What do you need to help with Pelvic Floor Problems?
Before going on to explain how Pilates might help , first let me outline the main Pelvic Floor problems.
There are quite a few of them and I only want to give a quick summary here
Stress incontinence where jumping, running or even walking causes leakage of urine. Sometimes coughing and sneezing can cause difficulties too
Urge incontinence, where the sound of running water or getting to your front door and turning the key in the lock causes the urge to urinate
Faecal incontinence, of faeces or gas. This is less common but nonetheless a significant problem and if it includes you, then you are not alone
Prolapse of the pelvic organs: the vagina, womb, bladder more commonly. Less so, the rectum (men and women)
Pelvic pain is an important but somewhat different issue that can be related to dysfunction in the pelvic floor. Mixed up with issues around pain can often be problems with sexual intercourse.
These issues can affect people of any age, although they tend to get worse following childbirth and with increasing age, menopause, surgery in the pelvic area
This is a rather rather depressing list, especially given that these problems are prevalent, life affecting and a source of anxiety and real sadness.
Can Pilates Help?
When I first trained as a Pilates instructor we were taught to “zip and hollow” before every single exercise. The intention was to actively engage Pelvic floor and the deep abdominals, basically, all of the time. At that time Pilates was very much seen as a exercise format which would help to strengthen the Pelvic floor.
Over the years the Zip and Hollow method has been disregarded. There are many difficulties with it which I won’t list here but as Pilates has moved on, there is less of a link in people’s minds that Pilates = Good Pelvic Floor. This is is largely a good thing because Zip and Hollow is not the route to a functional pelvic floor
So what is the route to a Functional Pelvic Floor?
- Knowing your body, truly. or rather the pelvis. Dear reader, we know more about our mobile phone than we do about our own pelvis and more acquainted with Kim Kardashian’s bum than our own
- Trying to identify the problems that you have. In really simple terms, could they be caused by a weak under-active pelvic floor or tight over-active pelvic floor. You may need a referral to a specialist Physiotherapist to help determine this. This is an important, crucial distinction
- Careful focussed Kegels. Don’t just squeeze and hope for the best! Don’t just squeeze and hope for a better sex life. Most of all, don’t just squeeze and forget to unsqueeze
- Combine work on the Pelvic Floor with functional work on the pelvis as a whole: the hip extensor muscles (gluteals, hamstrings), pelvic alignment, inner thighs, front of the hips. This is particularly the case if your pelvic function has deteriorated with ageing rather than following childbirth. Postpartum problems generally involve trauma to the pelvic floor. With age and menopause then the problem is more about gradual weakening of the pelvic floor and possibly in the lower body muscles as a whole
- If you are really worried that you have been doing the right kind of rehab and it is not working, or your problems are getting worse not better, seek help from a Specialist Physio via the NHS or privately
Do you need Pilates for that lot?
One one level no, you don’t.
So why look to Pilates for help with your pelvic floor and incontinence issues?
I think there are plenty of reasons
The first is to do with the fact that the pelvic floor does not exist in isolation. It is very much seen in those terms though : a bit of the body that can be Kegeled into submission, or failing that, dealt with using Inco Pads and lifestyle limiting changes.
The pelvic floor is part of the Pelvis and the pelvis needs to be looked at as a whole and beyond that work on pelvic floor and the pelvis needs to be integrated with the whole body. This is where Pilates will deliver the goods: you will work on pelvic mobility, strength and flexibility in the muscles that cross the pelvis . Beyond that you will link the upper body and lower body, and work the full body and optimise overall alignment. That is enough in itself to sell Pilates on the basis of helping Pelvic Floor function.
So any old pilates class will do then?
Hmmm
Having a weakened pelvic floor and incontinence can be upsetting, embarrassing and difficult. You need to find a class that is holistic (that is, works the whole body), reasonably gentle and mind/body focussed. The class philosophy should be about full body mobility, and strength approached from the point of view of being kind to the body and respecting where it is, as well as where we’d like it to end up. There is little room for aesthetics in this kind of class and it ain’t no celebrity Ab workout
The following picture is what I got on Google Images by typing “women doing Pilates”
Please note the thin young women with bare midriffs doing complex, demanding Pilates exercises or posing prior to doing something. A class with this aesthetic or intensity is not going to help you gently and calmly address your pelvic floor issues. This is one face of Pilates but you need the other one: gentle, calm, rehab orientated and crucially, meeting you and your body where you actually are
In the second picture I am doing Side Lying Open Doors. Not very rock ‘n’ roll is it?
