THE STEPS

MASTER THESE

Pelvic Floor Strengthening
Abdominal Co-contraction
PF + Abdomen Combined

THEN ADD BREATHING

PF & Abdomen + SNIFF, FLOP & DROP
PF & Abdomen + IN & OUT BREATH
PF & Abdomen + CONTINUOUS BREATHING

THE EXERCISES


PELVIC FLOOR STRENGTHENING

Strengthen

So far we have focused on the crucial work of releasing the pelvic floor. Once you have made good progress in this area, we start working on strengthening.

This exercise is similar to how we learnt to Drop the pelvic floor. However rather than focusing on just the release, we are now focusing on the contraction of the muscle also.

Using the diagrams here we already learned how to DROP the pelvic floor but now we learn how to strengthen. We do this once we have practiced the ability to release.

How do I know I am ready for the strengthening?

If you have pelvic pain it is important that you wait until you can feel that you have control of the release. You will gradually feel an increased ability to let go. If you feel an increase in your pain by doing strengthening exercises – then you STOP and go back to releasing.
If you have weakness but no pain then you can use the contraction as described in pelvic floor strengthening in order to better feel the DROP. So you don’t have to wait until you have 100% control of the DROP but make sure that you always bring the pelvic floor back down as much as you can in between contractions (squeezes).

GET READY

Lay Back

Lie on your back with your knees bent up. (You can also do this exercise lying on your side)
THE EXERCISE

PF Contraction

Contract the pelvic floor as if you were trying to stop yourself from passing wind. Think of the direction going from the back passage all the way up towards the pubic bone as shown here or towards the tummy button

PF Releasing

Now release the pelvic floor COMPLETELY. Again think of the direction; release all the way back towards the coccyx bone, thinking of relaxing the back passage – backwards

THE TIP

Don’t brace your tummy
Don’t lift your chest
Don’t hold your breath
On the release, think simply of just letting go. Don’t force the release
Think of softening

REPEAT

Start with five repetitions and work up to 10 repetitions.

We will be aiming to do exercises three times per day.
You should notice an increase in range of movement from the contraction to relaxation.

Think of the elevator analogy. You are lifting up to the sixth floor and then releasing all the way back down to the basement.


ABDOMINAL CO-CONTRACTION

This exercise focuses on the correct activation of the transversus abdominis muscle. It is very specific and you will need to concentrate very hard. It is important not to use the rectus abdominis muscle or the oblique muscles and to make sure they remain relaxed during the exercise.

It is very important to make this distinction as it is the transversus abdominis that will promote a better activation of the pelvic floor. The rectus abdominis and the obliques may lead to increased tension or increased pressure on the pelvic floor muscles when there is an imbalance through the cylinder of control.

GET READY

Lay Back

Lie on your back with your knees bent up. (You can also do this exercise lying on your side)

Press your finger tips into the lower abdomen at your stomach just inside your “hip bones”.
THE EXERCISE

Pelvic-Floor-In

Start with a gentle breath in and then breathe all the way out. Then without breathing slowly draw in the lower stomach as if to pull away from the zip of your trousers or knicker elastic.
Hold this for 5 seconds and don’t breathe either in or out.

Pelvid-Abdomen-Resting

Release the stomach all the way out into your fingers making sure to release the upper abdomen too. At this stage you will breathe in.

THE TIP

The biggest mistake is to pull in the stomach too hard and this will be felt as a bracing. Bracing is the same as what happens during a cough; push in to the stomach with your finger tips and you will feel it while you cough
In order to avoid this make sure to draw in the abdomen very slowly during the exercise

REPEAT

Do 10 repetitions. Practice this three times per day. Once you have improved the technique in lying you can progress to the sitting or standing positions.


PF & ABDOMEN COMBINED

We know that in many cases by using the transversus abdominis muscle – pelvic floor muscle activation will be better.
It is important that this is the transversus abdominis muscle only and not the rectus abdominis or the obliques (see PALPATION)

GET READY

Lay Back

Lie on your back with your knees bent up. (You can also do this exercise lying on your side)

Press your finger tips into the lower abdomen at your stomach just inside your “hip bones”.
THE EXERCISE

Draw in the lower abdomen and the pelvic floor
Hold this at first for just 5 seconds

Pelvic-Floor-In

PF Contraction

Now release both the abdomen and pelvic floor.
Flop out the stomach COMPLETELY.
Don’t just stop contracting, make sure you have released fully.

Pelvid-Abdomen-Resting

PF Releasing

REMEMBER

By contracting ( and similarly releasing) the tummy and the pelvic floor at the same time, one helps the other – see if you can notice this connection

Bear in mind, this exercise will require a lot of concentration.

The difference between the contraction and release should become more apparent with each repetition

REPEAT

Start off with five repetitions and increase to 10
We will be aiming to do 10 repetitions, three times per day

Each time you move on to a new level, this exercise will take over from the last one. This is now the one that you will do 10 repetitions three times per day. However you should always do at least 5 minutes of your breathing (SNIFF + FLOP + DROP) once every day – even when you move on.


PF & ABDOMEN + SNIFF, FLOP & DROP

Once we can coordinate the abdomen and the pelvic floor together we can hold for five seconds. In order to maximise the release we need to be able to coordinate the in-breath (SNIFF FLOP & DROP) after the release. Let’s assume that after you have contracted and when you decide to release that your pelvic floor doesn’t let go completely. Let’s say it only releases 60%. Now you are going to use your SNIFF FLOP & DROP to release the other 40%.

