Preparing For Pelvic Floor Muscle Training (PFMT): What You Need To Know (Part 2)

Andrew Siegel MD    1/13/2018

This entry, written for both males and females, will help you develop pelvic floor muscle (PFM) awareness and build PFM muscle memory.  

Image below: Male PFM (left); Female PFM (right)



Attribution: URL:
Version 8.25 from the Textbook
OpenStax Anatomy and Physiology
Published May 18, 2016

PFM Education and Awareness

Fact: Studies have clearly shown that most women with pelvic issues referred for PFM training are unable to perform a proper PFM contraction. Almost all demonstrate weak PFM strength regardless of age, ethnicity or diagnosis. Most males are clueless about PFM training, many not even realizing that they have this set of important muscles. 

Physical therapists and physical medicine and rehabilitation experts have used functional restoration to effectively manage injured skeletal muscles. This strategy can likewise be applied to weakened and poorly functional PFM. The principles involve segregation, guidance and progression.  Segregation is an awareness of PFM anatomy and function with the ability to isolate the PFM by contracting them independently of other muscles. Guidance refers to the instructions necessary to learn how to properly engage and train the PFM.  Progression refers to the incrementally more challenging exercises over the course of the PFM training regimen that result in PFM growth and improvement.  Again, exercise is about adaptation, so increasing repetitions and intensity is mandatory to achieve results. The goal is for fit PFM—strong, yet flexible, equally capable of powerful contractions as well as full relaxation.

Initially, one must become aware and mindful of the presence, location and nature of the PFM.  A good starting point is what the PFM are not: they are NOT the muscles of the abdomen, thighs or buttocks, but are the saddle of muscles that run from the pubic bone in front to the tailbone in back.

The PFM have a resting tone, even though you are not typically aware of it. They can be contracted and relaxed at will: a voluntary contraction of the PFM will enable interruption of the urinary stream and tightening of the anal canal and an involuntary (reflex) contraction of the PFM occurs, for example, at the time of a cough. Relaxation of the PFM occurs during urination or a bowel movement.

Dr. Arnold Kegel described a PFM contraction as “a squeeze around the pelvic opening with an inward lift.” With a proper PFM contraction, the perineum (the area between vagina and anus in females and scrotum and anus in males) pulls in and lifts in an upwards direction.  This is a “drawing in and up,” which is the very opposite feeling of “bearing down” to move one’s bowels.  For females, one method of getting the feel for doing a proper PFM contraction is to initially tighten the vagina, secondly the anus, and thirdly lift up the perineum.

Fact: Kay Crotty, a pelvic floor physiotherapist in the UK, feels that it is initially easier to learn to contract your PFM by concentrating on just the back PFM (anal sphincter).  She discovered that women who tighten their PFM while focused on both the front PFM (vaginal) and back PFM do better quality PFM contractions than those who tighten their PFM focused on just the front PFM. 

There are many mental images that can be useful in understanding PFM contractions. One is to think of the pubic bone and tailbone moving towards each other. Another helpful picture is to imagine the PFM as an elevator—when the PFM are engaged, the elevator rises upwards to the first floor from the ground floor; with continued training, the elevator rises to the second floor.  Alternatively, for females, envision that you are lifting a ping pong ball with your vagina and pulling it deep inside you. Another means is to mentally visualize that you are removing a tampon from your vagina and as you pull on the string you try to resist and hold the tampon in.

There are simple “biofeedback” techniques that can be helpful as well. After emptying your bladder about halfway, try to interrupt your urinary stream for a few seconds while you focus on the PFM that allow you to do so. Then resume and complete urination.  The feeling should be that of clenching and unclenching the vagina, urethra and anus in females and the anus and urethra in males.  Another method for females is to place a finger in your vagina and contract your PFM: the feeling should be of your vagina having a firm grip around your finger; alternatively, in either gender one can place a finger in the anus and when the PFM are contracted, the feeling should be of the anus having a firm grip around your finger.

Building Muscle Memory

It is important to understand how one becomes adept at using muscles.  This is relevant to gaining competence in any new physical activity and will be applied specifically to acquiring the skills to perform well-executed PFM contractions.

There are four stages of motor learning.  (I learned this as it pertained to the mechanics of a golf swing, but it is equally relevant to mastering contracting the PFM.)

Stage 1. Unconscious/incompetent

There is no awareness of the motion and it cannot be capably performed. It is challenging to make the connection between your brain and your PFM because the PFM under most circumstances are used involuntarily (without conscious awareness). This connection is not intuitive and must be taught.

Fact: The connections between brain and PFM consist of sensory and motor nerves. The PFM contain sensors known as “proprioceptors” that detect stretch, position and motion and convey this information to the brain via sensory nerves. Motor nerves originate in the brain and enable the PFM to contract.

Stage 2. Conscious/incompetent

Awareness of the motion is learned, but the motion cannot be competently performed.

Stage 3. Conscious/competent

Awareness of the motion is established and with sufficient practice the motion can be competently performed.

Stage 4. Unconscious/competent

With continued practice, the brain-PFM connection and muscle memory become well established and the motion can be performed reflexively (without conscious thought or effort).

…To be continued next week with a discussion on the execution of a proper PFM contraction and self-assessment of  your PFM strength and stamina.

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, Apple iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food


These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx






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