by Sue Croft Physiotherapist
Original version first published Mar 17, 2014 at SueCroftPhysiotherapist.com.au
In Step 3 of our 5-step prolapse management series, we explore pelvic floor muscle training, bracing techniques, and functional strengthening. These approaches can play an important role in supporting your pelvic health.
Understanding the role of the pelvic floor muscles
Your pelvic floor muscles have many key functions:
- Support the pelvic viscera.
- Prevent loss of urine, gas and faeces with increase in intra-abdominal pressure (e.g. cough, sneeze, bending, laugh, lift)
- Prevent worsening of prolapse
- Aid bladder function through detrusor inhibition (the smooth muscle pump of the bladder)
- Facilitate relaxation to empty your bladder and bowel properly
- Support sexual function and sensory awareness
- Support the pelvic floor during defaecation
- Stabilise the pelvis and the lumbar spine via co-contraction with diaphragm, transversus abdominis and multifidus muscles
How pelvic floor muscle training can support prolapse management
Pelvic floor muscle training (PFMT) can be approached with strategies such as:
- Up to 30 gentle contractions per day, without breath holding, aiming for a 10 second hold
- Using visualisation to improve (poor) sensory awareness – patients can use a photo of the model of the pelvic floor muscles to get the brain involved.
- Functional bracing* with safe abdominal exercises to build increased resistance to the pelvic floor muscles (this involves gently tightening your pelvic floor before activities that increase abdominal pressure)
- Electrical stimulation in some cases
- Vaginal weighted cones – are generally not recommended for women with prolapse or overactive pelvic floor muscles (levator spasm), pelvic pain
*Functional Bracing and Core Strengthening Strategies
Functional bracing involves gently tightening your pelvic floor before activities that increase abdominal pressure. This can add support to the prolapsed tissues. Safe abdominal and core exercises may also be introduced under professional guidance, ensuring they are “pelvic floor friendly” and do not strain the muscles.
The Role of Transversus Abdominis (TA) and Core Stability
The transversus abdominus or TA (deep abdominal muscles) work closely with the pelvic floor.
- Co-contraction with pelvic floor muscles can provide added support to prolapse
- Significance: If draw in using TA muscles, this causes increased tightening of an internal pelvic floor muscle (pubo-rectalis) and the anus (EAS) which:
- helps hold up prolapse
- can cause a problem with defecation if the muscles do not release properly (Pelvic dyssynergia), common in young women, elite athletes, and wind instrument players
- can be useful for managing urgency with bowel or gas control as the increased closing force can provide more time for reaching the toilet
- Significance: If draw in using TA muscles, this causes increased tightening of an internal pelvic floor muscle (pubo-rectalis) and the anus (EAS) which:
Physiotherapy Management: Transversus abdominis
- Co-contracting the transversus abdominis with multifidus
- Significance: Many patients with prolapse may have concurrent back pain which may be helped with strengthening and or better activation of multifidus. Strengthening both the transversus abdominis and multifidus muscles can help with spinal stability and symptom management.
- Diaphragm
- Significance: Breath awareness and a correct breathing pattern are very important for good muscle activation and coordination of muscles. Learning to coordinate breath with pelvic floor activation — and practising down-training (relaxing the pelvic floor) — is just as important as strengthening. Relaxation is particularly helpful before and after using the bladder or bowels.
Physiotherapy Approaches for Prolapse Support
Physiotherapists often describe the vagina as a “hernia portal,” where downward pressure can be offset by bracing from below. This means contracting pelvic floor muscles before and during movements that increase pressure.
Supervised assessment and training with a pelvic health physiotherapist ensures the exercises are tailored and performed correctly.
Why Supervised Guidance Matters
Every woman’s experience of prolapse is unique. Working with a pelvic health physiotherapist helps ensure:
- Correct technique in muscle contraction and relaxation.
- A personalised exercise plan that is safe and effective.
- Ongoing support to progress through each step of prolapse management.
Coming up next in the 5 Step plan for managing prolapse:
Step 4: Managing your bowels well – Practical strategies to reduce strain.
Step 5: Keep moving mindfully – Safe Ways to Exercise and Stay Active with Prolapse.
