IF you already know how to work your pelvic floor effectively, then YES! Definitely, Pilates can help strengthen the pelvic floor & teach you to use it in a functional way. Many specialist antentatal & postnatal physiotherapists are also experienced Pilates Instructors. Exercise is a key pillar of our physio training and Pilates has proven to be a style of exercise to really suit mums’ needs. Chosen carefully, some exercises can be started from the early days, even after a caesarean.
I am such a Pilates enthusiast that have made a series of postnatal exercise videos taking you from “birth to 6 weeks”, via abs & gluts focus sequences to getting ready to run. With Pilates for Pelvic Floor Strengthening to really target this most elusive bit! Join me here….
NOT if your pelvic floor muscles are very weak. Or even completely ‘switched off’. That’s when you do have perfectly good muscles but your brain is not telling them to work. Maybe because of some nerve problems since your delivery. Rather like having windscreen wipers but no button to switch them on in the rain. Or working too hard. Sometimes you are subconciously over-gripping since you had your baby. Perhaps still tense around an episiotomy scar or going into spasm when you sit or walk too long?
If your inside pelvic floor muscles are not ready (even if your outside seems fine), then unfortunatley, you could do an entire Pilates class with relatively little benefit. Some times things get worse:
you might feel more sore in your pelvis after a class than before.
it’s easy to accidentally bear down and stretch & weaken them more
or not reaslie that you have too much pressure on your bladder or uterus inside, encouraging a prolapse to appear as you exercise more.
Not sure what’s going on inside?
If you have any worries that your pelvic floor is not quite what it should be, or want to return to a high level of sport or fitness, get your technique checked before you do too much more DIY.
Ask your midwife or GP to refer you to a Specialist Physiotherapist. They will examine you and properly advise on your personal situation.
Why see a specialist physio?
There is so much a specialist pelvic floor physiotherapist can teach you to improve internal muscle strength, endurance & co-ordination. They will also check your posture, tummy gap, core strength & scars.
Through post-graduate training, we have the skill to properly assess and examine the pelvic floor muscles with a vaginal examination. We do this in a kind and gentle way putting you as much at ease as we can.
We aim to help you understand how your body works. With a better understanding of your muscles’ strength, weakness or tension problems, your exercises will make sense & be motivating. We can show you how to help them to grow stronger or release & stretch. As well as how to be skilled at using them, to prevent incontinence and improve internal organ support!
It’s not just up/down squeezes!
We have lots of different ways of exercising. The standard post-birth exercises are great – but they are not the end of the story. See some new ideas in our Pelvic Floor School. To encourage proper muscle activation we have tricks & tips. We have more advanced and interesting exercises to get you back to higher level sport. Even great gadgets that can show you what you are doing and enhance your muscle work.
How to get support?
Ask your GP to refer you to the local NHS services (if you are Cambridge-based you can self-refer). Or do come to see me at my practice South Cambridge Physiotherapy or arrange a virtual appointment.
Not near Cambridge? I believe finding a local physio is best for your longer term support. Women have a long journey from motherhood to menopause. Visit www.themummymot.com for a national directory of physios who specialise in caring for postnatal mums.
There are two types of units you can use to help improve your internal muscles: pelvic floor biofeedback devices and muscle stimulation units.
Pelvic floor Muscle Stimulation Units
These units are designed to be used at home to artificially stimulate the pelvic floor muscles to work. Electrical impulses are sent from the machine directly to the pelvic floor to mimic the messages that your brain is supposed to send.
These units are ideal for people who really don’t know where their muscles are. Or what they are supposed to do! They are also good for very weak muscles that can only contract a few times before they fatigue. Or muscles that can only muster a very tiny amount of strength.
the sensations (a sort of tingly feeling) created by the electrical impulses help your brain to correctly identify the location of your pelvic floor muscles.
the machine will stimulate the muscles to work (contract). It is possible to change the settings to favour different parts of the muscle.
you can practice joining in with the machine to learn how to contract your muscles without help
the machine can help you to ‘hold’ a muscle contraction while you concentrate on learning to breathe and/or move at the same time
we usually recommend that you wait until 3 months postnatally before using a stimulation machine.