GET READY

Lay Back

Lie on your back with your knees bent up. (You can also do this exercise lying on your side)

Press your finger tips into the lower abdomen at your stomach just inside your “hip bones”.
THE EXERCISE

Draw in the lower abdomen and the pelvic floor

Pelvic-Floor-In

PF Contraction

Now release both the abdomen and pelvic floor first.

Flop out the stomach completely. Don’t just stop contracting, make sure you have released fully

Pelvid-Abdomen-Resting

PF Releasing

Now in one swift motion, SNIFF IN, FLOP out the tummy and DROP the pelvic floor.

Pelvid-Abdomen-Resting

PF Releasing

REMEMBER

FLOP & DROP completely. Don’t just stop contracting, make sure you have released fully.

Don’t lift your chest

By letting the pelvic floor go on the in breath you are effectively isolating the pelvic floor muscles.

By breathing in more swiftly you get a better a FLOP & DROP.

REPEAT

Do five repetitions at first increasing to 10
Repeat three times per day

When you feel ready or after a few days of practice of this exercise, then move on to PF & ABDOMEN + IN & OUT BREATH.


PF & ABDOMEN + IN & OUT BREATH

We focus now on taking a breath while training the muscle.

This may seem like a small addition, however being able to breath has a significant impact on training the muscle

Once you are able to release the pelvic floor maximally using your SNIFF, FLOP & DROP technique, then you are ready to move on. In order to progress you need to learn how to coordinate breathing with holding the pelvic floor. By coordinating your breathing you will maximise your pelvic floor muscle training and you will be able to progress your endurance over time.

GET READY

Lay Back

Lie on your back with your knees bent up. (You can also do this exercise lying on your side)

Press your finger tips into the lower abdomen at your stomach just inside your “hip bones”.
THE EXERCISE

First breath in and sigh all the way out to empty the lungs.
Without breathing, draw in the lower abdomen and the pelvic floor.
Take a SMALL breath in just as far as the chest, while still holding your tummy and pelvic floor

Now make a long breath out, like a sigh, whilst still holding your tummy and pelvic floor in

PF Contraction

The pelvic floor might want to drop down, don’t let it keep holding to the end of a prolonged out breath

Do an extra squeeze at the end to make sure the back passage is still engaged

Now release both the abdomen and pelvic floor first.

Flop out the stomach completely. Don’t just stop contracting, make sure you have released fully

Pelvid-Abdomen-Resting

PF Releasing

Now in one swift motion, SNIFF IN, FLOP out the tummy and DROP the pelvic floor.

Pelvid-Abdomen-Resting

PF Releasing

REMEMBER

The combination of all of these is very difficult and requires a lot of concentration

When you can co-ordinate this, you are a long way towards success but it takes time

If it is too difficult you need to go back and practice the components of it again

Just by doing the exercises you are training the pathways between the brain and the pelvic floor – so even if you don’t feel something happening each time in the pelvic floor muscles you ARE training these pathways. You will feel it with practice

REPEAT

Repeat this 10 times, three times per day
You should always do five minutes of SNIFF FLOP and DROP daily even when you have progressed on to other stages
When you have practiced this stage for a few days then move on to PF and Abdomen + Continuous Breathing


PF & ABDOMEN + CONTINUOUS BREATHING

We commence continuous breathing while we hold.
Once you can contract and relax the pelvic floor and breathe in and out once you are ready to go on to breathing for a longer duration.

This will help you increase endurance in the pelvic floor and in the core muscles.

GET READY

Lay Back

Lie on your back with your knees bent up. (You can also do this exercise lying on your side)

Press your finger tips into the lower abdomen at your stomach just inside your “hip bones”.
THE EXERCISE

Breathe in and then sigh all the way out and now without breathing draw in the lower abdomen and the pelvic floor.

Now start to breathe normally while you continue holding; shallow and relaxed breathing into the chest only.
Keep this up for approximately 10 seconds- THIS IS WHAT MAKES THIS EXERCISE DIFFERENT – By holding for the 10 seconds you are further training your pelvic floor.

PF Contraction

At the very last outbreath – breathe all the way to the end of the outbreath reinforcing the squeeze of the pelvic floor to make sure it hasn’t slipped. Do an extra squeeze in just to make sure you are still holding before letting go.

Then the last Sniff Flop and Drop as it is on the page.

Now release both the abdomen and pelvic floor first.

Flop out the stomach completely. Don’t just stop contracting, make sure you have released fully

Pelvid-Abdomen-Resting

PF Releasing

Now in one swift motion, SNIFF IN, FLOP out the tummy and DROP the pelvic floor.

Pelvid-Abdomen-Resting

PF Releasing

THE TIP

As you continue holding, don’t let your chest rise

If you feel the pelvic floor dropping just squeeze again to hold it in

It is important to squeeze at the end before you drop to improve your awareness of muscle strengthening

REPEAT

Repeat this 10 times, three times per day
You should always do one set of five minutes SNIFF FLOP & DROP daily before one of these three sessions

Progressions include going being able to do this in lying to sitting to standing.

Are there any cases where one should move through the progressions of the pelvic floor and breathing without using the abdomen as well?

Yes if every time you contract your pelvic floor your abdomen braces outwards then this is incorrect and you should leave out the abdominal activation until you feel you can draw it in more gently without it bracing.

What happens if I can’t feel this?

If you have gone through these pages and tried the variations to make sense of what is happening in your body and still it does not make sense to you, it may be that the muscles are overheld and you need help releasing them. See the list of manual therapists for the pelvic floor on this site or contact the Women’s Health physiotherapy group in your country for further assistance.

For further progressions see the FAQs.