Your Pelvic Floor - Time to Reframe the Language & Show it Some Love
This blog was originally written by Gina as a guest blog for MumsChoice.co.uk. You can access the original post here: https://mumschoice.co.uk/blog/f/what-is-your-pelvic-floor
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When it comes to your pelvic floor, I really do believe knowledge is power. When we understand what the pelvic floor is, what it does and how it works we can start to tune into it as a functioning part of our anatomy. Don’t worry, I’m not going to throw lots of science at you here, I will keep it brief:
Your pelvic floor isn’t a single muscle but rather a group of muscles located within your pelvis, that carry out various functions including:
Supporting the bladder, bowel and uterus
Helping to maintain bladder and bowel function
Working with other muscles such those within your abdomen and back to stabilise and support your spine
Helping control pressure within your abdomen (“intra-abdominal pressure”), particularly when you lift or strain
You can think of your pelvic floor as consisting of 2 layers:
The Pelvic Diaphragm, which stretches from your coccyx or “tailbone’ at the back of your pelvis round towards the pubic bone at the front of your pelvis
The urogenital triangle, which stretches between the 2 sit bones (“ischial tuberosities”) of your pelvis.
Being able to picture the layers of your pelvic floor and the way they connect to the bony landmarks of your pelvis can really help you when it comes to awareness of what is going on down there and working your pelvic floor effectively.
The Goldilocks Effect
For any muscle to function well it needs to be able to be able to generate strength through a range of movement. Your pelvic floor muscles are no different. A bit like Goldilocks; not too loose, not too tight.
Sometimes we get so hung up on the idea of needing a strong pelvic floor that we end up just squeezing the heck out of it! Your pelvic floor needs to be able to release as well as engage. We need that range of movement so that when extra support is needed, such as when you cough, jump or sneeze, the muscles have somewhere to go.
The key word I use with my clients is “SUPPLE”. This is particularly relevant when working with my pregnant ladies. You need your pelvic floor to be able to release and stretch during childbirth, and then to have the suppleness and elasticity to come back once baby is born. Gripping on tight to your pelvic floor whilst trying to push a baby through there is not going to do you any favours.
Reframing how we look at pelvic floor function:
Your pelvic floor is amazing. When the pelvic floor is functioning well, it does so automatically without us really having to think too much about it, how cool is that. However sometimes things can happen that mean the pelvic floor maybe isn’t functioning as effectively as it could be. For us women, pregnancy, childbirth and menopause can all be contributing factors towards a pelvic floor that isn’t functioning quite as well as it should.
I’m not the biggest fan of the term “dysfunction” when we talk about the pelvic floor. I think language has a big impact on how we connect with our bodies and negative terminology can contribute to us feeling disconnected from parts of our body that perhaps need a little more support.
Rather than thinking of the pelvic floor as something that becomes dysfunctional, we should be thinking about supporting and optimising its role as an important and functional part of our body.
Optimising pelvic floor function:
Luckily there are lots of things we can do to improve and maintain pelvic floor function. Here are just a few top tips:
1) Learn to connect with your pelvic floor.
Not only will having a good level of pelvic floor awareness help you work the muscles more effectively during exercise, it can also help you identify situations or activities that may be having a less than ideal impact on your pelvic floor. You may notice how certain activities place a little more pressure on your pelvic floor, or even that certain situations lead you to carry tension around your pelvis.
2) Work on being able to find your pelvic floor muscles effectively
Kegals is the name given to the pelvic floor exercises, or “squeezes” we are encouraged to do to help maintain or restore pelvic floor strength. Kegals absolutely have a place in pelvic floor work, however for Kegals to be effective we need to be engaging the right muscles with the right intensity. Internal examinations performed on women told to engage or “squeeze” their pelvic floor have shown that many of us aren’t actually doing this. It isn’t really that surprising. Being asked to engage a specific muscle group in isolation is actually quite tricky, especially muscles that until recently we perhaps haven’t paid much attention to, or that are located in an area that may be feeling a little discombobulated after pushing a baby out! So how can we make this easier? We may not know exactly where a specific muscle is in our body but we do know where our bones are. When I work with clients on their pelvic floor I encourage them to try to focus on the bones rather than the muscle; feeling as if they are gently drawing the 4 bony landmarks of the pelvis towards each other from the inside. I also encourage clients to use their hands for feedback, to check they aren’t squeezing their bottom or bearing down in the abdomen as they do this.
