For words you might want to know more
A group of muscles, ligaments and other tissue that stretch back to front (from your pubic bone to your backbone) and side to side. Think of your pelvic floor as a hammock that holds up all your pelvic organs, including your bladder, bowel and uterus.
Kegels are a type of exercise designed to strengthen the pelvic floor, which supports the bladder, bowels and uterus.
Pelvic organ prolapse is when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina. It can be the uterus, bowel, bladder or top of the vagina. A prolapse is not life-threatening, but it can cause pain and discomfort.
If you’re dealing with a weak bladder or pelvic floor, you may have asked yourself if it’s worth investing in one of the many toys, gadgets, or kegel balls on the market.
Pelvic floor toys, stimulators, or trainers, are essential tools to help strengthen the pelvic floor and vaginal muscles. But what’s the difference between expensive products and just doing basic exercises? When’s the right time to seek help?
Forget all the — now-debunked — hype around Gwyneth Paltrow’s Jade Eggs. Over here at Jude, we’ve spoken to Consultant Gynecologist Dr Demetri Panayi and asked him all the questions you need answers to.
The pelvic floor muscles span the bottom of the pelvis and support all of the pelvic organs, including the bladder, bowel and uterus. They are located between the tailbone and the pubic bone within the pelvis.
Dr Demetri Panayi is a Consultant Gynaecologist and Urogynaecologist at the London Women’s Centre said that in most normal situations, these organs will be supported and continence will be maintained. However, the pelvic floor can go through events in a woman’s life that can lead to it being weakened.
“The two big events in a woman’s life that can weaken a woman’s pelvic floor are childbirth and menopause,” he told Jude. “Because the pelvic floor is hormone-dependent, that means that the bladder, vagina and pelvic floor are also all hormone-dependent for women.”
“So the hits that the pelvic floor takes in a woman's life is often through vaginal childbirth, particularly if they’ve had a difficult birth with forceps, a significant trauma or a big baby,” Dr Panayi added.
“Anything that adds to the trauma of childbirth will weaken the pelvic floor. And then when you go through the menopause and the hormones drop, then the pelvic floor also loses the benefit of the female hormones.”
He says that he typically sees patients with incontinence issues or prolapse and that women should begin doing pelvic floor exercises in the middle of their first pregnancy, ideally with a supportive physiotherapist to supervise them.
However, according to new draft health guidelines published by the National Institute for Health and Care Excellence (NICE) in June 2021, it's suggested that girls aged 12 to 17 should be taught in school how to do pelvic floor exercises because it could help them avoid issues such as incontinence later in life.
NICE suggested that this should be added to classes covering sex and relationships. It added that women of all ages should be encouraged to do pelvic floor muscle training and that up to 140,000 women-a-year stands to benefit from this.
Dr Panayi said that general vaginal wall laxity can often come when women have children vaginally, “but it shouldn’t necessarily affect function”. But pelvic floor weakness, however, he said is not just caused by birth and menopause but is also often caused via “repetitive straining”. This can happen from constipation or a job or lifestyle that involves standing.
“You can’t really affect the way your children are born, but you can do pelvic floor exercises during your pregnancy and afterwards and keep them going for life which is what's recommended or guidance recommends.
Beyond that, Dr Panayi recommended simple “lifestyle adjustments” to reduce the activities that weaken the pelvic floor, such as heavy lifting and standing. If those measures are unsuccessful, then there are surgical solutions for incontinence.
According to NICE, there are both modifiable and modifiable risk factors associated with pelvic floor dysfunction.
Modifiable risk factors include:
A body mass index (BMI) over 25
Lack of exercise
Non-modifiable risk factors include:
Age (risk increases with increasing age)
Family history of urinary incontinence, overactive bladder or faecal incontinence
Gynaecological cancer and any treatments for this
Gynaecological surgery (such as a hysterectomy)
Chronic respiratory disease and cough (chronic cough may increase the risk of faecal incontinence and flatus incontinence)
You’ve probably heard of Kegels by now, the pelvic floor exercises named after the American gynaecologist who invented them.
