Today, I thought I’d share answers to the 5 top frequently asked questions I’m often asked about the pelvic floor, so here goes:
1. SHOULD I PERFORM “SQUEEZE AND RELEASE” EXERCISES TO MY PELVIC FLOOR?
Yes and no.
It depends if you’re pregnant, postnatal and/or have issues in your pelvic floor muscles right now.
I’m not a big advocate for “squeezing and releasing” and/or “drawing up and holding” pelvic floor type movements, hence the reason I don’t teach them in my classes.
That’s not to say there’s not a place for them for some people, and certainly if you have zero signal or control over your bladder/bowel, then it’s at this point you’d be well advised to perform them (under the guidance of a Women’s Health Physiotherapist or similar).
In a lot of instances of where clients come to see me with sneeze wee, or that feeling of urgency to use the toilet at time throughout the day, it’s often a case of the pelvic floor being too tight.
In a word, no.
According to various studies, roughly a third of postnatal women suffer with some form of pelvic floor problem post-birth, but in my experience, I believe this figure to be much higher.
Put it this way, there are a lot of women suffering in silence with “sensitive bladder” issues as it’s now commonly termed (annoyingly coined, shall I add, as though it’s a perfectly normal issue for women to suffer with).
Don’t get me started on those “whoops moments” adverts – they drive me nuts and the actor portrayed is actually quite young.
Wetting (or indeed pooing) yourself whilst going about your day-to-day activities is NOT normal, alrighty?
Why do I have you perform this exercise so frequently with you?
Well, it’s for the health of your pelvic floor.
You probably weren’t expecting that to be my answer, were you?!
Apologies if you’re eating right now… Maybe pop that food down, ok?
I don’t actually prescribe Kegels very often to my pre/postnatal clients, and haven’t done for 3+ years.
Your feet have 26 bones, 33 joints and hundreds of muscles.
They’re your platform and serve you well most of the time (if you treat them fairly back, obviously).
The vast majority of people are born with the ability to stand and walk with their feet pointing straight ahead.
Your baby/children’s feet will also be parallel.
What’s up with your feet?
What do YOUR feet look like?
I once met a client who came to my postnatal Pilates classes who had all 3 of these things:
I’ve rehabilitated and lessened the symptoms all of these 3 issues in a lot of women (and men) over the past few years.
They’re all linked.
Let me explain a little further:
TOO MUCH PRESSURE
The human body has 3 cavities:
1) thoracic (chest and ribcage area)
If you have too much pressure building up in one of those cavities, there are 3 ways of that pressure is going places once it’s reached the pressure cooker stage:
When it comes to training the pelvic floor muscles during pregnancy and after birth, I’m here to tell you, as a trained Ante/Postnatal Fitness Expert who keeps her education and skills fresh and up-to-date, things in recent years have most definitely changed.
Strengthening your pelvic floor muscles for postnatal women should be of paramount importance.
No news there.
Keeping your pelvic floor muscles in check during pregnancy is vital too.
Again, no surprises.
Stress incontinence (that’s where you when you laugh, cough, sneeze or do exercise and a bit of wee or poo comes out too), is quite common with 30% of new mums suffering with the condition for up to 3 months after birth.
I personally believe this figure is more like 50-60% though and because it’s such a taboo subject, there are a lot of women out there suffering in silence.
When it comes to alignment during pregnancy, you may not realise, but the way that you stand, sit and even walk, all have a direct influence on your body and your baby.
Having a pelvis that’s in its optimal position will make childbirth a lot easier. No surprise there.
A toddler doesn’t just learn to walk all of a sudden – it observes how YOU move and mimics your movements.
So, how you hold yourself and go about your day, will affect your toddlers’ gait too.
A baby’s ability to move from a breech position into the head down position, ready for labour, will be determined by a number of factors, but the main one is whether your deep hip flexor muscles are flexible enough for him/her to make manoeuvre. Interesting, huh?
I’ll go into the first point in more detail for you now, and cover the other two topics in a future blog post, ok?
