by Professor Lynn Basford

You should exercise…

pelvic floor exercise

hysterectomyArm 2: Exercise

If you are not used to exercise it may seem very strange to have a heading that states, ‘you should exercise’, particularly if you are feeling run down from years of debilitating heavy bleeds and not sure of the future re: intimate relationships, your continued femininity, induced early menopause, fear of the unknown, and so on.

What should be remembered is that the word exercise in this context is to ensure your physical and mental body is in prime position to aide your recovery without any laboured complications.

Chief among these are Pelvic Floor Exercises (PFE). Yes you do not need to go out of the house, put on sweaty betty’s or any other clothing. They can be done anywhere, any time, and in any setting. They are however, crucially important for all women to do regardless of impending Gynaecological surgery.

You may ask WHY? well the simple answer is that women’s anatomical construction relies on the tautness of the pelvic floor muscles to keep everything in its place and working correctly. I.E the urinary system, the bowel system, and your sexual organs. Yes! pelvic floor muscles are very much involved in your sexual enjoyment.

Where and what is The Pelvic Floor?

pelvic floor exercisesThe pelvic floor is an intricate formation of muscles that provides the base ( lower floor ) of your pelvis and supports the contents of your pelvic region, bladder, uterus and back passage. It extends from your tail bone (coccyx) at the back to your pubic bone at the front, forming a ‘platform’ between your legs. – your bladder, uterus (womb) and back passage.

The pelvic floor also aides the control of the openings of : (i) the urethra- the opening/tube that you pass urine through; (ii) the vaginal canal- where sexual intercourse and the birth canal takes place; (iii) the anus- opening of the rectum/back passage where you open your bowels.

Throughout a women’s life stressors can occur to weaken her pelvic floor such as pregnancy, lack of exercise, pelvic and gynaecological surgery, chronic constipation ( straining of bowels), hormonal changes ( menopause), overweight and a chronic cough.

The weakening of the pelvic floor is often insidious, becoming a health problem over the years.

Signs that the pelvic floor is not doing its job are:

Stress Incontinence – leaking of urine when you laugh, jump, or force any pressure on the region;

Urinary Frequency – a need to go to the toilet frequently (day and night);

Urge Incontinence – an urgent onset to go to the toilet resulting in incontinence if you don’t get there in time.

Uncontrolled flatulence – Inability to control the passing of wind from your back passage.

A feeling of aching or dragging sensation in your vagina – indicative of a prolapse.

If symptoms have occurred- Is it too late?

Like all muscle groups they can be exercised to perform at their optimum best. Undertaking PFE is never too late as they can help strengthen your muscles to support the pelvic region and associated organs again. This will improve your bladder/bowel control and improve or stop any incontinence. With respect of impending Hysterectomy, or, indeed any gynaecological surgery, practicing PFE prior to the operation improves your chances of not losing pelvic floor muscle tone.


Pelvic Floor Exercise- The Regime

Trendy woman sitting on a modern chair

PFE is a regime you can do any time, any where! No one will ever know that you are doing them as they are so discrete and personal to you.

However, to begin understanding how to do them it is useful to sit on a toilet seat or high back chair. Your feet should be flat on the ground and legs slightly apart. NB. if you are short perhaps place your feet on a stool or hard cushion.

Now begin:

Lean forwards, resting your elbows on your knees.

RELAX – begin SLOW TWITCH exercise

(i) Close and draw up the muscles around back passage, as if you are trying to stop passing wind. Make sure that you do not contract your buttock muscles while you do this.

(ii) Now close and draw up the muscles around your vagina and urethra, as though you are trying to stop the flow of urine.

(iii) Hold for a count of five. Try not to hold your breath, breathe normally.

(iv) Then slowly relax and let go.

(v) Repeat five times in total.

Once accomplished at the slow twitch you can commence the FAST TWITCH method. The fast twitch aims at the pelvic floor muscles:

(i) Pull up the pelvic floor muscles as with Slow twitch.

(ii) Hold for one second and then relax.

(iii) Repeat 5-10 times or until your muscles feel tired.

All done, SIMPLE!,  just do them four or five times and notice the difference. Remember you can do them standing at the sink in the bath driving your car- In fact everywhere. Be a devil and try it!

NB. The pelvic floor muscles tire easily and you may notice that it takes a lot of concentration to begin with to do these exercises correctly. If this is the case build up to five repetitions over a few weeks.

Some don’ts

  • Do not squeeze your buttocks together
  • Do not bring your knees together
  • Do not hold your breath
  • Do Not lift your shoulders/ eyebrows or toes upwards.


Simply put, if you do any of the above you are not tightening the pelvic floor muscles correctly. In the beginning concentrate on developing a good technique, repeat several times a day and contract, contract, contract! a good contraction makes a wholesome, strong and supportive pelvic floor.

How do I know I am doing it right?

PFE are personal and relate to your very own intimate places, so it is very unlikely that you would want anyone testing you out here!

There are ways in which you can ascertain you are doing the PFE regime correctly:

  • You can feel your pelvic floor contracting by putting one or two fingers into your vagina whilst having a bath or shower. Tighten your pelvic floor so that the muscles squeeze your finger hard.
  • Every few weeks, you can test the strength of your pelvic floor by stopping the flow of urine mid-stream. This will feel similar to the exercises above and use the same muscles. NB. You may not be able to completely stop the flow of urine to begin with, but you may notice that you are able to slow the flow down. In health care we call this a base line test. I.E a base measure through which you can follow progress.

Do be patient, remember Rome was not built in a day, but with continuation progress will ensure. NB. the lack of pelvic floor tension possibly came on over many years unless due to trauma or surgery.

PFE are exercises for LIFE! FOR ALL WOMEN!

Hysterectomy Fast Facts

Arm 1: Attitude

Arm 2: Exercise – Pelvic Floor

Arm 3: Meditate

Walking in Sunshine – Tips to Prepare for Surgery

Pre-surgery Yoga

Laughter Yoga – What’s the joke?

Arm 4: Nutrition

Arm 5: Medicines & Supplements

Arm 6: Lifestyle

Arm 7: Personal & Family Arrangements

Arm 8: Personal Hygiene 

Surgical Innovation: Robotic Surgery

Patient Perspective: Experiencing a robotic surgery

Patient Perspective: Experiencing an abdominal hysterectomy

All about Anaesthesia

Recovering from Hysterectomy

Recovering from Hysterectomy – The Big Picture

Recovering from Hysterectomy – First 24 hours