream. Once you've identified your pelvic floor muscles you can do the exercises in any position, although you might find it easiest to do them lying down at first.
• Perfect your technique. To do Kegels, imagine you are sitting on a marble and tighten your pelvic muscles as if you're lifting the marble. Try it for three seconds at a time, then relax for a count of three.
• Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.
• Repeat three times a day. Aim for at least three sets of 10 to 15 repetitions a day.

Don't make a habit of using Kegel exercises to start and stop your urine stream. Doing Kegel exercises while emptying your bladder can actually lead to incomplete emptying of the bladder — which increases the risk of a urinary tract infection.

2. Bracing exercises.

Core bracing exercises are a great supplementary exercise once you've mastered pelvic control. Nevertheless, having an understanding of how to correctly brace your core is important for low back pain prevention and for proper movement. Some suggested exercises would be hollow holds, sandbag holds, pallof presses, and dead bugs. 

• Hollow Holds
  • Follow along with the below video for progressions. For incorporation in your training, I would recommend working to a full 1:00 hold in a perfect hollow body position. Slowly work your way flatter and straighter as you progress from one training session to the next. The hollow body position is infinitely scalable by adjusting your arms and legs. Adjust accordingly to maintain perfect form as you progress through your sets. Let your goal be to achieve 5 sets of 1-minute, perfect, flat, straight hollow body position. 

• Sandbag holds 
  • The focus when completing a sandbag carry is pelvic alignment, core bracing, and standing tall. Once you've mastered Kegels, incorporating Kegels when you're doing sandbag holds is great. The reason is that sandbag holds create a large amount of intraabdominal pressure which puts strain on the pelvic floor muscles. Sets and time holding the weight should vary. For starters, grab a weight that you can hold for 1:00 x 3 sets. Rest between 2-3 minutes between sets. From there, you can try walking with the sandbag for 25ft, 50ft, 100ft, and so on. 

• Pallof Press
  • The Pallof Press is a movement that is simple in nature, but dynamic in benefit. Traditionally, this movement is performed by standing parallel to an anchored base and then pressing a resistance in front of the body to create a feeling of rotation on the torso. The Pallof Press's benefits kick in when we resist the rotation that the external resistance is causing on the upper body. In doing this, we can strengthen and train the rectus abdominis, internal obliques, and external obliques. Check out this video for more in-depth information and guidance on completion. 

• Dead Bugs
  • Another great core exercise that focuses on bracing and anti-rotation. What makes this core movement stand out is the proprioception of the ground to assist with resisting lumbar extension. Add in arm and leg movement and bam- a much more complex exercise but saves the lower back. Strive for 3 to 5 sets of 10 repetitions on each side. 

3. Compound movements

Full body, compound movements should be done in your training-regardless of if you've worked on core bracing exercises. However, once you've become better at core activation and pelvic muscle strength, compound movements will feel easier. However, the OG movements that I'm talking about which may impact your pelvic floor are the squat and deadlift since they can create a large amount of intraabdominal pressure. So, continue to do these in your training cycle along with lots of other movements (follow your classes programming and you'll be good). But, stay attentive to your core. You could even try sandbag squats! 

4. Jumping

Incorporate jumping; like jump rope and box jumps, slowly back into your training. Definitely don't discontinue them since you'll never master these movements if you avoid them. Follow these steps below to incorporate them back into your training. 

• WHAT’S YOUR THRESHOLD? WRITE IT DOWN
  • Now that you are paying attention to your alignment, note when you pee. Is it after 10 reps? 20? 50? Whatever the number is, note it. This is your threshold.

• TRAIN UNDERNEATH YOUR THRESHOLD.
  • If you pee after 50 double unders, I want you to start doing sets of 35-40.
  • In the middle of the workout: do 35 reps, stop, rest, and then continue (limit to 35 reps/round if that’s easier). 
  • As accessory work: Do 3-5 sets of 35 reps (resting a few minutes between sets) 3-5 times a week.