If I’ve whet your appetite about how your posture, pelvic floor and your ability to give birth are all linked to posture, then keep reading:
SPACE IN AND THE SHAPE OF YOUR PELVIS
Without going into too much detail, put simply, if you sit down a lot, and have done for the majority of your day for the past how ever many years, your pelvic floor muscles might end up in a ‘tightened’ state. This is not really good news when you’re trying to push a baby out through your privates, now is it?
When we sit down in a relaxed state it’s often done so with a tucked under tailbone. Check out your posture now if you’re reading this in seated. Are you sitting on the edge of the chair with your tailbone out and your legs uncrossed, or are you sat with your back against the backrest, molding yourself to the chair, Homer Simpson, style?
If it’s the latter and you’ve done a lot of it before becoming pregnant, chances are the space between your pubic bone and your tailbone has actually got shorter. Why does that matter? Well, it kind of does, if you’re about to push a baby out through it, doesn’t it?
The pelvic floor shouldn’t be tight – it should be flexible, and when it comes to pregnancy in particular, it’s your pelvic floor that needs to have enough ‘give’ in it, to facilitate childbirth to physically get baby out through the birth canal.
If you visualise your pelvis looking downwards, the shape of the bowl or outlet of the pelvis should be somewhat circular. If your pelvic floor muscles are tight, it means you’ve changed the shape of your pelvis, and I know I’d much rather push a baby out through a circular outlet, than try and do so from a flat oval shaped one.
Getting some flexibility back into your pelvic floor muscles isn’t unachievable. It’ll just require a lot of squats, exercises to help strengthen the glutes to pull your tailbone back from out of the pelvis and a lot less sitting.
When you do sit, here’s how you should be positioned:
- bum towards the edge of the chair,
- feet flat,
- knees hip distance or a little wider to accommodate bump,
- hip bones forwards (meaning you might need to stick you butt out a bit to get the hip bones on top of the pubic bone),
- rib cage down, and
- chin in.
For some simple, effective exercises you can do which will get you thinking about your posture at work, rest and play, click here for a downloadable worksheet of movements you can do to help re-align your body and prepare you better for labour.
Certain muscle groups deserve extra consideration and attention when it comes to exercise for new mums.
It’s no surprise that your pelvic floor gets affected during pregnancy: a) due to the weight of your developing fetus placing pressure on these muscles, and also b) during labour and childbirth itself. Even if you delivered your baby via c-section, it still doesn’t give you a “get out of jail free card” when it comes to exercising and your pelvic floor, as some of you might think.
Roughly 1 in 3 postnatal women suffer with some of stress incontinence after birth. That’s where you wee or poo yourself when you laugh, cough, sneeze or lift a heavy load. Pregnant women who were induced and delivered their baby via c-section will still have gone through the stages of labour, and have effectively carried their developing baby for 9 months, so the pelvic floor can still be affected.
Exercising after birth is high on a lot of new mums’ agendas, but, it’s important that you do so with caution and care. I’d describe a postnatal woman’s exercise program as “working from the inside out”, starting with the pelvic floor muscles, which essentially form your foundation of support for all activity and exercise.
Your pelvic floor will have been stretched under the load of your growing baby for 9 months whilst you were pregnant, so it’s essential that every new mum puts her pelvic floor first. Returning to high-impact or intense exercise at this stage is not suitable, for a number of reasons.
Immediately after birth, your pelvic floor is compromised. This places you at a higher risk of not only incontinence, but also pelvic organ prolapse and back pain. These facts are even more true if you had:
2) a difficult delivery,
3) a large baby, or
4) if this is not your first baby.
The positive thing to bear in mind though is, there are plenty of things you can do to regain your pelvic floor after birth. All of the exercises you perform in my postnatal fitness and/or Pilates classes are suitable for you to do and have been designed with specific considerations towards your pelvic floor.
If your pelvic floor isn’t strong, chances are, you’ll wee yourself or feel a heavy/weak sensation in this area the first time you perform intense exercise, and ultimately, you’ll end up doing yourself some everlasting damage. This is not an attractive look, or indeed a sensible idea. Oh, and if you’re having to wear, or even contemplating wearing an incontinence pad to do exercise or perform tasks like lifting baby up, then ladies: “Houston, we have a problem!”.