No glamour, no bare midriff and definitely no youth.
Welcome to the kind of exercise that awakens the body, banishes stiffness and promotes good alignment. Here is the kind of movement you want from a Pilates class.
What to look for in a Pilates class so that you will help your Pelvic Floor & improve your continence
- breathing focus
- inherently calm, gentle nature is a necessity if you are to be able to “spare a thought” for the PF as well as everything else.
- whole body workout which recognises the inter-relatedness of everything
- value of downtraining , letting go of muscles not just contract/clench/squeeze/grip
- working in multiple different positions
- promoting good alignment
- not too much abdominal work
The one thing that you may not get from a pilates class is specific work for the Pelvic Floor although some Teachers will incorporate Pelvic Floor strength some or all of the time. Over the years I have tried various different approaches and in the end have tended to omit PF strength training most of the time
Why?
It requires a great deal of time, maybe even one third of the class and really, to be effective, that needs to be over a period of weeks. The problem with that is, that many participants did not sign up to that. As a teacher I feel that I cannot devote the necessary time to Pelvic Floor, especially given that I am cueing intimate bits of the body and everyone needs to be comfortable with hearing and doing the exercises. So I drop it in periodically and leave it at that.
My Solution: dedicated Pelvic Floor Classes
I have spent years pondering how, in the context of a Pilates class, to improve continence, reduce incontinence and generally improve the strength of the Pelvic Floor. In the end I decided to do specialist classes which launch in September 2020. By necessity I’m using a virtual platform but it has special advantages. You can be in the privacy of your own home whilst doing intimate exercises, and you can pop to the toilet if needs be
Finally I have a class space where we can really look at these things:
- Locate and work Pelvic Floor properly. No more squeezing. Instead a more nuanced, deep dive into how these muscles can be made stronger AND relaxed
- To identify what isn’t Pelvic floor and consider the wider context of the Pelvis and look at stiffness there or in the hips or spine
- Often Pelvic Floor dysfunction is made worse by weakness in other muscles , for example the Gluteals, or tightness in others, for example the Piriformis so we can look at this
- Combine Pelvic floor work with activities of daily living. There is no point in only being able to engage the Pelvic Floor whilst you are sitting on the bus! It needs to be there for you when you are doing Zumba or laughing at someone’s joke
For more info on my specialist classes please click here
There is more of my musings on pelvic floors here
My primary focus so far has been with women. Women are at a disadvantage in that they may have had children and may have been through the menopause or are currently in the eye of that particular storm. However, men have all the other risk factors: age, abdominal/visceral fat, history of poorly executed weight training, history of breathing problems, and another one: surgery for enlarged Prostate or Prostate cancer. This can cause weakness too. So please do get in touch if you are man or know a man who needs these sessions. What I plan to do is run Men Only sessions, and Women Only Sessions.
Working in this field it is vital to have Manual therapists with whom I can liaise and send clients if I feel that they need more treatment. This is especially true if you have pelvic pain. My Physiotherapist of choice for women is Anna Crowle who is based near Hyde Park in Leeds. For more info about Anna please click here
To return to the original question: what do you need to help with your Pelvic Floor problems?
- To make the decision to do something lasting to help
- To know that you are not alone
- Realise that Inco pads are extremely useful, maybe even vital, but they shouldn’t be the only solution. We can do better than that!
- Be prepared to work on your body, once you have a clear idea of what Pelvic Floor strength work actually is. It is more than just squeeze, squeeze , squeeze
- To understand that that relaxing the pelvic floor is as important as contracting it
- To know that the Pelvic floor does not exist in isolation: it is part of the pelvis, and part of the integrated system that is the whole body. Regular exercise like Pilates will help the whole body and impact the pelvic floor really positively