Examples of stimulation units:
To be professional, I do not recommend a single specific product or supplier. But I have aimed to narrow down the list of options for you. Please do read customer reviews to help you make your decision. Many specialist physiotherapists, like myself , have units in clinic for you to try out before you buy.
Traditionally the stimulation is delivered by a battery-operated handheld unit with wires to a internal electrode. The price points vary depending on the number of programmes available & the style of the electrode supplied. A new design on the market is Pelviva, which are wireless foam single-use electrodes.
The kegel 8 Tight & Tone Electronic Pelvic Toner £98.99 is a simple classic pelvic floor stimulation unit which we have used in our clinic for many years. The buttons are large and few! You may prefer to use it with a periform electrode
Neen Pericalm £69 + buy a probe
is often brought in by customers (availabe on amazon). I also find this one easy to follow the instructions and set the programmes. It is also very small and discreet. You will need to buy a vaginal or anal probe to go with it.
Kegel 8 Mother Nuture £79.99
Even though it is the cheapest one that Kegel8 offer it has all the programmes you will need, plus doubles up as a TENS machine if you anticipate another delivery.
Nu-tek Levator mini continence stimulator.
Win-health supplies our practice. It is a good stimulator though the buttons and set up are a little fiddly until you understand how it works. I recommend you select the Periform probe (which has a hole in the middle rather than solid) most clients find it more comfortable.
Kegel8 Ultra 20 £134
has more programmes & is supplied with the shapely Glide Gold Vaginal Probe
Pelviva £44.95 for starter pack of 3/£214 for 1 month pack x15
Pelviva is a unique product that does not require a handheld unit like those above. It is a disposable single use foam electrode which is activated just before use then delivers 30-min internal stimulation. video here
How to use a pelvic floor stimulation machine for different problems eg stress incontinence, urgency, pain or prolapse or after delivery.
FAQs from clinic!
You will see that these videos were created as a project for Kegel8. However, you will find most of the information applies to stimulation machines in general.
These videos will help you understand your condition, as well as how the machines work. Then, you will be able to decide whether a machine would benefit you and which programmes you would choose.
Pelvic floor Biofeedback devices
Generally, we advise that if you can already contract your pelvic floor muscles then you don’t need to do passive stimulation. The majority of women are ready to jump straight in with a biofeedback unit.
Muscles develop quicker by doing ‘active’ exercises where the brain initiates the activity. When you use a biofeedback device to enhance your practice your brain is learning a new skill-set. Your muscles need to perform in every day life even when you are not plugged in to a machine!
The action of your muscles contracting is relayed to a machine which “shows” you what you are doing. There are several different ways this can be done. Some machines pick up the electrical signal from your muscles while some respond to pressure. Some give you a visual picture of what you are doing, others beep or vibrate in response to your contraction.
These are great to correctly identify your pelvic floor muscles in different positions. They also ensure you are contracting correctly and also help you focus on relaxing fully between contractions
See how well your muscles contract and relax. Have targets to aim for to improve strength, endurance and co-ordination.
Practice more complicated tasks. Skills you need for real life or your sport.
Make exercising a bit more fun (!) and interesting. This will help you to keep up long-term practice (rather like a piece of gym-kit for your pelvic floor!)
Examples of pelvic floor biofeedback devices:
To be professional, I do not recommend a single specific product or supplier. But I have aimed to narrow down the list of options for you. Please do read customer reviews to help you make your decision. Specialist physiotherapists, like myself, have units in clinic for you to try before you buy.
Electrical biofeedback devices:
Peritone EMG biofeedback unit and Simplex EMG biofeedback unit are the ones we have used in our clinic for many years (same device in different packaging).
They are effectively two parts. You place a small internal electrode (called a Periform, which is single person use, into the vagina. Then put your clothes back on!. Then link your internal device by a cable to the handheld Pelvitone or Simplex unit (we can loan one of these to you).
