How can I help my Pelvic floor? It isn’t as efficient as it used to be. Just squeezing doesn’t seem to work
I have the occasional accident, running is problematic, I prefer to know where the next toilet will be located.
It is a very familiar story and it has a knack of bothering us on quite a visceral, primal level. After all, most of us potty trained as young children and that should have been the end of it, right?
Knowing that your pelvic floor is not working can be really quite challenging because of the fear that your own body is not up to the task of meeting one, albeit big, physiological need.
What is my pelvic floor anyway? Where is it?
The Pelvic Floor is so much more than the thing that stops you peeing when you sneeze.
It is a hard working set of muscles that integrates into the pelvis and from there into the whole body. The whole body can help with solutions to Pelvic Floor difficulties
Read on and you can start with some of things absolutely straight away
Number One: Know that You are not alone
Know that you are not alone and it is not just an issue brought about by childbirth. Women who have not had children and men also encounter problems. PF difficulties can have multiple causes and you might have more than one risk factor: age, weight gain, menopause, inactivity, weak buttock muscles, certain medications, being less mobile and agile, lower back problems, constipation, diastasis recti, COPD (chronic obstructive pulmonary disease).
Feeling ruled by difficulties with the pelvic floor, leakage of urine, gas or faeces can be very isolating, despite it being commonplace, especially as we grow older. I don’t know for certain, but this may be particularly true for men. There is more expectation (however misguided) that women will have problems and it is talked about more as a female problem and is talked about amongst females. Whilst bladder leakage is talked about and admitted more openly in women, as a society we are still not facing up, talking about and treating gas/faecal leakage. It is not rare
Number Two: Get to know your bits
We know more about how our mobile phone works than our pelvic floor. It’s all just “down there” and we think we know, but….do we?
Feel for the bony bits on your pelvis: the join of the 2 pubic bones at the front and feel down your sacrum to your tail bone (coccyx) at the back. That takes a bit of rummaging but keep going downwards. The tail bone is the most important attachment site of your pelvic floor muscles but the pubic bone is important too
If you look at this picture, where the anus is labelled. That is the at the outside of the body, skin deep. The pelvic floor lies deeper/higher up
Here is the pelvic floor pictured from below so that you can see how it relates to the actual floor and to our legs. Here it looks “skin deep” but bare in mind that it is not.
This picture is a female PF. Look how much of the PF is relatively at the back, traveling up towards the buttock muscles. In this regard, all genders have a similar Pelvic Floor
The picture below is also a female pelvic floor. (I have really struggled to get clear pictures of the male pelvic floor. They exist, of course, but lack the lay person’s clarity and that is why I have not included one below)
The names are pretty off putting! The side right labels are the true pelvic floor. The bottom labels are the more skin deep muscle layer and the labels to the left are of muscles intimately connected to Pelvic Floor and can be considered the Pelvic Wall. Note that they attach onto the thigh bone. The also stabilise and move the legs.
Everything connects into everything else. Most connected to the Pelvic Floor are the buttocks, the external rotators of the hips, the inner thigh muscles, the deep abdominal muscles.
Number Three: Breathe Properly. What…to help my Pelvic Floor? Yes. Read on
This is both important and really liberating because it is something that we can set about and do fairly easily. It will not substitute for pelvic floor strength. It will enable the pelvic floor to function correctly on an ongoing basis. Every time we breathe in correctly, using the diaphragm, the pelvic floor relaxes, and it contracts with every out breath. Poor breathing: using the upper chest muscles and not the diaphragm, and breath holding disrupts the pelvic floor. Habitually sucking the belly in has the same effect because that also blocks natural breathing
Breathing is generally under valued and very important and I have written about this in another blog post: https://www.pilates-leeds.com/good-breathing-how-why-we-should-take-it-seriously/
Number Four: Watch your body alignment when you sit down
It doesn’t have to be perfect all the time, and in some ways, fidgeting is good: keeping moving about
At least some of the time: aim to sit tall, one your sitting bones, as per the picture. This way the bones carry the body weight from the spine, out into the pelvis and down the legs to the floor
When we round/slump a little into a chair, body weight is on top of that pelvic floor, bearing down upon it.