3) Remember to Release
I mentioned the Goldilocks effect before. Not too loose, not too tight. Focus as much on the release work as you do on engaging the muscles. When you perform your Kegals, make sure you are releasing between each one. Spend some time focussing on relaxing into some pelvic release work, particularly if you know your pelvic floor may be carrying some tension or tightness.
4) “Above all learn to breathe correctly” Joseph Pilates
I’m a Pilates teacher so of course I was going to shoehorn a quote from the big man himself in this article! He was, of course, talking about his method of full body wellness but it also applies hugely to the pelvic floor. I cannot state enough the importance of your breath when it comes to your pelvic floor. Holding your breath results in a bracing effect, restricting movement and it can even increase pressure within the abdomen which isn’t great when trying to work on your pelvic floor function. When performing your Kegals, try to coordinate with your breath; exhaling as you engage and inhaling as you release. This breathing pattern works with the natural movement of your pelvic floor as you breathe in and out. It might take a bit of getting used to so be patient with it.
5) Think beyond Kegals
Kegals are great and they have a role to play, but your pelvic floor does not work in isolation and therefore exercising the pelvic floor should involve more than just isolated contractions. Bring in movement, work in different positions and in all directions. Work progressively, gradually bringing in new movements and degrees of load when you are ready for it. As a Pilates teacher of course I am going to tell you that Pilates is great for your pelvic floor, and it can be! The focus on body awareness, technique, breath work and full body integration in a Pilates class all lend themselves really well to those working on restoring or maintaining pelvic floor function in a guided manner. However, I also believe that in general all movement is medicine. Whatever it is you are into, get your body moving and your pelvic floor will be working with you. A quick caveat here, certain high impact activities and types of exercise are best avoided if your pelvic floor is not working as well as it should be so do be mindful of this and seek advice if you are not sure. Seek out teachers, trainers and therapists who have the specialist knowledge and training to be able to support you. It doesn’t have to be a fitness class or a gym, even just a brisk walk outdoors can do wonders for your body.
When to seek help
There are times when you should definitely seek the help of a women’s health professional. Here are some of the signs that your pelvic floor may not be functioning as effectively as it should be:
Leaking of wee, poo or wind. This may be leaking that happens when the pelvic floor is under pressure, such as when you jump, sneeze cough or run, or needing to dash to the loo
Feeling a sensation of heaviness or dragging down below, particularly towards the end of the day
Feeling like you aren’t fully emptying when you go for a wee or a poo
Experiencing pelvic or lower back pain
A Women’s Health Physiotherapist will be able to perform an internal exam to get an idea of exactly what is going on down there, and recommend specific exercises or other interventions to help. You may be able to ask your GP for a referral to a women’s health physio on the NHS, or you can seek out a private women’s health physiotherapist in your area. If you are attending exercise classes, speak to your teacher. They should be able to guide you in working appropriately based on your body’s needs.
The time of simply accepting reduced pelvic floor function as just something that happens to women after childbirth or in later life is over. There is so much you can do to keep your pelvic floor functioning well and to help restore function if it needs a little support. Ladies, above all I want you to feel confident. Confident to wear that white skirt, jump on that trampoline and enjoy whatever life brings without worrying about your pelvic floor!
About the author
Gina is a Pilates teacher, specialising in women’s wellness. She believes in empowering her clients to better understand and work with their own bodies; building confidence in their body’s abilities. Gina teaches private Pilates apparatus sessions from her garden studio in Chichester, as well as group Pilates mat classes in the community. For more info go to www.precisionpoise.com or email firstname.lastname@example.org. You can also follow @precisionpoise on Facebook and Instagram.
Some helpful resources:
Mummy MOT. We are lucky to have some fabulous Mummy MOT trained physiotherapists and osteopaths in the Chichester area: https://www.themummymot.com/for-mums/