Not all pelvic floor training is created equal! A number of different technologies and devices have been created that can improve symptoms like incontinence, sexual dysfunction and pain and heaviness from pelvic organ prolapse.
Here we compare 5 different types of pelvic floor training. Remember to chat to your pelvic floor Physiotherapist about which type may be the best option for you.
Biofeedback is a tool for muscle training that helps people become aware of how their muscles are working.
For pelvic floor biofeedback, small sensors are placed inside or outside the vagina or anus and connect to a monitor or an external display. These sensors detect the amount of muscle activity and give you ‘feedback’ on the screen about how contracted or relaxed your pelvic floor is during exercise. This helps you gain awareness of your pelvic floor to build strength and control and can be helpful for both strength and relaxation feedback.
Think of it a little bit like wearing a smart-watch or heart-rate monitor, but for your pelvic floor! It tells you when you need to work harder or relax more.
One of the most common reasons that women give for not doing their pelvic floor exercise is “I’m not sure if I am doing it right”! Biofeedback devices can help take out the guesswork and give accurate feedback about the pelvic floor contraction so you can be confident you are using your muscles in the most effective way.
Electrostimulation is another type of technology that can help to strengthen your pelvic floor. It works by attaching electrodes inside or outside the vagina, similar to biofeedback - but in “e-stim”, a small electrical current stimulates the pelvic floor muscles. This is a more “passive” treatment, because it can make your muscles work without you having to contract consciously.
This method may be an option for those who have a very weak pelvic floor due to injury to the muscles or nerves and need extra help to create a contraction.
In recent years, pelvic floor “thrones” or “chairs” have become a popular (albeit expensive) treatment, which involves sitting on a chair that provides stimulation to the pelvic floor. While this type of electrical stimulation may be beneficial in treating some stress urinary incontinence, there is low level of evidence of their effectiveness at this stage.
Kegel Balls / Weights
Another commonly used device for pelvic floor muscle training are Kegel weights. These are small balls of various shapes, sizes and weights that are placed inside the vagina. These work a lot like weight training in the gym, creating resistance for your pelvic floor muscles to work against to hold the ball inside.
These are usually placed inside the vagina while walking or doing other exercise for a brief period of time (e.g 15 minutes). Very light Kegel weights can be effective at training endurance for the pelvic floor in those with urinary incontinence or frequency issues.
For most women, the pelvic floor doesn’t actually need to be able to carry a lot of weight! Manual Kegels are usually sufficient for building and maintaining adequate strength for daily activity and exercise and for reducing incontinence. However, for those who experience stress incontinence during very heavy manual labour, or weight-lifting, Crossfit or power-lifting, heavier Kegel weights may be used as part of training to increase the strength of the pelvic floor to handle this high load. It's recommended that anyone experiencing these symptoms should seek advice from a Pelvic Floor Physiotherapist about the best type of training for you.
Sometimes the simplest is the best! Though these devices and tools can be fantastic to “level-up” your pelvic floor training and give extra support, there's also very strong evidence for the effectiveness of good old-fashioned Kegels.
The benefits of manual Kegels are that you can usually perform a pelvic floor contraction anywhere, any time, without anyone else noticing! This is a great option for those who are busy and may not have time to use a device, not to mention it's also the most cost-effective option.
As mentioned earlier, the downside to manual pelvic floor training is that some women find it hard to feel if they're performing an effective contract or relax, and it can also be a little less fun and motivating than a fun game on your biofeedback app!
Behavioral training (A.K.A Bladder Drill)
Another helpful tool for training the pelvic floor is changing behaviours related to toileting. This is particularly helpful for those with urge incontinence, who may feel the need to go to the toilet too often, or not be able to hold when they need to go.
These behavioural changes prescribed by your pelvic floor therapist might include:
- Timed voiding (e.g going every 2 hours, rather than in response to urge)
- Avoiding going “just in case”
- Keeping a bladder or bowel diary
- Controlled fluid intake
- Urge deferral techniques.
Here are some tips to try to delay voiding when you get a sudden strong urge that you feel you may not be able to hold:
- Stop and relax – do not rush to the toilet.
- Breathe slowly and evenly.
- Perineal / Vaginal pressure: (hold hand under perineum, sit on a hard surface, cross legs).
- Curl your toes repeatedly or hold firmly.
- Stretch your calf muscles and hold the stretch.
- If you are walking, slow your pace and emphasize heel-toe walking.
- Press or rub the trigger point on the inside of your leg just above your ankle.
- Squeeze and lift your pelvic floor muscles – hold them tight!
- Distract yourself! Try not to think about the toilet or about leaking. Distract yourself with a physical or mental task e.g. count backwards from 100 by 3’s or 7’s; think of 3 towns starting with A, then with B, then C etc.
- When you have performed the technique and the urge has slightly eased, walk to the toilet in a slow and controlled manner.
These techniques help retrain the signals from the brain to the bladder and pelvic floor, and reduce urgency and incontinence.