Episode 03: Pelvic Floor Exercises

In today's episode, Alexis is educating us on pelvic floor exercises – what they are, their benefits, and how to approach them – and then leads us through a couple of rounds in real time. The episode emphasizes the significance of approaching exercise with caution, starting light, and learning to breathe correctly through the motions. 

REMINDER: Before participating in any type of pelvic floor exercise program, it is important to get clearance from your healthcare provider, as pelvic floor strength training is not indicated for some folks.  

🎧 PS - This episode has helpful visuals if you check it out on YouTube!  
 

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RESOURCES AND REFERENCES 

• Episode 01: Pelvic Floor 101  

SHOW NOTES  0:57 – A welcome and introduction to what we are talking about today! 

1:44 – We run through a quick review of what pelvic floor muscles are, what they do, and how they are affected by exercise 

4:12 – Alexis discusses when pelvic floor exercises can come in handy, and what they can help remedy  

7:25 – Alexis starts off with some reminders as you prepare to exercise your pelvic floor 

9:02 – Alexis describes the two types of exercises given to pelvic health patients 

10:00 – Alexis leads us through a couple of rounds of pelvic floor exercises 

15:43 – Alexis brings the episode to a close with a review of what we talked about 

Transcript

SPEAKER_01 0:01

Hello, and welcome to the Alexis Anderson Podcast. I'm your host, Alexis Anderson, public health physiotherapist and guide for anyone navigating the messy, confusing, and often isolating world of public and sexual health. This season for breaking down the myth, sharing real stories, and giving you evidence-informed tools to understand your body. Whether you're a patient, a clinician, or someone quietly struggling, you're in the right place. Let's take the shame out of the conversation, bring clarity where there's confusion, and make public health feel human, hopeful, and actually talked about. Before we get into it, let's talk the legal stuff. While I am a physical therapist, I am not your personal physical therapist. So please remember, this content is for educational purposes only and not a substitute for personalized medical advice, diagnosis, or treatment. Now let's get started. Hello and welcome to the Alexis Anderson Podcast. I am your host, Dr. Alexis Anderson, Doctor of Physical Therapy. I'm so happy you're here. Today we will be talking about pelvic floor exercises. Most people know these as cagles. I will be referring to them as pelvic floor exercises because that is what they are. They are exercises for your pelvic floor muscles. But as a quick review, all humans have a pelvic floor. Your pelvic floor muscles are just like any other muscle in your body. With exercise, these muscles can bulk up, meaning they can get larger in size, what's called hypertrophy, and these muscles can become tighter at a resting state. So some people will refer to that as tone. So just like if you are weight training and you notice that your muscles are starting to get bigger in size and at rest, you start to notice that your muscles are more tone or more tight at a resting state. Your pelvic floor muscles do the same thing after participating in an exercise program. If you would like more information about the pelvic floor muscles and how to contract and relax them, please refer to the first episode, Pelvic Floor 101, where I talk about the pelvic floor muscles and how to isolate them. Before participating in any type of pelvic floor exercise program, it is important to get clearance from your healthcare provider as sometimes pelvic floor strengthening is not indicated for some folks. For example, if you have been told that you have extremely tight pelvic floor muscles or if you have pelvic pain, it is certainly recommended to get an evaluation by a pelvic floor physical therapist before starting any exercise program. Pelvic floor physical therapists may recommend pelvic floor exercises for a variety of reasons, but the most obvious being that we have found pelvic floor weakness. What does pelvic floor weakness mean? Well, that means that when we tested your pelvic floor contraction, we found that it wasn't very strong. Or we found that when you contracted your pelvic floor muscles and you tried to hold it for a long time, you were not able to hold it for very long. How do we test pelvic floor strength? Well, we do it with an internal exam. During an internal pelvic floor exam, we may insert a gloved finger into the vaginal canal and have you contract your pelvic floor muscles and then relax. We have you contract as hard as you can and we are assessing the strength of that contraction. We also assess how long you can hold that contraction for. So with our finger inserted into the vaginal canal, I would ask you to squeeze your pelvic floor muscles and count how many seconds you can hold that contraction for. If you are not an owner of a vagina, how we assess your pelvic floor muscular strength and endurance is through the rectum. By inserting a gloved finger into the rectum, we assess the same thing. I would have you contract your pelvic floor muscles and assess for how strong that contraction is, have you relax, take a break, and then have you squeeze again and see how long you can hold that contraction. And I'm assessing that rectally. If we deem that you have weakness of your pelvic floor muscles andor you're not able to squeeze and maintain that contraction for a very long time, then we will recommend pelvic floor exercises for you to improve your strength and your ability to hold that contraction for a longer period of time. Pelvic floor strengthening can help with a variety of issues, including urinary function, bowel function, and sexual function. For example, pelvic floor weakness may be responsible for incontinence. Incontinence just means that you have unwanted leakage. And sometimes that can be unwanted leakage of urine, where you're leaking urine when you