How To Move Your Way To A Healthy Pelvic Floor

Incontinence… Sneeze-pee… Organ-prolapse… 

Awkward conversation much?

Unfortunately these often ‘suffered-in-silence’ conditions are not openly discussed. This leads to a lack of conversation and adequate education about their causes.

Most importantly though, the question everyone wants to know is what can be done about it?

Here’s What I’ll Cover

What is pelvic floor dysfunction (PFD)?

Why the controversy?

What is pelvic floor (PF)?

Current theories on strengthening the pelvic floor

A whole-body approach to PFD

How to correct your posture to optimise PF function

Whole-body exercises to help your PF

My disclaimer

Summary

Pelvic floor dysfunction (PFD)

It is difficult to estimate just how many women suffer from pelvic floor dysfunction and/or urinary incontinence. Research studies say somewhere between 20-50% of women.¹

I personally think that this number should be higher, mainly due to most women ‘putting up with it’, and therefore not seeking help.

Pelvic floor controversy

Some experts argue that childbirth is a major cause of PFD. In some ways they are correct, but I suspect for the wrong reasons.

Others, myself included, would argue that it’s not childbirth per se that CAUSES PFD, it’s the whole body environment leading up to childbirth that does.

What does this mean exactly?

As with all functions in our body, the pelvic floor is reliant upon its surrounding structures to maintain optimal length and supportive integrity.

If the other surrounding structures aren’t taking their fair share of the workload, then the poor old pelvic floor will suffer the consequences.

These consequences are usually in the form of more tension.

What is the most common prescription for PFD? Even more tension. That’s right… We have decided that it’s a great idea to fight tension with more tension, in the form of ‘pelvic floor exercises’, or ‘Kegels’.

Before we delve into that abyss, it would be useful to have a bit of background information.

Such as…

What is the pelvic floor?

The pelvic floor is literally the ‘floor’ of the pelvis. It consists of a group of muscles that form a sling between the sacrum (tailbone) and the pelvic bowl.

It has many functions that include:

• Providing support for the pelvic organs (e.g., the uterus (in women), bladder and bowel).

• It maintains continence via the anal and urinary sphincters.

• It helps maintain intra-abdominal pressure.

• It facilitates birth by creating a resistance pressure to the cervix and uterus, encouraging the baby to rotate anteriorly (forwards). This optimises a smooth ride for bubs through the birth canal / pelvic girdle.

 (Pelvic floor seen from the back)

(Pelvic floor seen from the front)

To Kegel or not to Kegel? That is the question …

Firstly, what exactly is a Kegel?

      Kegel exercises

      ˈkeɪɡ(ə)l/

      noun

1. Exercises performed to strengthen a woman’s pelvic floor muscles.

Let’s break that down:

• They are a group of exercises

• The aim is to strengthen

• The above definition is extremely sexist (men need pelvic floor tone too!)

• They are targeted at the pelvic floor

Here’s my beef with Kegels… like most things in today’s view of healthcare, they are extremely specific and isolating.

That might be OK if all we were was a group of muscles attaching our sacrum (tailbone) to our pelvis. But we are not…

A (W)holistic view of pelvic floor dysfunction (PFD)

For those that have read my post on back pain and pregnancy, you may well remember one of my favourite movement superstars, Katy Bowman, M.S.

For those that didn’t, you can access it HERE.

Katy has strong views on Kegels and PFD, and I must say that I concur!

In her words:

“A Kegel attempts to strengthen the pelvic floor, but it really only continues to pull the sacrum (tailbone) inward, promoting even more weakness, and more pelvic floor gripping”.

This pulling in (forwards) of the sacrum is counterbalanced by the glutes. You know, those grand old muscles that form what is technically called our ‘boo-tay’.

It is actually a lack of control of the glutes / boo-tay that makes someone more susceptible to PFD.

Another major reason covered in my post on back pain is our lack of movement throughout the day. This coupled with long periods spent seated exacerbates this poor glute-pelvic floor relationship, allowing the pelvic floor to contract and shorten further.

“Tighter does not equal stronger. It’s just tighter…” – K.Bowman.

There is a deeply ingrained belief that TIGHT (read: shortened) muscles  are strong, and LOOSE (read: lengthened) muscles are weak.