Every so often sit up on those bones and give the Pelvic floor a rest from the weight. It is not a rest as such. The pelvic floor is still the floor of the pelvis , it is still moving with the breath and doing lots of other stuff, but it hasn’t got a heavy weight pressing down upon it.
If you have been diagnosed with a hypertonic PF having a bit of a slump might be quite useful. Nothing is ever black and white alas
Number Five: Move More
All leg movements involve the pelvis. All spine movements involve the sacrum and coccyx. Everything is connected to everything else. The pelvic floor moves when you move
This is supposed to happen, and constantly on a daily basis. This is of profound importance and inactivity is a driver of pelvic floor problems and before long, our sedentary lifestyles will be the number one risk factor for problems
Gentle movement is good for the pelvic floor. There is no need to add impact: running etc, which can be very challenging if you have bladder leakage
Inactivity is the enemy of the pelvic floor as it is the enemy of most body systems. Many of us have to sit to commute or work, but if possible, break up those periods of sitting , even if it is just standing up or walking across the room
Here is Katy Bowman who is famous for advocating movement instead of a sedentary life talking about the benefits of walking to help the pelvic floor https://www.nutritiousmovement.com/4-fast-fixes-for-pelvic-floor-disorder/
Number Six: Squat more
This is number five but turbo charged.
The pelvic floor is part of the pelvis and the pelvis moves when you move. Have you heard that somewhere before? Well, the pelvis moves even more when you squat and this pulls the pelvic floor wider and stretches it under load. It returns to resting state as you squat back up and de-stretches, also under load (of body weight). Not only that but they strengthen the buttock muscles which help to keep the pelvis is an optimised position, which in turn enables the pelvic floor to be in an optimised position.
However they are not for everyone and can cause leakage in some, making them distinctly off putting and a bit scary. Modified squat: sit to stand from a chair.
I have included here a couple of YouTube clips of mine demonstrating squatting and then modified squatting
Modifications: https://youtu.be/95u9wwEyPpM
Number Seven: Still sitting? Do seated pelvic tilts
Cast your mind back to the beginning of the post! A vital attachment of the pelvic floor is the tail bone. If you move the tail bone then you move Pelvic Floor and you can exploit that in a pelvic tilt exercise. When you do this exercise the tail bone tucks under, moving nearer to the pubic bone and then tucks outwards, moving away from the pubic bone. In consequence you contract /relax pelvic floor
Even better, do that whilst sitting on 2 spiky balls which lift the pelvis and give you more room for manoeuvre. Be warned though… not super spiky balls. Instead “soft” spiky. If you have none, you could just used a couple of facecloths
Number Eight: Try to do more gentle, dynamic movement
Think of this as an upgrade from walking
Consider anything where you carefully move your limbs, your trunk in lots of different directions and planes of movement (as opposed to the repetitive front to back movement of walking)
Pilates is wonderful. So is Yoga, Tai Chi or Barre
Keep you moving to keep your pelvic floor contracting and relaxing as the body pelvis, the trunk and the legs move.
Number Nine: If you Practice Kegel Contractions, make sure you do them properly and use the correct muscles
Kegels are the name given to the exercise that is specific, isolated contraction / relaxation of the pelvic floor
Without correct and careful training it is easy to end up squeezing the inner thighs, the back passage muscle, the buttocks or the stomach.
