Pilates for pelvic floor health & healing; How can a mainstream class help?

The pelvic floor & Pilates: two things often mentioned in the same sentence.

Can you address difficulties with pelvic floor function in your Pilates class?

I often get asked this.

Or rather I get real world questions or statements that relate to the pelvic floor.

My doctor said do Pilates for my pelvic floor weakness.

I have heard Pilates is good for pelvic floors.  Will this class help me?

Can you help with my stress incontinence?

I have prolapse.  Will this class help me?

I have a weak core, that is why I’ve chosen Pilates.

I thought Pilates might be better for me because of my weak pelvic floor

Or someone will mention their pelvic floor and someone else will overhear and say “That’s me too!”

The short answer to these questions or statements of intent is:

Yes! A really well designed and taught Pilates class will help you with your pelvic floor issues.

Firstly a note on the word issues.   It is a bit meaningless but I like it as a catch all term.  I don’t want to simply say pelvic floor weakness because not all  “issues” are related to weakness.  Dysfunction sounds clinical and a bit ominous.  Issues, sort of captures the implications of “my pelvic floor used to be ok but these days it lets me down”.

What are your “issues”?

Although this is not a complete list, I often hear:

  • Following either a difficult birth or even a straightforward one, never returning to previous pelvic floor strength levels.
  • Pelvic floor problems with increasing age, especially for women entering the post menopause time of life.
  • Difficulty with urgency.
  • Leaking with coughing and sneezing.
  • Not being able to go running anymore.
  • My physio (or doctor) told me to do Kegel exercises but they didn’t work.
  • Or perhaps, My physio (or doctor) told me to do Kegel exercises and I never managed to find the time to do them.

Specialist pelvic floor Pilates classes.

Specialist pelvic floor Pilates classes are an excellent option and widely available,  mostly online.  The entire class is devoted to addressing a range of issues around dysfunction, pelvic pain and quite possibly pelvic organ prolapse.  All the class participants would be in the same boat, so to speak (if class is live).  There are no concerns about some things being unsuitable.   If you working online then you can remain in the comfort of your own space.

Why you might not opt for specialist pelvic floor Pilates?

To work other bits of you at the same time.

You may opt for a  mainstream class because it is more affordable, is ongoing and local.  Perhaps you want to go with a friend or family member.

It may not be possible to access a specialist class that is live with an instructor to coach and correct you in real time.

You might have mild symptoms that will be helped by a whole body approach which a mainstream class can deliver.

Urgency

Urgency is when you have an urgent need to pee despite, upon reaching the toilet, finding that your bladder  wasn’t full.  Urge incontinence is when you leak urine on the way to the toilet.

Urgency is a really big deal and there are loads of things you can do to help and intervene.  It is, in part, a behavioural matter though.  You need to retrain your nervous system, your behaviours, your habits.  For that reason it can’t really be tackled in a mainstream classes

Kegels vs Not Kegels

Some of you may not even realise that is a relevant question.  However in the pelvic floor world it is totally on trend.

Firstly,  a quick definition: Kegels are the commonly prescribed, commonly practiced pelvic floor strength exercise where you squeeze  and release the pelvic floor.

Some people really need Kegels and I take the view that they need to be prescribed by a specialist physiotherapist rather than them being the “go to” exercise of first choice.

I have written in more detail about topic of Kegels and you can read that here.

Many people find them to be an absolute life saver.  Love ’em or hate ’em, though, they are highly specific exercises.    One very important consideration with Kegels, is the time it takes to  correctly identify in our own body, where the pelvic floor is, what it feels like and how it feels to contract and relax it.  This must happen in order to teach Kegels properly.   It is eminently possible to do but, like urgency, needs a specialist approach not a mainstream class.

A quick note on pelvic floor tightness.

Too much tightness can lead to chronic pelvic pain, problems with sex, and lower back pain. Making your pelvic floor tighter will not necessarily heal dysfunction.  Nor will it necessarily solve urine leakage.  Beware assumptions regarding the benefits of tightness in any muscle and definitely in these ones.   This is why I prefer people to be prescribed Kegel/squeezing exercises following a consult with a specialist physio.  Kegel/squeezing the pelvic floor (assuming you are actually squeezing the correct muscles which is a whole other story) is intentionally to make the Pelvic floor tighter.   Not everyone needs this approach.