When you contract your pelvic floor muscles their electrical activity registers on the screen. This makes the lights change from orange to green and gives an audible beep.
You can practice your quick maximum power squeezes seeing how high you can make the lights go. Also, practice keeping the lights green while you cough or try moving your arms or legs. There is also a work/rest function which ‘counts’ the endurance holds for you and tells you your average squeeze score at the end.
These devices are widely available from lots of online sellers +/- £160 (including the Periform).
Pelvic floor training device
Elvie updates the design of the traditional units above. It is popular as it has modern smart phone visuals, easy charting & a sense of community amongst users.
I have one I can show you in clinic but the internal device (the pebble) is the expensive part, and understandably single use only, so I’m afraid you can’t try before you buy.
It is a discreet, attractive, wireless bluetooth pebble-shaped device. This goes inside the vagina. Use an app to turn your phone into the biofeedback monitor/exercise tracker. No cables between you and the phone but you can’t put knickers back on or the bluetooth can’t connect. It is beautifully packaged and well designed by women. It can be used in the second trimester of pregnancy but is not recommended for the 1st and 3rd trimesters.
Available directly from Elvie £169 for the pepple device, the phone app is free. It’s officially available “on prescription” but sadly, I don’t know anyone whose managed to get one this way.
Pressure Biofeedback devices
Kegel 8 Biofeedback Pelvic Trainer Kegel8 are not offering an electrical biofeedback unit in their products any more. They have a product which uses a pressure system where you squeeze on a larger tube which moves a dial on the hand held unit. Relatively unsophisticated but an inexpensive option at £79.99
Epi-No Delphine Plus £89.99 This is another non-electrical device, which monitors the amount of squeeze pressure youare creating with your muscle contraction
Though, as with the Kegel 8 Trainer, this is less sensitive than the electrical one the advantage of the Epi-No is that it is certified for use through your whole pregnancy. It can also be used in the latter part of pregnancy (after 37 weeks) to help to stretch the vaginal opening. A recent study * did not show evidence of a protective effect of the Epi-No device on birth trauma, however, anecdotally many women feel it has helped with their confidence to relax the vaginal opening in preparation for birth.
*Kamisan Atan I, et al. BJOG 2016 Does the Epi_No birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial.
The Vibrance Pelvic Trainer is a petite internal device which vibrates when you correctly contract your pelvic floor muscles. The device is easy to insert but you may need to hold it in position. There are no wires, or external unit, the vibration is felt in the device itself.
This device could also be useful as a ‘bridge’ back to penetrative sex if you don’t want to use a traditional vibrator. You could practice inserting the trainer at your own pace. You might find the vibration element helpful to re-sensitise your tissues. They are available directly from www.vibrancepelvictrainer.co.uk £140.83 with VAT exemption.
If you have had a problem for more than 3 months you can declare yourself as having a ‘chronic medical condition’ and do not have to pay VAT. There will be a form to complete. This does not apply to the Elvie which is registered as an exercise tracker not a medical device. Not all the online suppliers can offer this service.
Combined Stim & Biofeedback Machines
You can also buy combined units which do both functions. However, these are surprisingly expensive (and a bit fiddly) so if you feel you need both systems I usually suggest you buy two separate simpler units and switch between them.
You will need a water-based lubricating gel to help the insertion of the devices. It is also essential to help the electrical devices to operate correctly. A simple, in-expensive, chemist-own or basic brand name is theoretically all you need. However, if you have concerns about ingredients you may prefer an organic version. Do read my posts about the difference between water-based and oil-based lubricating products.
Not sure what YOU need?
Get clarity first
If you are not too sure how good your muscles are then before you spend ANY money on a gadget or device I would highly recommend an hour spent with a specialist physiotherapist! Your appointment will be £70-90 outside London.
Our role at physiotherapy is to do an internal assessment of your pelvic floor muscles. We will check how well they are working and teach you how to get the best from them – you may not need any gadgets at all! And if you do we can help you make the best choice for your needs.
