Am I Doing It?.. How to know you’re activating the pelvic floor muscles correctly.

Table of Contents

• Why connecting to the pelvic floor is important

• How to know you are activating the pelvic floor correctly

• Other Considerations

• References

Goal: To learn how to know if you are activating the pelvic floor muscles correctly and where to go if you aren’t sure. 

Why connecting to the pelvic floor is important 

One of the most important pieces to pelvic floor functioning is the brain body connection, or motor control, of these muscles. This comes with an awareness of where those muscles are in the body (proprioception) and ability to  appropriately activate/relax them when needed (coordination). The pelvic floor muscles are subconsciously contracting and relaxing throughout our day to provide core support. It is SO VERY  important to keep in mind that the relaxation is just as important as the squeeze.

To learn what the pelvic floor muscles are and why they are important see the first blog post HERE!

How to know you are activating the pelvic floor correctly:

So much squeezing and so little confidence. Luckily, there are many ways to see how you are activating the pelvic floor muscles!

• See a pelvic floor specialist: The most comprehensive way to assess the pelvic floor is to see a professional who is certified in assessing and treating the pelvic floor muscles- like a pelvic health physical therapist! They may do one of a few strategies:

• Internal pelvic floor exam- An internal exam can give the best picture of how the pelvic floor muscles are functioning. This involves the provider using one gloved finger vaginally to assess these muscles. A trained pelvic floor physical therapist will be able to determine:

• If there is any abnormal muscle tension present.

• How the superficial versus deep pelvic floor muscles are working.

• The quality of the squeeze and the relaxation.

• If other muscles are trying to kick in and help out.

• The differences between the right/left/front/back of the pelvic floor.

• External pelvic floor exam- An external exam involves the physical therapist placing their hands along different parts of the pelvic and abdominal region to get a glimpse of how the pelvic floor muscles are working. This approach is not as accurate, but it can be very useful when an internal exam is not possible. 

• Biofeedback machine- This machine uses sensors placed on the pelvic floor muscles either internally or externally. Your provider will then instruct you to squeeze and relax the pelvic floor muscles, and the machine will provide feedback of how the muscles are activating/relaxing. Normally this will be a graph or bar that goes up when the pelvic floor muscles squeeze and goes down when they relax. 

• This way cannot always differentiate between the pelvic floor muscles contracting versus other muscles trying to kick in to help. 

• This method is most helpful when used in conjunction with an internal exam to get the full picture of how the pelvic floor is working. 

• The urine stream test*: Try to stop the urine stream as you are peeing. The pelvic floor muscles are the muscles that will stop the flow. 

• This is a simple way to get a small glimpse into these pelvic floor muscles. 

• You may find you cannot stop the stream, or maybe it slows down but doesn’t stop. Maybe the stream starts going a little to the left or to the right.

  • There are many reasons why these things may happen, and it’ll take an exam from a trained pelvic floor PT to know why. 

• *Disclaimer: this is a one time test, not an exercise! Do not do this every time you pee because we don’t want to train the pelvic floor muscles to start and stop during urination. 

• Self internal test: If you’re physically able to reach you may be able to do a self internal exam. Bear with me- we’ll walk through it together!

• In a comfortable position, either on a couch, bed or the toilet, insert one clean finger vaginally. Use lubricant or something like coconut oil to help!

• Gently press down towards the rectum and then to the right and left of the vaginal wall. Assess for any pain or discomfort. 

• Then squeeze the pelvic floor muscles and relax the muscles. You will be able to generally tell if those muscles are squeezed and relaxed around your finger or not. 

• Any discomforts, pains or trouble squeezing and relaxing can be further examined by a pelvic floor physical therapist. 

Other considerations:

• The pelvic floor does not act alone. Nothing in the body does! There are many other factors that can affect the way the pelvic floor functions including:

  • The abdominal muscles (especially the innermost abdominal muscle called the transverse abdominis)

  • The diaphragm (breathing muscle)

  • Overall posture

  • Pressure systems throughout the body

  • And more!

To have the best assessment of how the pelvic floor is functioning a comprehensive assessment of the whole body is required by a qualified  pelvic health physical therapist. 

References

• Bø, K., & Sherburn, M. (2005). Evaluation of female pelvic-floor muscle function and strength. Physical therapy, 85(3), 269–282.