Pelvic Floor Strength

If you don’t get stronger by squeezing the pelvic floor, then what does make it stronger?

The pelvic floor muscles need to widen slightly as we move about because the pelvic bones and leg bones move.  At another point in time, the pelvic floor needs to widen to absorb the downward push of a sneeze or the opening of the pelvis when we squat or sit to stand / stand to sit.

This is the functional strength of the pelvic floor.  Can the muscles in your body, or any body, widen under the load of the activity or body weight or pressure change (think sneeze)?    The technical term for a muscle widening under load is Eccentric Loading.      I am getting myself tied up in knots trying to convey this quickly but in short, we need to get the pelvic floor moving /widening in all different ways.  You do that by moving the pelvis and the bits attached to it, most often, the legs.

Another quick note on NHS Waiting Lists

I sound as though we can all routinely expect to see a specialist physio at the drop of a hat.  That is not the world we now live in here in the UK . There are not even that many specialists operating in the private sector.  If you can’t be assessed by a specialist, consider a whole body approach initially,  or specialist Pilates.  If  you are going to do Kegels, ensure you are really doing your Kegels correctly.

Identifying and truly feeling where your Pelvic floor is

If your focus is primarily healing pelvic floor issues then an essential element to that is to learn to feel your  pelvic floor.  Some of you will be thinking “you can do that?”

Yes you can and it takes a bit of time and effort.  This can’t really  be done in a general class, simply because it takes too long.  Arguably it is good for everyone, but it isn’t what most people in a mainstream class signed up for, so to speak.

So if we can’t do this in a mainstream class, how on earth can you help the pelvic floor?  Because of this:

Pelvic floor issues are a whole pelvis issue; beyond that they are whole body issue.

The heading basically states concisely, why you can benefit from taking a mainstream class.

I can’t just leave you with a heading so here is a bit more detail!

Where and what is the pelvic floor?

The pelvic floor is a group of muscles that form the basis of the pelvis.  It is part of a constantly adapting, constantly moving cylinder of the deep core. The other elements of the deep core are the diaphragm at the top, deep abdominals at the front and spine stabilisers at the back.

gif showing the relationship of the diaphragm with the pelvic floor
This Gif illustrates the deep core cylinder really well

This cylinder and the pelvic floor has a range of activities and relationships with other muscles. Other muscles, other parts, other bones affect it.

With our paradigm of whole body influence,  consider that if the whole body is under moved and sedentary, so is the pelvic floor.  If the body and the pelvis is stiff, so is the pelvic floor.  If everything else is weak, so is the pelvic floor.   If there is clenching and gripping of the legs, bottom, abdominals, then the pelvic floor is most likely, unhappy.

The pelvis is the crossroads of the body transmitting the energy of the legs into the trunk and upper body.  It houses organs of reproduction, the bladder, the outlets for urine , faeces and of course babies and contains bits of our digestive system.   It is all in there!  It all communicates.  It all needs to move and it will in your class.

A few Pelvic Floor Pilates class specifics

The pelvic floor moves with every breath and getting your breathing as efficient as possible is the bedrock of healing pelvic floor problems.   I have talked about this recently on a YouTube clip and we definitely do breathwork in mainstream classes.

The muscles of the pelvic floor attach to the pelvic bones: move the bones to move the pelvic floor.  You will help to keep the pelvic floor happy by preventing stiffness in the pelvis.  Of course we can do that in a mainstream class.    To give an exercise example from a vast range of options of pelvic movements:  Glute Bridge (also known as Shoulder Bridge)

The pelvis, the pelvic floor, the whole body, the heart, and the brain all need us to move.   Oftentimes the body craves more movement  than we give  it on a day to day basis.  Movement beats being sedentary for the pelvic floor.  If I’m honest you don’t need  Pilates for that, but the regularity of your weekly class is helpful.