Without correct and careful training it is easy to just squeeze and, well just that. There is more to Kegels then squeezing
YOU MUST SQUEEZE THE CORRECT MUSCLES IN THE FIRST PLACE AND YOU MUST UNSQUEEZE THEM AFTERWARDS
I am not given to shouty block capitals this is the only time I’ve done it in this blog post, because this is really important
They are subtle and need a degree of concentration to do them well
If Kegels aren’t working then that is a good time to review technique. If you are doing loads, perhaps it is too many? The NHS guidelines are 3 sets of 10 a day and quality is far more important than quantity
There are a lot of exercises you can do that will help tone up Pelvic Floor (for example squatting) so it might be worth considering them. I have talked about the world beyond Kegels in another blog post https://www.pilates-leeds.com/the-kegels-debate-heres-my-view-what-do-you-think/
In addition you might want to consider my specialist Pelvic Floor Restore sessions (a set of 5 sessions online or 1:1 in person). We look at Kegels and more. For more details click here
Number Ten: Assess the problem with your pelvic floor weakness. Urgency vs Urge incontinence vs Stress incontinence, or is it Faecal?
Whilst faecal incontinence is less common it is an issue in its own right and treated with Kegel exercises. Other things apart from a weak pelvic floor can cause faecal incontinence though, so it is important to talk to your GP first about this. One of the most common is actually constipation
Frequency (aka Urgency) is where you have a sudden overwhelming urge to pass urine, despite having visited the toilet recently or not having a full bladder. Urge Incontinence is where you leak urine on the way to the toilet as a consequence of Urgency. Yes the vocabulary is awkward. They are both problematic, very connected but only one involves actual leakage. That being said, it may be that Frequency is the greater problem.
Stress Incontinence (SI) is where pressure change in the body cavity causes a bearing down on the pelvic floor which is not strong enough to withstand it. The result is leakage of urine, possibly if you cough, sneeze, jump, run or even stand up or walk down a hill.
Urgency/Frequency is not caused by weakness in the pelvic floor. It is a neurological issue which requires a different approach to simply doing Kegels. This is important. Kegels are in the mix, especially if the Urgency causes Urge Incontinence, but if you have Urgency you need to think outside the Kegel’s Box too.
Quite a lot of people have a mixed picture of Urgency and SI and need a combined approach and this is when having a qualified practitioner to help you can be very useful indeed
Number Eleven: If you have constipation, do everything you can to treat it
Constipation causes Stress Incontinence. The full rectum presses on the bladder and causes leakage of urine. Chronic constipation is no joke and there is not necessarily an easy fix but you must attempt a fix, and this may require medication. Nothing extreme – over the counter preps will do. It is a question of finding the right one for you, plus considering some other small lifestyle changes. I cover this in my course because it is so important to address it.
Number Twelve: There may be some related issues that need a referral to a doctor or physiotherapist
Sometimes there is other stuff going on “down there” which you might consider part and parcel of pelvic floor issues. However, whilst related, some things may be different and warrants a trip to a health care practitioner. It can be hard to face up to a mixed picture of difficulties which you basically want to just go away.
This is not an exhaustive list but consider
- pelvic pain, during sex, after sex or not related to sex at all; inside the body or skin deep
- itching and inflammation in the vagina
- burning sensation when you pass urine
- blood in the urine (or stool)
- a sense of fullness in the vagina
- numbness in the area of your sacrum/bottom where you sit, or numbness when you wipe your bottom.
- repeated bladder infections
Conclusion
It takes a village to raise a child
This is a proverb of unknown provenance and belongs to several different African cultures
Well I would like to repurpose it
It takes a whole body to maintain and nourish a pelvic floor.
On the one hand you might think
“great, well, I’ll start to tackle those other things because they are a good idea anyway”.
On the other hand you might think
“well its game over then, because I’m unfit, don’t do much exercise or walking and sit a desk all day. The kids want me to cook tea, the bins need sorting and I have to pay the car tax”
This is where things need chunking down to more manageable goals or options. So if the idea of 12 things just prompted an overwhelm, and you would have preferred one thing, then it is this. Start with the breathing
If I locate the presence of the bin emptying fairy I will let you know