Pelvic floor exercises strengthen the muscles around your bladder, vagina and rectum. Strengthening these muscles — via exercises, toys, hormone treatment or surgery — can help treat urinary incontinence, treat pelvic organ prolapse and improve sex. Pelvic floor exercises have long been the most common form of non‐surgical treatment for stress urinary incontinence.
You can feel the muscles working if you try and stop your pee, mid-flow. The NHS recommends basic pelvic floor exercises to consist of sitting comfortably and squeezing these muscles ten to 15 times.
Kegel exercises involving weights may help treat urinary incontinence. Weighted vaginal cones can be used to help women to train their muscles and work by being inserted into the vagina. The pelvic floor then contracts to prevent them from slipping out.
“I probably wouldn't use the term ‘pelvic floor toys’ because I think it implies they’re like sex toys,” Dr Panayi said. Fair enough.
Instead, he said they are called ‘pelvic toners’, ‘peripheral toners’ or ‘inter-vaginal devices’. You may be more likely to recognise them, however, with reference to the term ‘Kegel exercises’, or ‘Kegel weights’.
“My view of them is that they're useful,” Dr Panayi said. “They usually have two functions. They are usually used to give people feedback that they are activating the right muscles. The toners do this, often via a visual means like a screen. They also act as something for women to squeeze around.
“But I wouldn't say it's a substitute for professional help following serious issues, like surgery, for example, and seeing a women’s physiotherapist can really help,” he said.
“It’s a bit of a crude comparison, but it's a bit like the difference between getting a personal trainer and getting a running watch. It's going to help you but it's not going to give you everything — it's a device. It's not going to give you a professional assessment and it's not going to give you feedback.
“Whereas a physio or someone like myself would feel in the vagina, feel the muscles and make sure that they are activated correctly and give you a programme of rehabilitation to build strength and stamina and use the device alongside that to get the best possible results. So while you're at home, you feel like you're doing it correctly.”
They range from the basic to the sophisticated, electrical and expensive, and work by being inserted into the vagina, and you teach yourself to squeeze around it.
“They can be very, very, cost-effective,” Dr Panayi said. “They range from a very low price point of a few pounds and can go up to hundreds of pounds. These are often much more technologically advanced and work not just by being an object in the vagina that gives you feedback, but also something you can squeeze around.
“Ultimately the aim of all devices is to assist women in practising doing good pelvic floor muscle contractions. Because the muscles are inside the vagina, it’s more difficult to feel if you’re activating the right ones. It’s not like using a barbell and you can see and feel your arm muscles activating.”
As ever, body image and self-esteem is inextricably linked with sexuality and sexual pleasure.
Studies have shown that women seeking treatment for advanced pelvic organ prolapse have less positive body image and overall quality of life.
So it’s not surprising that pelvic floor issues can impact sexual function. Dr Panayi describes this in both “direct and indirect ways” that can have an impact.
“If women feel that they're leaking urine or they may smell of urine or if they feel there's a lump in there or that it is dropping down, they may avoid having sex for reasons that they embarrassed or they're worried that a partner might be able to smell something. So it may have a negative impact in that regard.”
“It's a very complex area, but from talking to patients, it's not actually something that demotivates them to be sexually active, more that it makes them feel less sexual by having issues in that part of their body.”
“Yes, it can reduce women’s confidence,” Dr Panayi said. “But not only can it impact self-esteem and not make women feel particularly sexy if their vagina is dropping down or leaking, but also sometimes there are more direct impacts.
“For example, in very unusual circumstances, women may experience urinary leakage during sex in relation to arousal or orgasm, which can be very mortifying for some women, resulting in them having sex.
“Furthermore, if some women have a prolapse in their vagina or something that may cause discomfort or an obstruction to having sex, they may not be comfortable having sex.”
“I haven't got any personal endorsements,” Dr Panayi said. “Usually patients come to me after they've tried all these other devices and haven't been successful. There are well-known brands, like Kegel8, for example, but literally, just the basic plastic ones that fit inside the vagina work well. Others which can connect to an app on your phone there's also an app called Squeezy which the NHS runs to help you do pelvic floor exercises.”