Bums, Legs & less Tums

The buttock muscles have a particular relationship with pelvic floor function.   They need to be strong.  Buttock strength is something we can do in a regular class. For example, via Squatting.    My introduction to the world beyond Kegels came via Katy Bowman who shot to fame after going public with her pro squat anti Kegel stance.  Squats are great for bodies, great for bottoms, great for pelvic floors.

Are you saying to the computer that you can’t manage squats, or they make urine leakage worse? Point taken.   Over to Katy Bowman here.  She outlines a range of excellent  modifications, and vital calf stretches, most of which I have used at one time or another in classes,  You can see the list with pictures here 

Talking of calf stretches…. what starts in the feet does not stay in the feet.   There is a profound relationship with foot health, mobility , strength and function and that of the pelvic floor and the entire deep core.  Who knew eh?   Yes we do foot work in regular classes!

And ‘tums?  In short, during class I’ll always remind you to avoid clenching or sucking your abdominal muscles and teach exercises to get the deep abdominal muscles to work synergistically with the pelvic floor.

Female pelvic floor as seen from underneath with its close relationship with the buttock muscles
The pelvic floor nestling around the buttock muscles and inner thighs

Alignment matters

The buttocks are at least near the pelvic floor so their close relationship feels reasonably  logical, once you point it out.  But the muscle relationships of the pelvic floor go beyond the pelvis.  Partly this is a muscles-are-all-connected thing and partly this is an alignment matter.  A pelvis stacked nicely underneath the ribs and  shoulders enables the the whole lot, pelvic floor included, to function better.   Do we look at alignment class? Of course we do.   It is almost the thing we do in class. Most people refer to that as posture, but in truth we mean alignment and more often than not that means getting the stiff bits stretched, widened, moving and stacked.

Most of us need to be less stiff and more supple.  This may not be a law of nature but it is a law for bodies living the UK especially as we age.    Our bodies, all bodies benefit from gentle, gradual movement for example spine rotation, pelvic clock, Cat exercise. or self massage using spiky balls or squishy balls and that ultimately benefits the  pelvic floor too.

Learning to let go

Just to complicate matters, our collective pelvic floors are affected  by our emotions and stress levels.  Many of us a muscle clenchers in times of stress.  For some it is the jaw, some the neck, some the stomach, others the pelvic floor.   That is is without even factoring in trauma which could be sexual, childbirth or injury related.

An unexpected value of Pilates for  pelvic floors is time taken to lie down on the mat, with the postural muscles inactive, with time to soften.  This can be in the form of an end of class relaxation but it doesn’t need to be.  Letting go is not necessarily easy but it is important and like all of these full body interventions in a mainstream class, it might be the very one that does you the most good.

Chose your class carefully

Ideally you need a small class taught by an experienced instructor.  We need to get away from a binary conversation of a weak vs strong core strength and exercises of gripping, engaging, or bracing.  Instead listen out for the more nuanced talk of the connectedness of breathing and pelvic floor, and talk that is beyond the core, so to speak, whole pelvis and whole body.

Beware the social media influencers bearing gifts and promises

Most likely also,  the siren call of the easy way out.

There is a lot of it about and don’t believe the hype.

There are supplements and gadgetry that purport to help us.  If you are advised by a trained professional to use some kind of device that is fine.  Otherwise, don’t rule them out but do consider them with a sceptical, cautious approach.

And supplements?  Heaven help us, because believe me, a pill from the wild west that it is the totally unregulated supplement industry certainly won’t.    Here is my last blog post on just that subject.

Conclusion

Like everything else in life, we are dealing in ideals here.

I have a 2.5 fingers wide abdominal separation (diastasis recti) and have learnt to manage the problem but have never healed it completely.  I use Pilates to prevent it getting in worse and sadly  it prevents me doing a lot of classic Pilates exercises.    I’m saying this because I want to call out that I might sound glib, making simplistic assumptions about healing our issues with a bit of regular exercise.  I know from personal experience that is not necessarily the case.    On the other hand,  every little really does help.

Gently, carefully, regularly.

 

 

 

 


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