Pelvic floor exercises - stage two

Only use this handout if you have completed Pelvic Floor Exercises stage 1

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 10 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. Ideas include

• If doing the exercises lying down, start to do them in sitting
• When doing well in sitting, start to do them or some of them in a standing position
• Once in a standing position, try the variations below.

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 when you progress the exercises. This is okay! Slowly progress them like you did in stage one until you are able to do 10 x 10 second holds, and 10 fast squeezes before you progress. Remember this may take a number of few weeks to achieve.

Try these positions below

Standing adds gravity and body weight to the exercises to challenge the pelvic floor muscles more. Get into the position shown below, do your pelvic floor contraction and then stand up/rest before repeating this.

Wide leg position

Stand with your legs apart, feet outside the hips – in this position gently contract the pelvic floor muscles. Do both your long holds and quick squeezes

Variations to this movement include standing with the feet turned in or out.

Lunge position

Stand in a lunge position with your hands by your side or on your hips. Gently contract the pelvic floor muscles. Complete your long holds and quick squeezes.

You can come back to a normal standing position to rest for a few seconds, allowing your pelvic floor to full relax between pelvic floor squeezes and then repeat exercise again. Do 5 on each side.

If this is too hard, make your step forward slightly smaller or hold for less time.

If this is too easy, try to contract the pelvic floor throughout a full lunge movement.

• Begin in the lunge stance, contract the pelvic floor, lower the back knee towards the ground, then stand up again and relax the muscles. Repeat.
• If able, hold the low lunge position, then practice the quick squeezes.

Squat position

Stand tall with feet slightly wider than hip-width apart. Toes pointing forward or turned slightly outwards. Keep your chest up and your spine and neck in a neutral position.

Squat down by sitting back, keep your hands on your hips or move them out in front. In this position practice both your long holds and quick squeezes. Between each squat stand up to relax your pelvic floor muscles and legs.

If this is too hard, make your squat smaller or hold for less time

Variation: Contract the pelvic floor muscles and hold them as you move into the squat position as above, hold for 1-2 seconds and then return to standing. Relax the pelvic floor muscles at the top and then repeat.

Bridge variations

Lie on your back, with knees bent and feet hip-width apart. Gently contract the pelvic floor muscles. Squeeze your buttocks, push through your heels as you lift your hips up. Lift only as high as you can without arching your back. Lower your hips down in a controlled manner whilst holding the pelvic floor squeeze, relax the pelvic floor muscles and your legs at the bottom.

Variations:

• Practice your longer holds throughout the bridge movement
• Hold the bridge position, contract the pelvic floor muscles followed by a ball/pillow squeeze, let the pelvic floor muscles relax and return to a rest position
• Hold the bridge position with a ball/pillow between your knees, perform small pulse on the ball/pillow as you maintain your pelvic floor contraction

Hip flexion

Start by standing holding on to something stable if you need to. Bring one of your legs up and hold it. In this position practice your long holds alternating between legs with each repetition allowing your pelvic floor to relax in between.

To practice the quick squeezes try to hold your leg up as you quickly contract and relax the pelvic floor muscles. 

Tips on Pelvic Floor Contraction

• Should feel like a gentle squeeze and lift
• Should NOT feel like you are pushing down or straining
• Should NOT be painful
• Should NOT need any extra muscles to contract with it (tummy muscles, buttock muscles, inner thighs)
• Always breathe while doing pelvic floor contractions. Do not hold your breath
• Make sure your tummy remains soft and doesn’t bulge outwards or suck inwards
• Try to contract more towards the front and try to contract more towards the back. See if you can connect to both

The Goal

Aim to build up over time to being able to do:

10 Long squeezes with a 10 second hold on each one.

Allow yourself time to relax fully between each exercise and do some gentle calm belly breathing in between.

Followed by 10 of the fast/quick squeezes.

If you feel you these progressions are too difficult, please see our Pelvic Floor Exercises Stage 1

The knack technique

This is another important technique to use within your day to day life. Consciously squeezing your pelvic floor muscles before and during certain activities can reduce strain on your pelvic floor muscles and prevent leakage of urine.

You should use this technique when you:

• Cough
• Sneeze
• Laugh
• Pick something up

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.

What next?

Keep going! It can take about 3-6 months of daily exercise to increase your muscle strength. In order to see muscle strength improve, muscles need to be progressively challenged. When you feel these exercises becoming easier you are ready to progress to the next stage, see the Pelvic Floor Exercises Stage 3 leaflet

Pelvic Floor Exercise App

“Squeezy” is the NHS App for pelvic floor muscle exercises and is available from the App Store and Google Play. This app has been designed by physiotherapists working in the NHS. It is discreet, informative and has helpful visual and audio prompts to support your exercise programme. It can give you reminders to exercise and records the number of exercises you have completed. There are also other pelvic floor exercise apps available.