What are the best cues for your pelvic floor? Well, this is probably very subjective! So, I’ve used my own experience of working with clients who have pelvic floor issues (that may be leaking, pelvic organ prolapse or pelvic pain) to highlight some of my favourites. As well as looking at what the research suggests for the best pelvic floor cues.
Why cue the pelvic floor?
The purpose of cueing the pelvic floor muscles, is to create a desired response. Most often to be able to feel a lift (and a relaxation or lengthening) of the pelvic floor muscles. Those with prolapse, leaking or pelvic pain may feel disconnected to those muscles. Or find them tricky to find and use. A cue for the pelvic floor can help build a mind to muscle connection so is a great place to start for your pelvic floor rehab or journey.
How much pelvic floor activation do you need?
The million dollar question! There is a tendency to want to add more activation than is needed. We often think more is better! However, the research suggests otherwise;
Research identified that submaximal pelvic floor contractions are sufficient to elevate the bladder neck, can be maintained longer, and do not lead to breath holding. Maximal pelvic floor muscle contractions resulted in bladder neck descent in 29% of continent and 28% of incontinent women, which was not observed during submaximal pelvic floor muscle contraction. What this study suggests is that a submaximal pelvic floor muscle contraction provides comparable or even improved support to maximal contractions.
This also supports the concept of TENSION TO TASK (a phrase coined by Australian Physio, Antony Lo). Which means the tension you need matches the tension of the task you are doing.
However, for those with birth injuries such as levator avulsion or very weak pelvic floor muscles, a small and submaximal contraction can feel incredibly taxing and take a lot of mental effort. This may feel like 100%! In these instances finding ways to connect to the pelvic floor muscles “easily” e.g. using props, breathing or positioning can be really helpful.
My favourite cues
Gently blowing through a straw – this is a great cue for someone who wants to give 100% activation to everything. It softens the activation and is really easy to self assess. It can take the focus off the pelvic floor and onto the breath.
Visualising the movement of a jellyfish – this is super easy to visualise and again adds some softness to an over eager connection!
Picking up a marble or blueberry (or any other small item) with the vagina – the use of a small item helps with a submaximal contraction and is easy to visualise the lift and hold.
And to help with the relaxation part (and if you have pelvic floor dysfunction, this can be as challenging as the activation and lift) – I like to use the idea of inhaling into the hip bones, or bum-hole and starting the lift from the back passage (research shows this is a very useful cue as well).
Funnily enough the cue of “engage your pelvic floor” tends to elicit more pressure down than using a cue which is easier to visualise.
Pelvic floor connection or activation can often be the missing link for pelvic floor symptoms. This is why I will spend time with my clients finding a cue that works for them. And since everyone is different, there’s often a lot of imagination! If you’d like help with this, you can book a free call here or check out my pelvic floor programmes here