Try before you buy
We can loan you both muscle stimulation and biofeedback units to try out at home. To see how well they work for you before you consider buying your own. It is particularly important to consider an individual assessment by a specialist physiotherapist if you are at all worried that your pelvic floor muscles might be too tight rather than too weak.
We can also teach you exercises , which require no equipment at all! We usually combine pelvic floor exercises with appropriate abdominal muscle work as these two areas need to work well together for best support of our internal organs.
Please don’t hesitate to be in touch if you have further questions.
This is absolutely my favourite standing pelvic floor exercise. I love that it anchors you to the spot with a quick little routine to stop you getting distracted part way through.
Honestly takes 35 seconds but pings your pelvic floor muscles awake.Little and often improves muscle memory, reaction times, and encourages quick muscle growth.
Turn your toes out, like a ballet dancer, 5 squeezes of the back passage
Turn your toes out, like a ballet dancer.Tighten your pelvic floor and notice how this position favours the back passage (the anal sphincter) just like you are stopping wind.Pretend you are having tea with the queen and made the mistake of baked beans for lunch.You need to effectively close the anus opening, without clenching your buttocks more than a smidgen and without it showing on your face!Do 5 on and off squeezes, not trying to hold, just a good squeeze, then let go completely.
2. Turn your toes in, like a pigeon, 5 lift and tucks of the vagina/bladder tube area
Then turn your toes in, like a pigeon. Now when you tighten up underneath it should feel different.Less going on at the back and more focus at the front, around the bladder tube and vagina area.Let the area be soft, almost a bit saggy,then lift and tuck the vagina up inside.Let go – completely.Then repeat 5 on – off contractions.Best lift you can do ….and relax. Don’t worry if your abdominal muscles join in a little bit but keep the focus on your pelvic floor.
3. Turn your toes normal, both areas together as a unit
Finally turn your toes into your normal standing posture.Now try to do both the previous actions at the same time.Most people start with the back tightening and then like a big zip come forward to lift and tuck the front.When you let go each time now it should feel like there was a bigger ‘up’ and a bigger ‘drop’.Repeat.If you are feeling clever add in some side to side tension too (yes, the pelvic floor is bowl shaped, see this in my video showing a model pelvis in the pelvic floor school)
When you have done 5 squeezes with your toes turned out, 5 with your toes turned in and 5 with everything together you will have done 15 really good pelvic floor muscle contractions.NOW your muscles will be thinking – hey she doesn’t normally work us like this – we are going to need to grow!
In this video I go through the exercise with Stephanie from Kegel8 and The Knack too.
When to do it?
Perfect exercise to do little and often through an ordinary day.It tags on really well to cleaning your teeth – or after a wee.At home, use that quiet moment in the toilet to focus on yourself.If you are working, linger in the cubicle for an extra 40 seconds – you are getting paid to exercise!
If you think this exercise is mad and you couldn’t feel a thing when you tried to do it – try it lying down, not so much the feet positions but focusing first on the back passage and then on the front. This positon takes the weight of your organs off the pelvic floor and gives you more chance to ‘feel’ the muscles working.If that still leaves you cold – then I would recommend you have a chat to your GP and ask for a referral to a specialist pelvic floor physiotherapist for a full assessment and examination.There are lots of things we can teach you in clinic 1:1 to help you find and improve your muscle function.
I still clearly remember when I helped a client stop leaking in just one week by teaching her the Knack – and she was FURIOUS.
Sarah came to physio with the problem of urinary stress incontinence, leaking urine when she coughed and sneezed. It had been happening since her second son was born……….17 years before.
She had diligently practiced pelvic floor muscle exercises as everyone had told her to. When we checked them properly, with a vaginal examination, her muscles were firm, with an excellent strong contraction.But, no one had ever explained the connection between practising strong muscle squeezes and WHEN TO USE THE SKILL IN REAL LIFE.