don't want to. That could be unwanted leakage of gas, so maybe you're farting when you don't want to, or unwanted leakage of fecal material, aka poop. Sometimes people poop their pants, sometimes people have fecal smearing, where maybe they smear a little poop in their underpants. And some people can't really tell the difference between a fart or a sharp, right? So some people say never trust a fart. And if you fit in that category, that may be because you have weakness of your pelvic floor muscles. And if so, then pelvic floor exercises may be indicated for you. Pelvic floor strengthening can also help you override urge. Urgency is that sensation that you have to pee and you have to pee now. Urgency is that sensation that you have to have a bowel movement. Sometimes people will feel the urge, they can feel the gas coming on. Sometimes we are not in an appropriate place to urinate, to have a bowel movement, or to fart. So in those cases, we have to hold these things inside of our body. If you have difficulty doing that because you have weakness of your pelvic floor muscles, then pelvic floor exercises can help. Pelvic floor exercises also help to support your pelvic organs. For example, they help to support your bladder, your prostate, your urethra, that's the tube that you urinate from. They help to support your uterus, if you still have one, and your rectum. So for some folks who have pelvic organ prolapse, and if they have pelvic floor weakness, pelvic floor exercises can help to support these organs and may also prevent the pelvic organ prolapse from getting worse. And yes, pelvic floor exercises help with sexual function. Now, usually when I talk about sexual function, then people's ears perk up when they say, Oh, okay, now I'm gonna do my pelvic floor exercises. How do they help with sexual function? Pelvic floor exercises can help you with the arousal process. They can help you get aroused, and they can help you stay aroused for longer periods of time. During the arousal process, the pelvic floor muscles contract and relax, contract and relax. And that contraction is what causes blood to flow into the penis. That's what causes blood to flow into the clitoris for an erection. Then, once you get the erection, your pelvic flow muscles contract and stay contracted at a sub-maximal level so that you can maintain that clitoral erection. Then during orgasm, the pelvic flow muscles contract and relax, contract and relax. And that's whenever you start to feel that climax coming on, right? And then boom, like a sneeze, a chew, you climax. For some folks, they may even feel their muscles kind of quiver after they orgasm. Pelvic floor strengthening can allow your orgasms to feel more intense and more pleasurable. If you're an owner of a penis and you have found that your semen is not shooting as far or as forceful as it once did, you may notice improvement after participating in pelvic floor exercises. So, as one of my patients said, his shooter is able to shoot further now. So let's get into it. When starting your pelvic floor exercise program, it's important to isolate these muscles, meaning that you are contracting your pelvic flow muscles and your pelvic flow muscles only. You can think of it as an exclusive pelvic floor party where your glutes, your abdominals, and your facial muscles are not invited. During the beginning phases, we're asking you to isolate these muscles. Do your pelvic flow muscles work in isolation? No, they don't. Your pelvic flow muscles work with other muscles in your body, but when you're first starting out, it's important that you can contract these muscles in an isolated way. The pelvic floor exercises I'm going to share with you today are basic and for beginners. Obviously, when I see patients, their presentations vary wildly. I have some folks that don't know how to contract their pelvic floor muscles at all. I also have patients who are CrossFit athletes and are professional athletes. So when you see a pelvic for a physical therapist, we are able to cater your exercises to meet you where you are. But for the purposes of this podcast, we're going to keep it simple. Typically, when prescribing patients pelvic floor exercises, we give patients two different types. One called quick flicks and one called endurance holds. The reason for this is because in general we have two different types of muscle fibers. One, we have fast twitch muscle fibers, and the other one we have slow twitch muscle fibers. Fast twitch muscle fibers are responsible for quick contractions. For example, if you have to sneeze or clear your throat, we need your pelvic floor muscles to contract really quickly to brace for that movement. On the flip side, we have endurance contractions, and that's because we have slow twitch muscle fibers. These muscle fibers are responsible for long holds. For example, if there's a long line for the bathroom, your pelvic floor muscles need to contract and hold to keep your urine inside until it's your turn. Your ability to contract and hold that contraction for a long period of time is given to you by your slow twitch muscle fibers. So we exercise them both. Let's talk about quick flicks. When you're first starting out, try three sets of 10 repetitions. If this is too hard, you can do less. If this is too easy, you can always do more. When doing your quick flicks, you want to contract your pelvic floor muscles for one second and release for one second. This contraction should be a maximal contraction. So it's contracting as hard as you can without recruiting any other muscles in the body. So for example, you're going to contract, relax. Contract, relax. You're going to contract for one second, release for one second. When starting your quick flick contractions, see if you can perform three sets of 10 repetitions.

unknown 10:51

Okay.

SPEAKER_01 10:52

Let's do the first set of 10 repetitions together.

unknown 10:55

Okay.

SPEAKER_01 10:55

Remember, when you contract, you want to do a maximal contraction and then a full relaxation.

unknown 11:01

Okay.

