Recently, pelvic floor muscle training has become popular not only in health magazines but also in women’s magazines, on television and on social networking services. The pelvic floor muscles are difficult to visually confirm movement of in a clothed situation, making it difficult to get a sense of muscle contraction; and, thus, there are many cases of incorrect training leading to pelvic floor dysfunction, including urinary incontinence and pelvic organ prolapse, and significant reduction of quality of life and healthy life expectancy. Therefore, the ability of instructors to teach appropriate pelvic floor muscle training is an important key to the prevention and improvement of pelvic floor dysfunction. The purpose of this review is to understand the functional anatomy and motor function of the pelvic floor muscles and to disseminate evaluation and training practices for preventing and improving pelvic floor dysfunction such as urinary incontinence and pelvic organ prolapse.

Pelvic organ prolapse (POP) is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy). This is a female specific illness and is one of the women’s health problems that negatively impacts quality of life (QOL). The causes of prolapse are multifactorial. However, it is primarily associated with vaginal delivery, which leads to pelvic floor muscle and connective tissue injury. POP presents with various symptoms that may include urinary, bowel, and/or sexual dysfunction. Available POP treatments vary according to the degree of the prolapse symptoms. Pelvic floor muscle training (PFMT) is the treatment of first choice for mild POP (evidence level Ⅰ, recommended grade A). In Japan, it is not yet covered by health insurance, so patients have limited opportunities to learn about correct PFMT under the diagnosis from a specialist physician in pelvic floor disorder. In this article, the PFMT for POP provided in our hospital is reported.

Pelvic floor muscles play an important role in inner unit functioning related to excretion, reproduction, support of pelvic organs, posture, and respiration, while their weakening is a characteristic health problem for many women. The pelvic floor is closely related to women’s life events, and protection and strengthening of the pelvic floor in accordance with life stages will lead to the prevention of pelvic floor disorders (pelvic frailty). Pelvic floor muscle exercises may be the first choice for prevention, improvement, and/or conservative treatment of pelvic organ prolapse caused by weakening of pelvic floor muscle groups. Also, pelvic floor muscle exercises can be done on a daily and continuous basis as a fitness activity; but proper assessment and practice with appropriate methods are important. In addition, an integrated program that includes lifestyle modification can enhance its effectiveness. In order to realize the lifelong well-being of women, there is a need to further develop effective pelvic floor exercises in creating a more comprehensive prevention-care health system for society.

Urinary incontinence (UI) among older people is a common problem. Several treatments are available for older people with UI including surgery, drug therapies, and behavioral interventions. Recently, much attention has been placed on the behavioral treatments for UI, including pelvic floor muscle (PFM) exercise, weight loss exercise, and thermal therapy, as they have few risks, no side effects, and are effective. These therapies are often recommended as first line treatments for older people with UI. PFM exercise programs often incorporate alternations of fast contractions that are usually held for about two to three seconds interspersed with relaxation intervals of four to five seconds, and sustained contractions, where participants hold the contraction for about eight to ten seconds followed by a relaxation interval of ten to twelve seconds between the contractions. While exercise periods vary between 3 to 24 weeks, 8 to 12 weeks seems to be the most effective length for PFM exercise. The effectiveness of PFM exercise for the improvement of UI has been validated by many studies, with improvement rates ranging widely from 17 to 84%. Also, research has shown that UI is associated with obesity. Increases in body weight cause increases in abdominal wall weight, which in turn increases intra-abdominal pressure and intra-vesicular pressure. Therefore, abdominal fat reduction from exercise may decrease intra-abdominal pressure, perhaps causing improvements in urethral sphincter contraction and, hence, decreasing UI risk. Evidence reveals that PFM exercise and fitness training targeted at reducing modifiable risk factors are effective strategies for treating UI in older people, regardless of UI type.

Pelvic floor trauma developing into pelvic frailty is a significant concern in urogynecology or orthopedics. The majority of women who have experienced vaginal childbirth are affected, to a certain extent, by some form of pelvic floor damage, thereby eliciting substantial alterations of functional anatomy in the pelvic cavity which are manifested as urinary incontinence or pelvic organ prolapse (e.g., uterine prolapse). With the above in mind, medical researchers, continence experts, and continence exercise practitioners in the research areas of sports medicine and rehabilitation medicine believe that the coordinated activity of pelvic floor muscles, in association with the abdominal muscles, is a prerequisite for urinary and defecatory continence. Since the pelvic floor forms the base of the abdominal cavity, stronger pelvic floor muscles are crucial in maintaining such capabilities. Opposing action of the abdominal and pelvic floor muscles ensures that exercises for one may also strengthen the other. Appropriate abdominal maneuverability or logical exercise training of the abdominal muscles may thus be beneficial in maintaining not only strength but also coordination, flexibility, and endurance of pelvic floor muscles and abdominal muscles. Such exercises, collectively known as pelvic floor muscle training, may be effective for long-term pelvic cavity care and also in rehabilitating cases of pelvic floor dysfunction. Further research is needed, however, in determining whether pelvic floor muscle function can be truly enhanced or maintained by such exercises in cases of pelvic floor dysfunction and/or decreased urinary continence.