I taught her about the Knack.The next time she came back she was CROSS!It worked – no leaks when she coughed – and quite rightly she was angrythat no one had taught her something so easy, so simple and so effective sooner. It was humbling.And my priority ever since to make sure I spread the word about this technique.I don’t want today’s new mums to wait even 17 hours to figure this one out.
What is “The Knack”
The Knack is the magical art of drawing up your pelvic floor muscles just before you cough, sneeze, laugh or pick up something heavy.Research has confirmed it works *
Your pelvic floor is like a trampette
You probably didn’t have to do this pre-contraction of the pelvic floor before you were pregnant, because a pre-pregnancy pelvic floor has a lot of natural tone and tension in it.Like a trampette, straight out of the box from Argos, you can bounce up and down on itand your body weight barely makes a dent in the springy surface.Pre-pregnancy, most of the down pressure when you cough or jump is deflected straight back up towards your head by the pelvic floor muscles.Your bladder barely feels a bump.
However, you don’t need me to tell you that pregnancy and delivery have a notable affect on our soft tissues.The abdominal wall is a clear indicator of what happens when you stretchelastic slowly and steadily for 9 months.Some are more lucky than others in the natural ‘spring back’ department.Most women know that they are going to have to work to restore abdominal muscle tone and strength. The pelvic floor has carried the same baby-burden and if you had a vaginal delivery (or pushed a long time before eventually needing a caesarean) there will have also been some micro tears to the muscle fibres and their connective tissue attachments.Now, at least temporarily, the pelvic floor behaves like the well-used trampette – a sense that if you jump too hard your feet might touch the floor!
The Knack creates supportive tension
If you tighten your pelvic floor muscles, in the exact moment before you cough, it is like two friends pulling your trampette tight for you just for that moment that you want to jump.Yes, I admit its not ‘natural’, it’s not ideal, it requires thinking, you didn’t have to do it before……but it can make the difference between a bladder leak or not.
Practice makes perfect
Practicethe Knack with a ‘pretend’ cough after you have had a wee. Your bladder is empty so you are unlikely to come unstuck. Challenge the system gently.Hold your pelvic floor muscles firmly – cough lightly.After a few days of practice, when that is feeling safe and secure, challenge the skill by coughing a bit harder.Then increase your confidence by allowing an hour to pass so that your bladder is fuller when you cough (but start with the lighter coughs again!).
With practice you will train a “learned-reflex”, a habit.Your brain gets so used to the sequence of prepare, protect, cough that you do it on auto-pilot.
Sneezes are harder (and coughing fits, choking, vomiting….)
Sneezes are harder to resist with your pelvic floor than coughs, because you have less warning that they are coming and generally they create more downward abdominal pressure. Especially if you are one of those people who make everyone in the room jump out of their skin when you sneeze or are prone to 6 in a row? A hacking cough with a head cold, or an allergy induced coughing fit are jolly tricky too.Work on getting the anticipated, lighter coughs sorted first and then the rest can follow as your muscles strengthen.
Allow yourself some slack
Beware multi-tasking – I remember having a full bladder, baby in one hand, the folded Maclaren in the other, one foot on the escalator, and I sneezed – NOPE – the Knack did not work!!!But hey, I could live with that – it seemed fair – it was a lot to ask of my pelvic floor system.
If you can successfully use the Knack 9/10 times and only the occasional leak gets through that is excellent.
Know when to ask for help
The Knack alone might not be enough for you. Your pelvic floor muscles can be so weak that you need help to get them working again.And it is possible to have muscles that have repaired too tight or are constantly overworking and becoming easily fatigued or sore.Remember there are specialist physiotherapists attached to every UK maternity department who can give you an individual assessment, training and support. Don’t hesitate to ask your GP to refer you to a specialist physiotherapist (full members of pogp.csp.org.uk have extensive post-graduate training).
Does the Knack work for you? Any questions?Please do ask, I am very happy to help.
*Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence. Miller, J.M., Sampselle, C., Ashton-Miller, J. et al. Int Urogynecol J (2008) 19: 773. doi:10.1007/s00192-007-0525-3).
Drawings copyright of A M Savage(Proudly using stickmen since 1991)