Keeping your pelvic floor muscles strong is essential, but sticking to the same exercise regime can be tedious.  Wondering how to stay strong without falling into a rut?  Read on…

Nearly 50% of all adult women will experience some form of urinary incontinence.  Despite this high prevalence, only 25% will seek treatment and of this group, less than half will receive treatment.  

This epidemic of bladder dysfunction, along with a growing demand for alternative treatments to medication, has driven the steady rise of demand for pelvic floor physical therapy.  

Pelvic floor muscle training is now recognized as a first-line treatment for overactive bladder (OAB),  and bladder leaks.  Additionally, pelvic floor muscle strengthening has been shown to improve sexual satisfaction even in women who are postmenopausal.  

As a pelvic health physical therapist, one of the main goals of my clients is to strengthen their pelvic floor muscles.  This could be to stop bladder leaks, prevent bladder urgency or just ‘hold it’ when needed.  

So why the resistance and even groaning when pelvic floor muscle exercises are recommended?

Not all of us are good at sticking to a routine, let alone the same exercises to be repeated daily.  Pelvic floor muscle exercises can be repetitive and boring, no matter how easy they may be.

The good news is that other muscle groups in your body like to work with your pelvic floor muscles.  This means that if you activate these synergistic muscle groups you will get over-flow participation from the pelvic floor muscles as well.  

What muscle groups like to work with my pelvic floor muscles?

Abdominal Muscles

You are correct if you’ve felt that your abdominal muscles want to work with your pelvic floor muscles.  Specifically, your deepest abdominal muscle, called your Transverse Abdominus muscle and your pelvic floor muscles work together to create strength and stability in your body.  

Your Transverse Abdominus muscle is located at the bottom half of your trunk, from just above your belly button to your pubic bone.  To activate this muscle, start by taking a breath in, on your breathing exhalation, and pull your belly button in towards your spine.  

If you see or feel your belly button sink inwards, you know you’ve got it engaged.  For more on how your breath affects your pelvic floor and core, check out my blog on the subject here.

Gluteal Muscles

Your gluteal muscles or ‘glutes’ are a group of muscles that provide essential stability and strength for your hip and spine.  These muscles include the Glute Maximus, Medius, and Minimus.  They are the muscles that move our leg out to the side, backward, and rotation.  As such they help us to lift, bend, climb stairs and walk.  

We often take these muscles for granted until they become weak and stop working effectively.  They can become weak due to pregnancy, physical injury, or inactivity due to a sedentary lifestyle.  

Whatever the cause, weakness in these muscles means your not moving at your best.  Because they are so important to your functional mobility, strengthening them is often a priority when getting physical therapy treatment.  

These muscles are also synergistic with your pelvic floor muscles.  This means that when strengthening your glutes, your pelvic floor muscles will want to participate.  

Adductor Muscles

The adductor muscles are located on the inside of the thigh attaching to your pubic bone and inside of the femur.  They provide support to the inside of the hip and pelvis.  Their job is to move your leg inward towards your midline and for rotation. 

These muscles also work synergistically with the pelvic floor muscles and when activated your pelvic floor muscles want to join in.  This is why it helps to cross your legs when you cough or sneeze to avoid bladder leaks.

Because all of these other muscles are working with your pelvic floor muscles you might be wondering; is it enough to only strengthen your core and hip muscles?

No, sadly it is not enough to only exercise your core and hip muscles.  Studies show there is not enough of a ‘training effect’ when you only exercise core and hip muscles.  That is, even with synergistic overlap, the pelvic floor muscles are not getting enough direct activation to keep them strong.

But, you can take advantage of the synergistic action to exercise both at the same time.

Who doesn’t love a two-for-one deal!

The good news is that if you link your pelvic floor muscles with your abdominal muscles as in the ‘zipper’ technique.  This synergistic activation can be incorporated into regular exercise.

Follow the steps below to understand how to include the pelvic floor, core, and hip strength all in one exercise.

1. Start by taking a breath in, on your breathing exhalation activate your pelvic floor muscles by closing and lifting inward.  
2. Extend the lift inward to your abdominal muscles by drawing your belly button in towards your spine.  This is also called the ‘zipper’ technique, see this link for more information.
3. Continue holding the ‘zipper’, as you squeeze your glutes and lift your hips up so that your back and hips are straight.  This is called a ‘bridge’ position. 
4. Hold this position for 5 seconds, counting out loud so you don’t hold your breath.
5. Bring your hips down as you lower out of the bridge position. 
6. Let go of the ‘zipper’ and rest completely between repetitions.  
7. Repeat the above routine 10-12 times.  Daily

This particular exercise involves the glutes, abdominals, and pelvic floor muscles.  Because of the positioning of your hips higher than your shoulders you get gravity assistance with pelvic floor muscle activation.  Bonus!

While there is no replacing specific pelvic floor muscle activation,  you can beat boredom by including the ‘zipper’ technique in regular exercise.  When you feel your core activate make sure you are using the ‘zipper’ technique to get the most out of exercise and include your pelvic floor muscles.  

Once you get the hang of incorporating the ‘zipper’ into a few key exercises you are already doing, what was once a ‘chore’ is now an easy add-on to your exercise routine.  

 Doesn’t it feel good to know you are creating a new healthy habit!  Yay!

What other topics would you like to hear about?  Leave me a comment below and let me know…

Happy Bladder wishes!

~ Tami

Tami Lines is a licensed Physical Therapist with certifications in Pelvic Rehabilitation and Women’s Health Coaching.  She is the founder of Pelvic-Health-Matters.  Tami has over 15 years of experience with expertise in bladder Health, and pelvic floor muscle dysfunction for adolescent and adult women.  She is also a mom of two wonderful young adults working their way through college. 

References:

Marques SAA, Silveira SRBD, Pássaro AC, Haddad JM, Baracat EC, Ferreira EAG. Effect of Pelvic Floor and Hip Muscle Strengthening in the Treatment of Stress Urinary Incontinence: A Randomized Clinical Trial. J Manipulative Physiol Ther. 2020 Mar-Apr;43(3):247-256. doi: 10.1016/j.jmpt.2019.01.007. Epub 2020 Jul 21. PMID: 32703614

Foster SN, Spitznagle TM, Tuttle LJ, Sutcliffe S, Steger-May K, Lowder JL, Meister MR, Ghetti C, Wang J, Mueller MJ, Harris-Hayes M. Hip and Pelvic Floor Muscle Strength in Women with and without Urgency and Frequency Predominant Lower Urinary Tract Symptoms. J Womens Health Phys Therap. 2021 Jul-Sep;45(3):126-134. doi: 10.1097/jwh.0000000000000209. PMID: 34366727; PMCID: PMC8345818.