Your Functional Pelvic Floor - Why it's not just about remembering to squeeze
I recently had an exchange with a commercial underwear brand regarding some marketing messaging that I felt was putting women at harm of worsening pelvic floor dysfunction. To the brands credit, they did eventually concede that their messaging was not appropriate and agreed to pull the advert, but their primary defence that they do also encourage women to do their pelvic floor exercises got me thinking.
You see it's not just about remembering to fit in a few squeezes of your pelvic floor every so often. When I ask new clients about their pelvic floor, they usually start by telling me whether or not they have been doing their pelvic floor exercises...but that's not quite what I asked. One of the biggest challenges, in my opinion, is that we need to shift away from viewing the pelvic floor as being this separate entity that works in isolation. As something we're supposed to do few squeezes of now and again. As something that affects us rather than is part of us. We need to CONNECT with it, and OWN it. It is a part of us, and actually a pretty impressive part at that!
Your pelvic floor provides support to the pelvic organs such as the bladder, uterus and bowel, and it is important in controlling continence (urinary, faecal and wind). But it's role doesn't stop there. The pelvic floor also has an important role in pregnancy and childbirth, helping to support the growing uterus and being involved in the birthing process. It plays a role in sexual function in men and women and when functioning well can contribute to greater sensation and arousal. Importantly, the pelvic floor plays a much wider role in stabilising our torso, working together with the muscles of the abdomen, back and respiratory diaphragm. Here proving the point that the pelvic floor does not exist and function in isolation - it is an important part of your body system.
One of the most common symptoms of pelvic floor dysfunction is leaking urine during activities that place pressure on the pelvic floor, such as sneezing, coughing, laughing, running or jumping (known as stress incontinence). If you are experiencing leakage, this is a good sign from your body that your pelvic floor is not functioning well and it needs some attention. So what should you do? Here are my top tips:
1. Listen to the warning signs:
If you are experiencing any leaking, that is your body's way of telling you that something is not right. Please, do not ignore it. Pushing on through and hoping it will go away is not going to help! If you are doing exercises that are placing pressure on your pelvic floor, such as running, jumping, or lifting heavy weights then please stop those exercises and seek help. It does not mean stopping forever, it means stopping temporarily so that you can rehab your pelvic floor with a view to returning once good function is restored. Otherwise you risk worsening the dysfunction, even possibly risking eventual prolapse, and then you are going to find that far more difficult to come back from!
2. Seek Professional Help:
I strongly recommend that you are seen by a Women's Health Physiotherapist. You can either seek an NHS referral via your GP or find a private Women's Health Physiotherapist who can help you. Through the nature of what I teach, I have a lot of clients come to me with some degree of pelvic floor dysfunction and, whilst I can offer general exercises and guidance to help, I will always recommend seeing a Women's Health Physio. They will be able to do an internal examination and advise specifically on what areas you need to work on.
3. Do your pelvic floor exercises - with purpose!
Pelvic floor exercises (often referred to as "Kegals") are an important part of pelvic floor rehab. To do these with purpose, i.e. with the aim of achieving a well functioning pelvic floor, you need to think beyond the squeeze. First of all, what are you squeezing? For quite a lot of women this tends to be their bottom! It can be helpful, especially if lying on the floor, to place your hands on your bottom cheeks as you try to engage your pelvic floor - then you will be able to feel if you are actually squeezing your bottom instead. A cue that is often used is to imagine you are stopping yourself having a wee and imagine you are trying to stop yourself passing wind. This cue has merit, but the downside is that the focus here can end up being on the sphincter muscles rather than the pelvic floor as a whole. A lot of clients find it helpful to be able to visualise their pelvic floor as they do their exercises. Whether this is by being shown a model of the pelvis (that's when Penelope-Pelvis comes out in my classes) or a diagram. I love this diagram from Kenhub.com as I think it shows the layers of the pelvic floor beautifully, as well as showing how they relate to the bony landmarks of the pelvis. I like to use the 4 bony landmarks of the pelvis to help clients perform their pelvic floor exercises (the "tailbone", the pubic bone, and the two "sitting bones"). Feeling as if you are drawing these 4 points together on an exhale to engage the pelvic floor. Another thing to consider is whether you are exercising your pelvic floor's ability to relax as well as engage. To be functional your pelvic floor needs to have movement. A pelvic floor that is stuck in a position of hyperactivity has nowhere to go when you need to engage it, so you want your pelvic floor to be able to engage and release to keep it functional. Working with your breath can really help. Engage as you exhale and relax as you inhale, as this ties in with the pelvic floor's natural movement in line with the respiratory diaphragm. Ultimately with pelvic floor imagery and cueing, there are lots of examples around. Find the cues that work for you but try to keep this image in mind, it will help you think of the pelvic floor as a functional part of your body.