Here’s a checklist that every new mum must pass first, before she even thinks about returning to high-impact exercise/perform intense tasks. Ready? Ok, so you need to make sure:
b) you’ve done a couple of months’ worth of work on pelvic stabilisation exercise eg Pilates to ensure your pelvic floor, core and abdominals are in a supportive state,
c) you’re returning to an activity you were doing prior to getting pregnant ie don’t go running if you’ve never run before,
d) you’ve invested in a good sports bra to support your breasts whilst you’re exercising, AND,
e) you’re wearing new, shiny, well-fitting trainers to support your joints, because often the biomechanics of your pelvis, knees and feet have changed to accommodate your baby bump during pregnancy.
And there you have it. My top tips for returning to exercise after birth, with specific consideration to your pelvic floor. If you have any questions relating to this issue, do get in touch. I’m more than happy to help, as you know.
For some women, pelvic floor dysfunction may be no more than a slight nuisance, whereas for others, it can really affect your quality of life.
Simple pelvic floor function is taken for granted. We use our pelvic floor muscles to go to the toilet, they protect us from urinating/defecating when we laugh, cough or sneeze and they help us hold everything in place when we do exercise, lift objects and move about.
Imagine what life would be life if these simple functions were taken away from us, and we weren’t able to go about our day-to-day lives without them having an impact on us?
Below, I’ve listed some problems people experience when they have a problem (however minor) in their pelvic floor muscles:
- Isolation / fear of venturing out / missing social engagements / travel opportunities
- Restricted activity / no exercise
- Frequent trips to the loo
- Disturbed sleep / fatigue
- Poor sexual function
- Chronic pelvic pain
- Depression / anxiety / stress / trauma / fear
- Financial expense of purchasing incontinence products
It’s vital that if you have any pelvic floor problems, however slight, that you speak to a Medical Professional about a) getting a proper diagnosis, and b) receiving treatment to help fix it.
There are many ways of treating dysfunctions in the pelvic floor muscles, and one thing’s for certain, although childbirth and pregnancy can attribute to problems ‘down below’, it’s important that you seek advice sooner, rather than later.
In more cases than not, surgery is the last option offered. Often, it’s just poor muscle tone, issues with posture/breathing, and awareness of the muscles that needs to be addressed.
If you feel that now is the time to start focusing on fixing your pelvic floor problems, follow my step-by-step guide here which will help you locate your pelvic floor muscles and get you a flat tummy in the process.
Who doesn’t want that?!
Life is much better with a flexible pelvic floor.
Unfortunately, we’re harnessing a generation of ‘pelvic tuckers’ due to the sedentary lifestyles we now lead and I’m seeing more and more pregnant (and postnatal women) showing signs of this.
When you sit on your sacrum all day, every day at work, rest and play, for hours on end, you’re likely to have a tight pelvic floor and weakened gluteals (butt) muscles.
Have a look at the diagram here. See where your coccyx is? Now have a think about the position you’re in for most the day. It’s in seated, isn’t it?
When you’re sat down, your tailbone is tucked under, creating less space between the sacrum at the back and the pubic bone at the front. This constant positioning shortens the distance between your sacrum and the pubic bone, which in turn, tightens your pelvic floor muscles.
There’s no easy way to say this, but if you’re pregnant, it’s going to be a lot easier to push baby out if you have a flexible set of pelvic floor muscles, rather than a tight set.
Now have a look at the diagram again and tell me if the person pictured has a strong set of gluteal (butt) muscles? They do, don’t they? They’re nice and purt, and there’s a noticeable natural curve in their lower back.
Any new mums reading this? Do you have pelvic floor dysfunction ie do you wee yourself on movement or when you laugh/cough/sneeze etc? Do you have no bum and no natural curve in your lower back? Yep? Well, these are surefire signs there’s something wrong with your pelvic floor muscles.
Solution: Do squats, and lots of them. They’ll help: a) strengthen the gluteals and b) stretch out your tightened pelvic floor muscles.
For an instant downloadable worksheet which will work your pelvic floor safely during pregnancy click here.
If you’re a new mum reading this and you want to fix your pelvic floor dysfunction, click here.