Pelvic floor dysfunction (PFD) is a condition that impacts the lives of millions of women globally, often with significant repercussions for their physical, emotional, and financial well-being. For those of us who specialise in women’s health, understanding PFD’s widespread nature, its profound effects, and the available interventions is essential to providing effective support and guidance to clients. This article delves into the prevalence of PFD, the ways it affects women’s lives, the innovative PEFLOW protocol for recovery, and the robust body of evidence supporting pelvic floor muscle training (PFMT) as a solution. Additionally, it offers practical exercise suggestions to incorporate into clients’ fitness routines, complete with detailed coaching guidance.
Prevalence and Impact of Pelvic Floor Dysfunction
Pelvic floor dysfunction is a term encompassing a range of conditions that arise from the weakening or damage of the pelvic floor muscles (PFMs). These conditions include urinary incontinence (UI), pelvic organ prolapse (POP), and sexual dysfunction, among others. The prevalence of these issues is striking, with approximately 30% of women worldwide experiencing UI, making it one of the most common manifestations of PFD. Stress urinary incontinence (SUI), in particular, is frequently observed, particularly in postpartum women. Additionally, pelvic organ prolapse affects around half of all women to some degree after childbirth, while nearly a third of women report challenges with sexual function, such as dyspareunia (pain during intercourse), often linked to weakened PFMs.
The impact of PFD extends far beyond physical symptoms. Many women experience chronic physical discomfort, including lower back pain and a persistent sensation of heaviness or instability in the pelvic region. Emotionally, the stigma and embarrassment associated with conditions like UI and POP often lead to diminished self-esteem, avoidance of social and physical activities, and, in severe cases, mental health challenges such as anxiety or depression. Financially, PFD can be burdensome due to the costs associated with medical consultations, treatments, and incontinence products. Collectively, these factors underscore the urgent need for effective interventions to manage and mitigate PFD’s effects on women’s lives.
Innovative Protocol: The PEFLOW Approach
An innovative solution to address PFD is the Pelvic Floor Workout (PEFLOW) protocol, developed by researchers at Peking University. This 12-week programme offers a structured and holistic approach to pelvic floor recovery, particularly for postpartum women. PEFLOW integrates breathing techniques, core stabilisation, and progressive pelvic floor muscle exercises to promote functional recovery.
One of the distinctive features of PEFLOW is its emphasis on breathing integration. By coordinating breathing patterns with muscle engagement, participants can maximise the activation of their pelvic floor muscles. For instance, exhaling during muscle contractions optimises the tension and effectiveness of each movement. The programme also progressively strengthens both fast-twitch muscle fibres, which are responsible for quick contractions, and slow-twitch fibres, which provide sustained support.
Additionally, PEFLOW incorporates core and postural work to address broader biomechanical imbalances. Exercises such as hip bridges, planks, and standing postural adjustments enhance alignment and facilitate comprehensive muscle engagement. Recognising the barriers posed by in-person attendance, especially during the COVID-19 pandemic, PEFLOW is designed for online supervision, making it accessible to a broader audience while ensuring participants receive professional guidance.
Studies evaluating PEFLOW have demonstrated its effectiveness in improving pelvic floor muscle strength, as measured by the Modified Oxford Scale (MOS). Participants showed significant improvements, progressing from weak initial scores to near-optimal strength levels within 12 weeks. Additionally, the programme has been shown to reduce UI episodes, alleviate symptoms of POP, and enhance overall posture and functional fitness, making it a valuable tool for postpartum recovery.
Research-Backed Benefits of Pelvic Floor Work
The benefits of pelvic floor muscle training are well-documented in the scientific literature. A meta-analysis conducted by Dumoulin and colleagues in 2018 highlighted the profound impact of PFMT on reducing symptoms of urinary incontinence. Women practising PFMT were significantly more likely to report symptom improvement compared to those who received no intervention. This underscores the importance of targeted exercises in managing SUI.
