Pelvic floor exercises - stage three

Only use this handout if you have completed Pelvic Floor Exercises Stage 2

The pelvic floor muscles sit at the bottom of your pelvis, between your legs. They are attached from the tailbone (coccyx) at the back to the pubic bone at the front and to each of your sit bones at the side. This creates a hammock to support the pelvic organs such as the bladder, the womb and the bowel.

These muscles work to help to keep the bladder and bowel openings closed to stop leakage and they relax when you pass urine and empty your bowels. 

Pelvic floor muscles are like every other muscle in the body. They can become weak or damaged with injury, and enjoy regular exercise to stay strong and healthy.

Pelvic Floor Muscles Explained - YouTube

A quick recap of pelvic floor exercises

Pull in your back passage (anus) as if trying to hold in wind, then draw the pelvic floor muscles forward and upwards imagining you are stopping the flow of urine at the same time.

You want to feel a squeeze and lift

Or

Think of closing anus, close vagina (females) or lift the base of the penis (males), hold and lift

Follow this by a full relaxation, just let go and allow the pelvic floor muscles to release and drop again, imagining the softening and opening of the muscles within the pelvic bowl and your sit bones spreading gently apart.

Training your pelvic floor muscles involves doing a mixture of long holds and short quick squeezes, always making sure you relax fully between each one.

• You should aim to complete 8-12 long squeezes of up to 10 seconds, with sufficient rest in between each exercise.
• You should aim to complete 10 quick strong squeezes where your muscles are able to relax properly between each squeeze.
• Aim to complete 1 set of long holds and 1 set of quick squeezes 3 times per day.

The next steps to progress

Like any muscle in the body to build it up we need to progressively load it. See the exercises below for ideas.

• When we progress our exercises, it is normal for them to feel a bit more difficult when we start off.
• You may not be able to hold for as long or do as many quick squeezes. This is okay!
• Slowly progress them like you did in stage one and two until you are able to do 10 x 10 second holds and/or 10 fast squeezes before you progress.
• Remember this may take a number of weeks to achieve.
• Level 3 exercises progress from standing still to adding movement to the exercise.
• You can pick from any of the exercises below and change which exercises you do as often as you like. This allows you to keep your exercise regime interesting and challenge your pelvic floor muscles in different ways.

Walking lunge

If do not have a weight, use a water bottle or raise your hand above your head.

1. Stand with feet hip-width apart and hold a weight in one hand.
2. Press the weight up to straight arm and hold the weight above your head with your shoulders level.
3. Gently squeeze the pelvic floor muscles.
4. Take a long step forward and bring the back knee towards the ground.
5. Keep holding the pelvic floor muscles and push up through the heel of your front leg and step your back leg next to the other.
6. Relax the pelvic floor muscles and then repeat forward lunges with each leg in turn. Complete 10 in a row, or until the pelvic floor muscles get tired.
7. Repeat the exercise holding the weight in the opposite hand.

Heel drops

1. Standing on the ground or on the edge of a step.
2. Squeeze and hold the pelvic floor muscles as you lift the heels to balance on the balls of the feet. Keep holding as you quickly drop the heels to the floor.
3. Relax the pelvic floor muscles and then repeat the above process.
4. The aim of this exercise is to maintain the pelvic floor contraction even with the impact of the heels hitting the ground. Repeat this exercise 8-12 times as able or until the pelvic floor muscles get tired.

Hopping

1. Stand with your hands on your hips. Lift one foot off the ground.
2. Gently contract the pelvic floor muscles and hold them throughout the movement.
3. Hop up and down on one leg for as long as you can hold the pelvic floor squeeze.
4. Land softly on the ball of your foot and keep the contact with the ground as short as possible.
5. To increase the challenge/impact, make your hops higher, or change direction of the hops.

Wood Chop

If you don’t have a resistance band, hold a water bottle or small weight. This can also be done with no equipment, in which case focus on rotating the body as you move both hands from the right shoulder to the left hip, then repeat on the other side.

1. Securely attach one end of the band to a stationary object above your head.
2. Grasp the band with both hands over your shoulder closest to the attachment, with your trunk slightly rotated toward the band.
3. Gently contract the pelvic floor muscles and abdominal muscles, make sure you keep breathing throughout.
4. Pull the band down to the opposite hip with both hands, turning your trunk away from the attachment. Slowly return. Relax the pelvic floor muscles and then repeat 8-12 times each side or until the pelvic floor muscles get tired.

Step up with knee drive

1.  Stand tall behind a step, with one leg lifted on the step.
2.  Gently squeeze the pelvic floor muscles and hold throughout the movement.
3. Step up on the step, lift the knee high.
4. In a controlled manner step back down to the starting position and relax the pelvic floor muscles. Repeat 8-12 times or until the pelvic floor muscles are tired, and then repeat on other side.

Squat jump

1. Standing tall with feet shoulder width apart.
2. Sink into a squat.
3. Squeeze the pelvic floor muscles and hold throughout the movement.
4. Push through your heels and breathe out as you power up into a jump for height.
5. On landing bend the knees to provide a soft land and return to the starting position.
6. Then relax the pelvic floor muscles. Repeat 8-10 times or until the pelvic floor muscles tire.

If you feel that any of these exercises cause back, hip or leg pain, stop the exercises and focus on the exercises you can do comfortably.

If you feel you these progressions are too difficult, please see our Pelvic Floor Exercises Stage 2

Remembering to do your exercises

Now that you have begun to progress your pelvic floor exercises, try to incorporate them into your regular exercise routine to help you remember them. You can still practice basic pelvic floor exercises with activities such as brushing your teeth or during a daily journey in the car, bus or train.