Marietta Mehanni

Aquacise Your Pelvic Floor For CFA

Written by Marietta

September 11, 2014

Aquacise Your Pelvic Floor

By Dianne Edmonds and Marietta Mehanni

“Lower back pain is also strongly linked with pelvic floor weakness and there is certainly an awareness that aqua aerobics provides a safer choice of fitness program for these individuals.”

Many people that want to continue exercise without the implications of impact, joint stress, post exercise muscle soreness and overheating issues will prefer to exercise in water. This cliental group is usually, also the population group that are challenged by pelvic floor issues. It is well known that mature adults and certainly menopausal or post menopausal women would also prefer to exercise in water because of the issues with ‘wetting themselves’ during land based exercise. Pregnant women and obese clients would also prefer to exercise in water for the obvious reduced impact benefit, but also because the pelvic floor is more protected in water. Lower back pain is also strongly linked with pelvic floor weakness and there is certainly an awareness that aqua aerobics provides a safer choice of fitness program for these participants. It is clear, then, that aqua aerobics has not only massive appeal for these population groups for the benefits of exercising in water, but also because of the potential pelvic floor issues that they will face with land based exercise. This provides aqua aerobic instructors with a huge opportunity to provide much needed education, information and instruction on what is the pelvic floor and how to use it during the workout.

Teaching correct pelvic floor technique

A lifting up and hold action is desired when activating the pelvic floor inside the pelvis, and the muscles will work more effectively when the lumbar spine is in neutral.
In aqua classes pelvic floor muscle exercises can be included in standing, during cool down, stretch or postural awareness components.

Consider the following mental reminders:

“Focus on lifting up your pelvic floor on the inside”

“Drawing up inside, tightening around your front and back passages”

“Imagine you are holding onto a full bladder and wind at the same time” (in whatever way you feel most comfortable saying this)

“Breathe, don’t suck in the ribs and upper abdominal area (under the ribcage)”

Between contractions, it is okay to feel your lower abdominals tighten, but  you shouldn’t feel tightening under your ribs or in your upper abdominal area.

It is also important to relax your pelvic floor too, and you should feel your pelvic floor muscles release completely. If you don’t feel a relaxation – your pelvic floor muscles have fatigued, and they have relaxed already, or you may be still holding them tightly and you should focus on relaxing between the contractions. To check if the muscles are fatiguing, you can do a shorter contraction e.g. 2-3 seconds, and if you then feel the muscles relax, you will gain the awareness of your own pelvic floor muscle hold time, and be able to work on building that hold time up over time.

Land verses Water


The effect of buoyancy decreases the gravitational forces acting through the pelvis and therefore a decrease in the pressure on the pelvic floor with exercise compared with similar exercise on land. In fact buoyancy does not simply affect the force of the internal organs on the pelvic floor, but also in fact ‘floats’ the internal organs, so even jumping and jogging exercises that would normally be not recommended for land based activities are still appropriate in the water. This is of particular benefit for people who are pregnant or obese. There is a precaution here – this depends on how jogging is performed.

Fast verses Slow

When performing either a fast or slow jog, there are marked differences between the two activities. Similar responses were also found with other exercises, for example, cross country ski, jumping jacks and kicks. What was discovered with these classic aqua moves was that when they were performed with speed and consequently more turbulence, the pelvic floor responded by lifting and engaging with the transverse abdominals to create a stable torso. Slower rebounding actions created more force on the pelvic floor and thus causes more pelvic floor stress. This can be problematic for those whose pelvic floor is weakened.

Buoyancy equipment – Dumbbells, Noodles, Kickboards

Buoyancy equipment is predominantly used for buoyancy resisted and buoyancy supported exercises. Buoyancy resisted exercises is when the buoyant tool is pushed down into the water or kept submerged whilst performing various shallow or suspended exercises. Quite often people hold their breath and thus bear down onto their pelvic floor when performing buoyancy resisted exercises, which is problematic if there is pelvic floor weakness. Using the core muscles this way is incorrect and may be a factor leading to pelvic floor weakness.

Breathing is an essential component when performing buoyancy resisted exercises. Forced exhalation is required when the buoyant equipment is pressed downward and inhalation when the tool is released to the surface. When the buoyant tool is submerged for a lengthy period of time to either suspend the body or to develop muscle endurance, breathing is extremely important.

Buoyancy supported exercise is when the body is fully supported by the buoyant tool. This method is most often used for suspended exercises and is the recommended alternative to buoyancy resisted suspended exercises. Buoyancy supported exercises provide the opportunity for clients to focus on recruiting the pelvic floor and breathing correctly whilst performing the exercises. When using dumbbells and noodles for buoyancy supported exercises, these tools need to be held under the armpits, below the buttocks or between the legs. Gripping with the hands may encourage some participants to hold their breath, thus defeating the purpose of performing buoyancy supported exercises.


  1. Bump, R C; Hurt, G; Famtl, A and Wyman, J (1991). ‘Assessment of kegel pelvic floor muscle exercise performance after brief verbal instruction’. American Journal of Obstetrics and Gynaecology. pp 322 – 329.
  2. Sapsford, R R, Hodges, P W, Richardson C A, Cooper, D H, Markwell, S J and Jull, G A (2001). Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourology & Urodynamics, 20, 31-42.
  3. Thompson, J.A., O’Sullivan, P.; Briffa, K.; and Neumann, P.  Assessment of pelvic floor movement using transabdominal and transperineal ultrasound. International Urogynecology Journal 2005; 16: 285-292.
  4. Thompson, J.A., O’Sullivan, P.; Briffa, K.; and Neumann, P (2006). Differences in muscle activation patterns during pelvic floor muscle contraction and Valsalva manouevre. Neurourology & Urodynamics, 25, 148-155.

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