Pelvic Floor Basics
Let’s Talk Pelvic Floor...
As a personal trainer, a fully qualified pre & post natal coach and a mother of two little rascals (I mean angels, two little angels), I’m here to confess that childbirth had a big impact on the strength of my pelvic floor so don’t be surprised or ashamed if you suffer / have suffered a similar fate.
After an episiotomy during my first labour and a second pregnancy not long after, I noticed that my pelvic floor muscles were left tired, weak and needed some work (as if us new mothers didn’t have enough on our plates already..)
Fortunately, through consistent exercise and strength training I have been able to regain and maintain the strength I had lost but it didn’t happen overnight.
Huge changes occur in the body during and after pregnancy and yet very few women know what to expect or what to consider normal postpartum.
With this in mind, I thought it could be a good idea to write a little about the pelvic floor and shed some light on an important issue that unfortunately often gets overlooked by mainstream media.
So what is it?
The Pelvic Floor is a group of muscles and connective tissue that sits inside the pelvis.
Most of us discuss it as being weak or strong, or the effects childbirth can have on it but let's look a little deeper at what the pelvic floor actually does, how best to keep it strong, and what to do when it needs some work.
What is its function?
The pelvic floor is used to constrict the urethra, vagina and anal canal. In other words it helps us to hold in our wees and poos. Imagine for a minute you're having a cuppa with your in-laws and suddenly need to pass some wind. Hold it in - that's your pelvic floor at work!
It provides support to all internal organs. If a woman has damage to the muscle or connective tissue (from birth, surgery, trauma or radiation) it can be difficult to maintain optimal support of the internal organs.
It is a part of the deep stabilizing system for the abs, lower back muscles, and the diaphragm. All of these muscles, including the pelvic floor, can become too weak and too tight so it is important that we get that balance right. (1)
What is the best way to look after my pelvic floor health?
The pelvic floor muscles are used in every movement we do and every breath we take - so by simply living we are exercising our pelvic floor muscles.
However, the only way muscles can maintain their strength (or get stronger) is through use, so being active is so important in having good pelvic floor function.
These days pelvic health physiotherapists are moving women away from focusing solely on isolation exercises (which you may know as ‘Kegels’) and encouraging all women to integrate functional training to help promote good movement and a strong body too.
That being said, there is still a lot of merit in doing Kegels, particularly if you have symptoms of a weakened pelvic floor.
So who should do Kegel exercises?
For symptomatic women, pelvic floor exercises can work very well.
Common symptoms include:
Incontinence - leaking urine when coughing, sneezing, laughing, jumping, running or exercise in general
Finding it hard to hold in urine (rushing to the toilet)
Lower back pain
Accidentally passing wind
Pelvic pain
Pain during sex
Kegels can also be performed on a daily basis by pregnant women to help maintain strength in their pelvic floor throughout their pregnancy as their baby grows. During pregnancy try doing three sets of eight repetitions twice per day and hold the contraction for around 6-10 seconds.
How to perform a Kegel
Sit up tall. Open your sit bones (by pulling your bum cheeks out to the side) and connect your perineum to the surface below you. Allow your spine to be long and draw your head up away from your hips.
Breath. Place one hand on your stomach and the other just above, either on your ribcage or chest. Breath the air through your nose and down into your stomach. Push your belly out against your hand as you inhale. Imagine you are filling both tummy and pelvis full of air. This is where our pelvic floor muscles fully let go and relax.
Now as you inhale, draw the stomach inward and the pelvic floor inwards and upwards and hold before your next big inhale and full relax of the pelvic floor. You should feel a sensation of the pelvis drawing upwards (some women can feel a bearing down feeling - but this not what you are looking for)
Repeat
If you find this breathwork difficult, find it hard to connect with the muscles in your pelvis or feel a bearing down sensation instead of an upwards one I would recommend visiting a pelvic floor specialist.
Beyond Kegels
As we have mentioned above Kegels are not the only answer…
In addition to becoming weak, the pelvic floor can also become too tight. And Kegals will not be the answer here! It is important that we use both the strengthening exercises (kegels) and the relaxing exercises (breathwork and active relaxation during the inhale discussed above).
We need to first release the pelvic floor muscles so that we can get balance across the pelvic floor. Only then can we strengthen in a way that optimises the performance of the pelvic floor. (2)
This is why the inhale (relax) phase of the breathwork is just as important as the exhale (kegel) phase. Muscles need to relax fully in order to then generate a strong contraction. Abdominal muscles, spinal stabilizing muscles, and pelvic floor muscles need to work perfectly together to create balance, which is why total body strength and functional training is so important. (3)
During vaginal delivery it is this relaxing portion that becomes really important as the baby transcends through the birth canal. Here the perineum needs to relax, soften and open up (not tense up) so practicing this portion of the breathwork during pregnancy is super beneficial!
For example, on my second labour, with so much more knowledge about this than my first, I had a totally natural delivery with no tears at all (with the practice of the correct breath work during pregnancy)
Causes of Pelvic Floor Dysfunction
There are many factors that can affect pelvic floor function from a young age such as genetics, nutrition and your sporting background.
Childbirth has a major impact on pelvic floor function due to the variations of injury/recovery after vaginal birth such as strength of the soft tissue, the size of the baby and interventions during labour such as forceps or episiotomy.
The aging process also plays a role as we go through menopause.
It is important to be curious about the health of our pelvic floor so that we can look after it and avoid any issues worsening over time.
The best thing we can do to nourish and protect our pelvic floor health is to (not have any kids - lol just kidding) stay active, do strength training, and look after our nutrition. If you are working with a trainer seek out one with a good education in the pre and post natal area.
9/10 women will either become pregnant, be pregnant or be postpartum. Becoming pregnant changes our bodies in so many ways and it is so important to be in the hands of professionals who fully understand these changes. If you are concerned about anything in this article and are worried / curious about the health of your own pelvic floor please reach out to a pelvic floor physiotherapist.
As always, I am also happy to help with any questions (within my scope of practice) you may have. Feel free to email me at katy@nikafitstudios.ie.
Katy
References
(1) Pre & Post Natal Coaching. Coaching and Training Women Acadamy
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