An expert's guide to restoring your pelvic floor.

Jane Simpson, author of The Pelvic Floor Bible, has a private practice at the London Clinic in Harley St, where she treats women (and men) of all ages with pelvic floor dysfunction. In this Q&A she shines a spotlight on urinary incontinence and implores us to join her pelvic floor revolution. Rise up and take part!

1. What should every woman know before she starts doing pelvic floor exercises?

The first and most important thing is: have you isolated the right muscles? Here are a couple of ways to find your pelvic floor muscles.

  • Sit on the arm of a chair, an exercise or fitness ball or any hard surface, with your feet flat on the floor. Lean slightly forward with your vulval area in contact with the hard surface. With your hands on your thighs try to lift the area around your vagina and anus away from whatever it is you are sitting on.

  • If you are a tampon user, try inserting one, then pull gently on the string. At the same time contract your muscles around the tampon to stop it coming out, a bit like a tug of war. This is a good way of helping you to isolate and use the correct muscles.

  • Pretend you are controlling an attack of diarrhoea or about to pass wind. Pull up the muscles around your anus, squeeze, lift and hold. I often tell my patients to imagine they are in a lift full of people and need to pass wind.

2. A quick start routine for beginners.

  • Draw up all your muscles at the same time. Squeeze, lift and hold for a count of five, if you can. Then let go gently and count to five - this is the rest phase of the programme. It’s very important not to overtire your muscles, particularly when you are just starting and your muscles are weak.

  • You then need to repeat the same exercise (hold for five seconds and release for five seconds) five times.

  • Try to do the exercises three times a day but don’t worry if you occasionally only manage it once or twice per day. Anything is better than nothing.

  • Once a day, do a series of ten short sharp contractions. These are done in a rhythmic pattern of squeeze, let go, squeeze, let go.

3. For the more advanced?

Try to increase the hold time to ten seconds. Do this slowly over time, holding first for five seconds then building up to ten seconds

4. Is it ever too late to get your pelvic floor health back on track? And when do you know it’s time to talk to a GP?

It is never too late to get your pelvic floor health back on track! I see patients from the age of 20 all the way to my oldest patient who is 92. At different points in your life your pelvic floor will need different approaches.

There are many types of pelvic floor issues: stress incontinence, overactive bladder (key in the door syndrome), prolapse, urine infections, constipation and painful sex. Pelvic floor dysfunction can have life changing consequences yet is sadly still woefully under-reported and taboo. If you’re at all concerned by new or existing pelvic floor problems my advice is always to seek help from your doctor, women’s health physiotherapist or continence specialist as there is often a simple solution to something that may have been bothering you for ages.

5. How long does it take to start seeing/feeling results?

This will depend on many things, including how bad the problem was to start with. Have you had one small baby by caesarean section or four giant ones all delivered with forceps?! But as a general rule of thumb, if your muscles are weak but not so bad that they need extra help from someone like me, you should start to see progress in about four to six weeks. But if you don’t, whatever you do don’t give up. Keep trying or seek help from a women’s health physiotherapist or continence specialist. Maybe you are just not able to engage with your muscles and need extra help finding and contracting them correctly.

6. Many women would be thrilled to no longer leak after sneezing but are there any other benefits to pelvic floor rehab?

Absolutely! That’s why I have been able to write a whole book about the subject that is super close to my heart! I have written chapters on overactive bladder and urge incontinence, childbirth, menopause, pelvic organ prolapse, sex life, bowels and men - lets not forget that guys have a pelvic floor too!

7. What can we do to 'restore the floor’ other than pelvic floor squeezes?

Adopting a healthy lifestyle is a good place to start. Try to lose weight if you know in your heart you need to. Carrying extra weight, particularly around your abdomen, puts pressure on your pelvic floor. If you suffer from constipation now is the time to address it. Avoid very heavy lifting… this includes large toddlers! Try not to do too much high impact exercise, swap running on hard pavements for running on grass or use a treadmill if you can, this may lessen the impact on your pelvic floor. Repeated coughing can also impact your pelvic floor, so if you smoke this may be a good time to quit.

8. Is it possible to reverse a prolapse purely from doing pelvic floor exercises?

It depends how bad it is. There are 4 different degrees of pelvic organ prolapse. With grades 1 and 2 you should be able to strengthen your pelvic floor enough so that your prolapse is not bothering you any more. With grades 3 and 4 these will probably need the help of a vaginal pessary or in extreme cases a surgical solution. Whatever you do don’t just put up with a heavy feeling in your vagina. No matter what degree of prolapse you have there’s always something that can be done to help alleviate symptoms.

9. Are femtech gadgets (such as Elvie, weighted balls etc) worth the cost? Do you have a favourite that you recommend?

There are lots of gadgets and devices on the market. If you have bought something or been recommended something  by a healthcare professional or friend and it’s working for you that’s great.

Doing pelvic floor exercises in conjunction with a gadget will hopefully be very motivating – and motivation is key! However, this doesn’t mean that doing your pelvic floor exercises alone isn’t enough, it absolutely is. We are all different. Do whatever works for you and encourages you to be consistent. Ultimately we all want the same result: the perfect pelvic floor!

I use a variety of gadgets depending on the individual client’s needs. This varies from vaginal weights, electrical stimulation, the Elvie trainer and apps.

10. Any good tips on remembering to do squeezes? What’s your go-to app for pelvic floor rehab?

If you do your exercises when you are cleaning your teeth you will have done them twice a day every day so that’s a great start! My go-to app has to be The Squeezy app, it’s great. You can follow a pre-set exercise programme in the exercise plan section of the app, or you can tailor the app to a doable pelvic floor programme for yourself. It may be that your healthcare professional has set a programme for you. The app will even remind you to do your exercises, which in most cases is half the battle. I see women every week who tell me, ‘I so want to do my exercises but I keep forgetting.’ The app has the ability to time your pelvic floor contractions, so no cheating and counting to ten really fast! It also counts the rest phase of the exercise, which is also very important. It has a bladder diary setting that you do over three days, which may give you an insight into what is happening with your fluid intake and urine output, information that will be very helpful if you ever need to see a specialist healthcare professional. It also has lots of helpful tips about bladder health. 

11. Is it ever too soon to start doing pelvic floor exercises?

 If only we could start having more  pelvic floor awareness at a younger age that would be amazing. Encouraging young people to talk about, embrace and understand their bodies is slowly happening. When I was at school my girlfriends and I didn’t chat to each other about periods. I spent half the time checking the back of my skirt, terrified I might have started without realising. These days young girls are much more aware and many of them plot their periods on apps. They are more open and learn every day from things that they read and see on the internet. I believe that if young people understood the importance of their pelvic floor muscles and pelvic floor health early on this would be a great step forward for their future wellbeing. I also think young women would start to be more open about it.

12. Your take home message advice is…

Start paying attention to your pelvic floor today. DO NOT DELAY!

I want to start a pelvic floor revolution and I want everyone to participate.  We should all be doing pelvic floor exercises – and I mean everyone: young and old, male and female, wherever you live in the world. It’s an absolutely vital part of our physical wellbeing. Not only is it easy, it can be utterly life-changing. I want everyone to feel empowered enough to change the way they think and to start caring about their pelvic floor the same way they care about the rest of their body.