4. Tune into your pelvic floor and think beyond Kegels
In my opinion, this is one of the most important parts of successfully rehabbing your pelvic floor and maintaining good function in the long term.
Forget the kegels for a minute. How does your pelvic floor feel, as a functioning part of your body? How does it feel when you move, when you walk, when you run? What about when you lift your child, lift the shopping bags out of the car, do the hoovering? Your pelvic floor will be working when you do all of these activities. It may need a bit of support, such as consciously taking an exhale and engaging your pelvic floor muscles just before you pick up your child. You can do your kegels faithfully 3 times a day, but if you are spending the rest of the day lifting heavy items or doing activities that place pressure on the pelvic floor without applying a bit of conscious support then you could be undoing some of your hard work. Pelvic floor aware movement is something that will set you up for better pelvic floor function in the long term. When something is not functioning as we would like, we tend to disconnect from it. I want you to reconnect with your pelvic floor, own it and treat it as part of your whole body system.
5. Take a whole body approach
I return to one of the primary messages of this blog...the pelvic floor does not exist and function in isolation. Kegels are important for pelvic floor rehab and maintenance, but they are not the only way to exercise the pelvic floor. Think about your shoulder bridge/spine curl exercise on the mat in a pilates class. Pulling tailbone to pubic bone and pubic bone to chest as you initiate the pelvic curl to start your journey up to the shoulder bridge position...there's your pelvic floor. Or the stabilising the body as you lift your leg/s to table top on the mat...hello pelvic floor and abs working in synergy. How about your every day movements, climbing the stairs, taking a walk...pelvic floor will be working there.
If you want the pelvic floor to be functional, I truly believe we need to start thinking of its relationship with the rest of the body. The pelvic floor moves in synergy with the respiratory diaphragm, so if we aren't breathing well or are breath holding then what impact is that having on our pelvic floor. How about our abdominal muscle function, how does that impact on the pelvic floor's role in providing stability and support?
If you are looking towards rehabbing your pelvic floor so that you can get back to activities such as running, HIIT or lifting heavy, then you need to ensure the whole body is working to provide support to the body and avoid placing undue pressure on the pelvic floor. For example, when running is the strength, alignment and technique there in the lower limbs to properly absorb ground forces and avoid adversely affecting pelvic alignment and stability. If you are thinking about returning to running after childbirth, or following any pelvic floor rehab, check out my earlier blog https://www.precisionpoise.com/post/returning-to-running-after-having-a-baby
If you are training or attending any sort of exercise class, you must make sure your instructor knows that you have symptoms of pelvic floor dysfunction / are working on rehabbing your pelvic floor. Even if you are attending an exercise class because you have been told it is a good exercise form for your pelvic floor. I hear a lot of women tell me they have been told Pilates is good for their pelvic floor. It is, yes, BUT there is a lot of Pilates repertoire that I would definitely adapt for someone with pelvic floor dysfunction. Communication between you and your instructor is so important. If something doesn't feel right, let your instructor know so that they can adapt it for you.
About the Author:
Gina is a Pilates teacher specialising in working with pregnant women and mums throughout all stages of motherhood. Gina runs Precision Poise, based in Chichester West Sussex.
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