Similarly, research led by Bo and colleagues in 2024 found that PFMT plays a critical role in preventing and managing pelvic organ prolapse. For women with early-stage POP (stages I and II), PFMT was shown to improve pelvic organ support and prevent the progression of prolapse. Beyond structural benefits, pelvic floor exercises also enhance sexual function. Chedraui’s 2012 study reported significant improvements in sexual satisfaction among women engaging in PFMT, as measured by the Female Sexual Function Index (FSFI). These findings highlight the multifaceted benefits of pelvic floor work.
Postpartum recovery is another domain where PFMT excels. Woodley et al. (2020) demonstrated that early intervention with PFMT significantly reduces rates of UI and POP while accelerating recovery in postpartum women. Furthermore, Barber’s research in 2005 revealed that women practising PFMT report substantial improvements in their quality of life, as reflected in their scores on the Pelvic Floor Distress Inventory (PFDI-20).
Practical Exercises for Clients
There are several effective pelvic floor exercises we can incorporate into training sessions to support clients with PFD. Below are detailed descriptions of these exercises, along with coaching cues to ensure proper execution.
- Kegel Contractions: This foundational exercise strengthens the pelvic floor muscles. Clients should sit or lie down comfortably and focus on contracting the muscles used to stop urination. They should hold the contraction for five to ten seconds before relaxing for an equal duration. Encourage clients to avoid engaging their glutes or thighs and to maintain steady breathing.
- Hip Bridges with Pelvic Floor Engagement: This exercise strengthens the glutes and PFMs simultaneously. Clients lie on their backs with their knees bent and feet flat on the floor. As they lift their hips toward the ceiling, they should engage their PFMs, hold briefly, and then lower back down. Trainers should emphasise maintaining a neutral spine and avoiding overextension of the lower back.
- Balloon Breathing: This exercise integrates diaphragmatic breathing with PFM activation. Clients sit comfortably holding a balloon, inhale deeply, and exhale forcefully into the balloon while engaging their pelvic floor muscles. Encourage controlled, slow breaths and ensure alignment between pelvic floor engagement and exhalation.
- Side-Lying Leg Lifts with PFM Activation: This exercise strengthens the surrounding muscles while engaging the pelvic floor. Clients lie on their side with legs straight, lifting the top leg while keeping their hips stacked. Reinforce the importance of core engagement and controlled movements to prevent hip rotation.
- Plank with Pelvic Floor Engagement: This is a core-strengthening exercise that also engages the PFMs. Clients assume a plank position on their elbows and toes, engaging their pelvic floor muscles throughout the hold. Ensure proper alignment, avoiding sagging or excessively raised hips, and encourage even breathing during the exercise.
Understanding and addressing pelvic floor dysfunction is an integral part of supporting clients. The prevalence and impact of PFD underscore the need for effective interventions, and protocols such as PEFLOW provide evidence-based solutions. By incorporating targeted pelvic floor exercises into training programmes, we can help clients regain strength, confidence, and quality of life. Empowering women to take control of their pelvic health is not just a fitness goal but a transformative journey toward holistic well-being.
References
- Zhu H, Zhang D, Gao L, Liu H, Di Y, Xie B, Jiao W, Sun X. Effect of Pelvic Floor Workout on Pelvic Floor Muscle Function Recovery of Postpartum Women: Protocol for a Randomized Controlled Trial. Int J Environ Res Public Health. 2022 Sep 4;19(17):11073. Click here to review the full research article.
- Chedraui P, Pérez-López FR, Sánchez H, Aguirre W, Martínez N, Miranda O, Plaza MS, Schwager G, Narváez J, Quintero JC, Zambrano B. Assessment of sexual function of mid-aged Ecuadorian women with the 6-item Female Sexual Function Index. Maturitas. 2012 Apr;71(4):407-12. Click here to review the full research article.
- Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, Hay-Smith EJC. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020 May 6;5(5):CD007471. Click here to review the full research article.
- Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005 Jul;193(1):103-13. Click here to review the full research article.
- Zachovajeviene B, Siupsinskas L, Zachovajevas P, Venclovas Z, Milonas D. Effect of diaphragm and abdominal muscle training on pelvic floor strength and endurance: results of a prospective randomized trial. Sci Rep. 2019 Dec 16;9(1):19192. Click here to review the full research article.
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