"You’ve had kids, it’s normal"…and other myths about the pelvic floor.
That unwanted dribble during ladies night laughfest, the sense of pressure that weighs you down after a long day of standing, the bulge (down there) you see now that you never noticed before, going to the bathroom for the umpteenth time before lunch so that just in case you sneeze you won’t leak….those are signs that your pelvic floor isn’t working well and is in need of help. In most cases, we just need to show our pelvic floor a little TLC and give it a nudge to start working again.
MYTH #1: Despite what you may have been told by well-meaning grandmothers or aunties, it certainly is not normal to be leaking during exercise or coughing/sneezing/laughing fits. TRUTH: But it is common.
For years, maybe even decades, the best (and maybe only) exercise suggested to ladies dealing with incontinence and pelvic floor weakness has been the kegel-MYTH #2. A concentric contraction of the muscles running from the pubic symphysis (front of the pelvis) to the coccyx and sacrum (in the back of the pelvis), a kegel should create a squeeze and lift of the those muscles to, in theory, provide organ support and sphincter control. Collectively, the muscles are known as the pelvic floor. In fact, the medical community used to encourage ladies to “do your kegels” every day by stopping mid-stream during urination - MYTH #3. And while doing this may be an effective test to see if you can actually isolate those muscles appropriately, we have learned that actually performing a kegel contraction as an exercise during voiding is more detrimental than beneficial.
So recommendations shifted to something more like “do 10 kegels, holding for 10 seconds, at every stop light.” I don’t know about you, but my pelvic floor is not the first thing that pops into my head when I roll up to a red light. So if I was reliant upon that scenario to get my pelvic floor exercise in, then I would be a mess. Don’t get me wrong, there is value in learning how to activate your pelvic floor and in doing a kegel contraction, I really believe this. But I believe there is more value in learning to activate the pelvic floor during functional tasks that we do every day. And there is value in learning to relax your pelvic floor as well -TRUTH.
One of my favorite functional exercises is a squat…aaahh! Just saying it makes me happy. There is just something about the movement as a whole that embodies strength and health, in my mind. Now don’t panic thinking you need to rack up 150# on a barbell and drop into a deep squat to get your pelvic floor going. That is not the vision I am trying to create. In its most basic form, moving from sitting to standing is a squat. How many times a day do you do that? Let’s make that functional transition work for us ladies. Or turn it into a straight up exercise session. Our booty and pelvic floor muscles will thanks us!
OK! Here we go: it is the strength of the glute muscles that can assist our pelvic floor muscles, so with that in mind, let’s try a booty-friendly sit to stand, ahem, squat.
Sit forward near the edge of your chair so feet are firmly planted on the floor.
Position ankles under knees, so that your tibia (shin bone) is fairly vertical.
Lean forward, keeping your back flat (no slouchy shoulders), exhale and push up to stand. Much of your pressure will be through your heels.
Finish the stand with a slight glute squeeze.
Inhale and relax your pelvic floor as you return to sit.
Check out a related post I wrote on my own blog for more details, but for now just know that when you exhale, the pelvic floor should naturally elevate after elongating downward during your inhale. This makes the exhale a perfect time to add a kegel contraction if you need some additional support across the pelvic floor since it is already moving in the upward direction-TRUTH.
When just beginning this type of “glute driven squat” your depth may need to be shallower than typical or you may even find it useful to hold onto a counter top to allow your hips to drop back a bit, keeping the ankle and knee better aligned. The Smith Machine in your local gym is a great asset here too. As you can tell from the pictures above, I need to work a bit on fine tuning the form. As a squat it isn’t bad, but I could still get my backside more involved with better support. It gives you the idea though.
Exercises even done well with the most perfect form, are just part of the pelvic floor healing equation. Your breath is key. Whether you are getting up from a chair, squatting down to pick up your toddler, reaching in to the washing machine to do laundry, pushing the stroller uphill, all the posture and form in the world won’t matter if you hold your breath and push down through your nether region. One of the biggest struggles I see from women that see me professionally for pelvic floor physical therapy is the tendency to hold their breath during tasks they do every day. Even when they try and do a kegel. This really could be a whole other post, so for now, think exhale on effort. When you do anything that requires effort or a change in your body position, breathe out (and add a kegel if you can).
Take home message? Kegels are not the only exercise available to you if you are looking to improve the health and strength of your pelvic floor. A strong booty and proper breathing are just as important. Taking a little extra time with your daily transition from sit to stand, or adding a few dedicated sets of this a few days a week could really pay off for your overall core health.
Heidi Pierce, PT, CLT and women’s health coach
If you are looking for more information on pelvic floor and core friendly fitness, pop on over to my website at www.thenurturedlife.com