SPEAKER_01 11:02

Let's go.

SPEAKER_00 11:04

Contract. One, relax.

unknown 11:06

Okay.

SPEAKER_00 11:06

Two, relax. Three, relax. Four, relax. Five, relax. Six, relax. Seven, relax. Eight, relax. Nine, relax. Ten, relax.

SPEAKER_01 11:25

Big belly breath. Reset. Release.

unknown 11:29

Okay.

SPEAKER_01 11:29

If that was easy for you, go ahead and continue and see if you can do two more sets of ten. If that was too difficult for you and you fatigued, then back off. And maybe you should try to do sets of five repetitions to begin with. And once you get stronger, then you can build up to three sets of ten repetitions. All right. Now let's switch to the longer holds. During this phase, you're going to contract your pelvic fore muscles and you're going to maintain that contraction for five seconds and then relax.

SPEAKER_00 12:05

Let's try a set of ten together. Here we go. Contract, hold, one, two, two, three, three, release. That's one. Contract. Hold. One, two, two, three. Release. That's two. Contract. Hold. One, two, three. Release. That's three. Contract. Hold. One, two, three. Release. That's four. Contract. Hold. One, two, three. Release. That's five. Halfway there. Contract. Hold. One, two, three. Release. That's six. Contract. Hold. One, two, three. Release. That's seven. Contract. Hold one, two, three. Release. That's eight. Contract. Hold one, two, three. Release. Nine. Contract. Hold one, two, three, three, release. You just did ten.

SPEAKER_01 13:34

Now, if that was pretty easy for you, go ahead and try two more sets of ten repetitions, holding each contraction for three seconds. If that was too difficult for you, see if you can hold for two seconds. So when we first start off, I like to see if patients can do three sets of 10 repetitions of the quick flicks, three sets of 10 repetitions of the long holds, holding each one for three seconds. Practice this. Once this is easy, feel free to progress. For example, you can do five sets of 10 repetitions of the quick flicks. That's going to give you 50 quick contractions. For the longer holds, see if you can increase your hold time. Instead of holding for three seconds, can you hold for five seconds?

unknown 14:25

Okay.

SPEAKER_01 14:26

Can you do five sets? So now you're going to do five sets of the 10 repetitions holding each contraction for five seconds. That's going to give you 50 of the long holds. If that gets easy, you can always do more for the quick flicks. If that is easy for your long holds, you can increase your hold time. So if doing five sets of 10 repetitions, holding each one for five seconds is easy, can you hold for longer? Can you hold each contraction for seven seconds? Practice that for a while. Once that's easy, can you hold for 10 seconds? And so on. So like I said, these are just the basics. If it's too hard, make them easier. You can work your way up to three sets of 10. Maybe you start doing three sets of five contractions. That's okay. Start there and improve when you can. Again, these are just the basics. When I have my patients who are crossfitters or athletes, I obviously make their exercises much harder to meet them where they are. If I have patients that are not able to contract their pelvic floor at all, then we have other techniques that help them to get to where they want to be. When performing your pelvic floor exercises, it is important that you are not holding your breath. So during your quick flicks, can you contract, relax, contract, relax without holding the breath. For the long endurance holds, when you're contracting, see if you can count out loud so that you know you're not holding your breath. See if you can contract your pelvic floor muscles, breathe while you have that contraction held, and then relax. So let's review. Pelvic floor exercises are for everyone. Just like you exercise your muscles to maintain healthy strength and endurance, your pelvic floor muscles are no different. I think it's great for everyone to do pelvic floor exercises. However, if you have pain or if you have been told you have really tight pelvic floor muscles, it's best that you consult a professional before starting an exercise program. Pelvic floor exercises are great and recommended for patients who have pelvic floor weakness, meaning they may not have a strong pelvic floor contraction and or they may not have the ability to hold that contraction for a long period of time. When starting a pelvic floor exercise routine, you want to start with something that you can do. So start slow and work your way up to progressions. Pelvic floor exercises should never hurt. Pelvic floor strengthening can help with leakage, it can help with urge control, it can help to support your pelvic organs, it can help to support your pelvis, it can enhance sexual arousal, improve your ability to become aroused and stay aroused, and intensify orgasms. Start small, and as soon as you achieve your goal, progress. I hope you found this helpful. And if you did, like, comment, and share. If you have any questions, put them in the comment section below. And I look forward to seeing you in the next episode. Thank you so much for joining me in today's episode of the Alexis Anderson Podcast. I hope you learned something that brings you more clarity, validation, and compassion for your body and your journey. If this episode supported you or you think it could help someone else, please share it, leave a review, or send it to someone who might need to hear it. And if you're a clinician or a patient looking for more resources, tools, or support, you'll find everything linked in the show notes. Remember, you're not alone, you're not broken. And treatment exists that treats you as a whole person. I'll see you in the next episode.