Let’s clear this up right now…

Strong muscles are those that are at their OPTIMAL length, and are able to adapt and respond to various challenges.

When applied to the pelvic floor, optimal strength comes from a reciprocal relationship between the pelvic floor and gluteal muscles.

Only focusing on Kegels will create too much forward pull on the sacrum, shortening the pelvic floor and exacerbating the problem long-term.

Tone vs Tight and Goldilocks

“Tone is having the MOST strength and the MOST length” – K.B

Imagine your pelvic floor muscles as a TRAMPOLINE that elastically supports all of your pelvic organs, and allows optimal function of our elimination functions (aka wees and poos).

If that trampoline was too loose, it would stop supporting your organs. If it was too tight, it would be difficult to maintain control of your bladder and bowel function.

Like Goldilocks, we need our pelvic floor to be JUST RIGHT…

Take the above image for example.

• In image A, your wrist is in a neutral position. This is its optimal length (remember the trampoline) of the muscle to perform a fist clench action.

• Try clenching your fist in all three positions and note how easy it is and how strong the clench feels.

• In image B, the wrist is in a flexed position, effectively shortening the wrist clenching muscles.

• In image C, the wrist is extended, effectively lengthening the wrist clenching muscles.

If Goldilocks wanted to clench her fist and yell at the three bears, she’d be best to keep a neutral wrist (image A) and optimal muscle length to do so.

Is there a time for Kegels?

Absolutely!

Kegels can be extremely effective when starting the process of connecting the BRAIN to the MUSCLE.

This means learning how to contract the muscle in the first place.

This occurs when there has been a lot of trauma to the pelvic floor (think third degree tears and episiotomies).

It can also be of benefit when someone has lost the sensation of being able to contract the pelvic floor muscles.

In these instances, Kegels should definitely be used in conjunction with learning how to align your lower limb, pelvis and lower back. This should be followed by preparation for natural movements such as squatting and lunging, with the aim to progress to doing these movements.

For this reason, I would definitely recommend Kegels post-pregnancy to regain this important brain-pelvic floor connection. To achieve the best outcome possible, you would have done some prep work during your pregnancy (or before), working on squat preparation and activating the all important gluteal muscles.

It is imperative that whilst performing Kegel exercises, you also focus on a RELAXATION component. Not all Kegel information includes this, and for me it is the most important aspect.

Try this exercise:

• After contracting your pelvic floor (AKA Kegel), focus on letting your pelvic floor relax and loosen.

• It can be helpful to take a deep breath in, and on the out breath imagine a wave of cool breeze drift down through your pelvis and out through the perineum (area of tissue between the vagina and anus).

Tuck vs Tilt

One of the most common presentations I see as an osteopath is the pelvic ‘tuck’.

This tuck posture has a domino effect:

• Hips shift forward, creating more load on the front of the hip joint (AKA more likely to develop arthritic change).

• Shoulders move back and chin moves forward to counterbalance. This creates excessive tension through these regions and can lead to pain, headaches, jaw dysfunction and so on.

In the above picture, aside from looking slightly constipated, my hips, shoulders and ears are relatively stacked on top of each other.

This allows the bones, ligaments and joints to fulfill their role of structural support. This then frees up the muscles (those not involved in postural alignment), so they don’t have to ‘grip’ to support us.

The result of which is less pain and tension throughout our bodies. Yay!!!

These are the cues I give my patients everyday to get a feel of a proper “stacked” posture:

• Stand in front of a mirror, looking side-on so your can see if your body is in alignment like mine above.

• Start at your feet. Get your weight 2/3rds under your heels and 1/3rd under the “balls of your feet”.

• This ‘stacks’ the lower limb joints on top of each other.

• Next, allow your pelvis to tilt slightly forward as if your are pouring something out the front of your pelvis.

• When you do this, make sure that your ribcage doesn’t push forwards. You want to maintain the ribcage/thorax ‘stacked’ on top of the pelvis at all times.

• The final step is to imagine a piece of string from the top back part of your head (the crown) pulling you gently towards the ceiling. This feels like the back of your neck lengthens and gently encourages your head to sit correctly on your shoulders.

