Intended for healthcare professionals

Practice Practice Pointer

Pelvic floor muscle training: a practical guide

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj-2022-070186 (Published 05 September 2022) Cite this as: BMJ 2022;378:e070186
  1. Nicola Adanna Okeahialam, urogynaecology clinical research fellow1 2,
  2. Maria Oldfield, clinical specialist physiotherapist in pelvic health3,
  3. Ellie Stewart, clinical nurse specialist, urogynaecology and gynaecology matron4,
  4. Carol Bonfield, patient representative5,
  5. Cristiane Carboni, pelvic floor physiotherapist and professor in the post-graduation of pelvic floor rehabilitation6 7
  1. 1Croydon University Hospital, Thornton Heath, UK
  2. 2St George’s University of London, London, UK
  3. 3Manchester University NHS Foundation Trust, Manchester, UK
  4. 4West Suffolk NHS Foundation Trust, Suffolk, UK
  5. 5Manchester Metropolitan University, Manchester, UK
  6. 6Department of Gynaecology and Obstetrics, UFRGS, Porto Alegre, Brazil
  7. 7University Inspirar, Brazil
  1. Correspondence to NA Okeahialam nicola.okeahialam{at}nhs.net

What you need to know

  • A basic unsupervised pelvic floor exercise programme is 8-12 maximal voluntary contractions, three times a day, with adequate rest in between each contraction

  • The pelvic floor can also be contracted in preparation for a leakage-provoking event (an approach sometimes referred to as the “knack”)

  • Adherence to pelvic floor muscle training often decreases over time. However, long term adherence is key and can enhance the effect of pelvic floor muscle training

Pelvic floor disorders affect women of all ages, with one in 10 over the age of 20 being affected, increasing to one in two over the age of 80.12 One in 10 women with pelvic floor dysfunction require surgical management in their lifetime, with more requiring re-operation.3 Management of pelvic floor dysfunction has substantial healthcare costs. For example, managing urinary incontinence costs the UK National Health Service (NHS) £818m annually, with surgery incurring higher costs than conservative management.4 Moreover, surgical management of pelvic floor dysfunction can be invasive, with potential complications, particularly with pelvic and vaginal mesh.5 Therefore, the recommended first line intervention for pelvic floor dysfunction is conservative, using pelvic floor muscle training (PFMT).6 This article offers a practical guide to help non-specialist clinicians working in primary care and the community, particularly when advising women how to do their own PFMT. This article refers to women but is relevant to anyone with internal female pelvic organs.

What is the pelvic floor?

The pelvic floor is a supportive structure that spans the bottom of the pelvis, attaching to the pubic bone and sacrum. It is composed of nerves, muscle, and associated connective tissue, which support the pelvic organs and maintain bowel, bladder, and sexual function.7 Normally, the pelvic floor musculature has a constant tone at rest. The pelvic floor also voluntarily and involuntarily contracts and relaxes to allow …

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