// Don't forget the pelvic floor

by Lisa Westlake

Incontinence affects over one million Australians. Up to one in three women experience urinary leakage when coughing, sneezing, laughing, lifting or playing sport, and over fifty per cent of these women keep it a secret, probably due to embarrassment or the mistaken belief that there is nothing that they can do about the problem.

The truth is that between 60 and 70 per cent of women who suffer incontinence could be assisted by such simple things as education, information, diet and specific exercises. consider what this means in your 9:30am high impact group fitness class. half of your participants could potentially be wearing a continence pad or be worried that they might embarrass themselves.

Healthy strength and function of the pelvic floor is imperative for bladder and bowel control and also contributes significantly to back health. but it’s not only young mums and older women that need a strong pelvic floor; young girls can also suffer loss of control, particularly those who participate in high levels of activities such as trampolining, gymnastics and other high impact sports. men can also benefit from pelvic floor exercises, particularly those who undertake heavy weight training.

Stop the neglect!

Pelvic floor exercises can make a massive difference to people who experience this loss of control, yet it is probably the most neglected muscle group in fitness classes.

If the pelvic floor is such an important muscle group then why is it so neglected in regular fitness programs? firstly this may be because it is ‘out of sight, out of mind’; people tend not to think of it until there is a problem. secondly, instructors may feel uncomfortable discussing such things as urine, vaginas and rectums in their step class! furthermore, it seems that many people who are doing pelvic floor training in class situations are performing the exercises incorrectly, potentially doing more harm than good.

The difference we can make

As a group, fitness leaders have an exciting opportunity to make a difference to the alarming number of Australians who suffer silently with associated hygiene and social implications by giving the pelvic floor the training and attention it deserves. An outline of how and what you might comfortably include in your class follows.

What and why

Use simple terms and phrases to briefly orientate your class to the pelvic floor and why it is important. for example; ‘the pelvic floor is a muscular sling that lies between your pubic bone and your tail bone, it’s strength is imperative for control of wind and water and it helps keep your back strong too.’


  • Initially start by standing or sitting tall. relax your neck and shoulders.
    Visualise the group of muscles that forms a sling from your pubic bone to your tail bone. now lift these muscles upwards and inwards. Slowly create the strongest contraction possible.
  • Hold this for the duration of 3 breaths, consciously avoiding breath holding and tensing other body parts such as your shoulders, toes, gluteals, abdominals or face.
  • Gradually increase this to 5 and then more breaths.
  • It is important to think of the process as ‘lifting’ your pelvic floor; do not use the term ‘squeeze’ as it is likely to encourage unwanted gluteal recruitment.
  • 3 good pelvic floor lifts is plenty at one time, with a second or third set a little later.
  • Vary the position for training the pelvic floor; standing, sitting, kneeling are all good options.


Cool downs are one time you might include pelvic floor exercises, and alongside other strength exercises is another option. Any time is a good time to include pelvic floor. once your class is comfortable with the concept, start to cue for pelvic floor before lifting and starting an exercise. encourage your participants to get into a routine of regularly performing the exercises in their own homes.

How often

As with other muscle groups, you should train your pelvic floor 3 to 4 times per week. if you have particular concerns about your pelvic floor or you are pregnant or post-natal you may need to identify more specific exercises to undertake on a daily basis.


Lisa Westlake, BAppSc (physio) 

Lisa has worked in the health and fitness industry for over twenty years. Australian Fitness Network named her Fitness Instructor of the Year in 2000, and Presenter of the Year in 2003. Through her business, Physical Best, Lisa combines physiotherapy and fitness to create classes and programs for a variety of ages, levels and abilities, and is well known for her work in developing the Fitball program in Australia.