If you are finding the above too difficult, then I highly recommend seeking out a healthcare professional who has a particular interest in posture and pregnancy.

How do I make an appointment?

CLICK HERE or CALL 07 3368 1300 to contact Dr Arun Shapleski (osteopath)

Squat the difference

The first step to having a healthy pelvic floor is adopting general postural cues as described above.

Second step is to maintain this posture during sitting, getting out of chairs and on and off the toilet etc.

I’ve outlined some helpful tips on how to integrate optimal pelvic posture in your everyday life in my post on pregnancy and back pain. You can access it HERE.

Third step… start prepping your body for squatting. It’s no use just jumping straight into an activity without doing any preparation.

The best way to prepare yourself is to start lengthening your calf and foot muscles. These are generally tight in most people and need to be adaptable to allow a full-squatting posture:

The best way to do this is with a ½ dome:

If you don’t have one of these, then a book or rolled towel will suffice.

It’s important to stretch both sets of calf muscles (superficial and deep). The superficial muscle (gastrocnemius) is stretched with a straight leg as in the picture above.

To stretch the deeper muscle (soleus), bend your knee (you should feel a stretch lower in the leg around the achilles tendon and low calf):

Now you may have come across ‘calf’ stretches before, but most people are unaware that we should also stretch the front of our leg and foot/ankle. I advise using a towel initially to soften the pressure on your toes.

If needs be, hold on to a chair or wall for balance:

If you get any cramping sensation during these stretches, just stop. Instead of holding them for longer periods, start off shorter (e.g., 10 secs), and more frequently (10-20 x day).

The cramping is due to the muscles not being used to stretching and being loaded. They will get used to it and you can eventually build up to holding each stretch for 30-60 secs.

As everyone will be at different places in regards to where to start with squatting and lunging, it is imperative to be assessed by a qualified health practitioner. This is by far the safest and most productive way of learning how to move properly so that you can quickly restore healthy function to your pelvic floor.

If you’d like to read more about progressing to a full-squatting practice, check out my recent post on back pain and pregnancy HERE.

Summary

I’ve explained how pelvic floor dysfunction (PFD) is more common than we think. 

I’ve taught you what a ‘pelvic floor’ is, and why the current-day treatment recommendations are controversial and somewhat outdated.

I have outlined ways to start improving your pelvic floor function today, including an assessment with a qualified practitioner. This means that you no longer have to suffer the awkwardness and discomfort of pelvic floor (PF) symptoms.

Here are the highlights of this post:

1. PFD is VERY common – roughly 50% of women suffer unnecessarily!
2. Current treatment recommendations consisting of PF exercises, aka Kegels, only provide short-term relief of symptoms.
3. A whole-body approach to PFD is desperately needed to empower women with the tools to maintain a healthy PF.
4. Thankfully this is doable with the right guidance and education.
5. Tighter muscles don’t always equal stronger muscles.
6. There is a right time for Kegels. They need to be utilised in a whole-body approach (if required at all).
7. Be mindful of your postural alignment whilst standing, getting in and out of chairs and on and off the toilet – a perfect place to start practising a squatting movement.
8. Prep your lower limb and pelvis for squats by releasing tension in your calves, hammies and pelvis.
9. Then, and only then, start working towards a regular squatting practise to lengthen your pelvic floor and support those organs!
10. Learn the unique role that an osteopath can play in relieving your pain and educating you on optimal movement for life.

If you’d like a better understanding of tools that you can start implementing today, download ‘5 Tips For a Healthy Pregnancy, Great Birth and Beyond’. In this free guide, you’ll learn:

• How simple changes in your posture and alignment can greatly affect your health

• Safe ways of moving during pregnancy to reduce back pain now

• How to prepare your body to facilitate a great birth

• How to rest optimally to enable ideal pelvic alignment

• Tips to encourage optimal lie of baby prior to birth

• and more … 

CLICK HERE TO DOWNLOAD YOUR FREE GUIDE

I  welcome your comments or questions in the comment section below … but please realise that I can’t provide any professional advice in this context.

References:

Nitti, V.W. The Prevalence of Urinary Incontinence. Rev Urol. 2001; 3(Suppl 1): S2–S6.