Women’s pelvic health is a subject that is starting to become more talked about, but it’s still much more taboo than it should be especially when most studies report that 25-45% of women experience or have experienced urinary incontinence.
Regardless of the complaint she may have, as soon as someone brings up the fact that they’re dealing with some leakage, heaviness, or pain in their pelvic area, the most common advice they’re given is to “do more kegals”. The solution is often more complex than that and “doing more kegals” may, in some cases, make your issues worse.
First off, kegals are not the answer to every pelvic health concern, oftentimes the issue is that the muscles are too tight, and continually trying to contract them won’t be an effective strategy! Second, the majority of women perform these exercises incorrectly, which can be frustratingly ineffective at best, and sometimes increases the pressure on the pelvic floor which can make the issues even worse! If you are dealing with any of these concerns, I highly suggest you look up a pelvic health specialist in your area to get an individualized assessment and treatment plan. However, one exercise that everyone with a pelvic floor can benefit from, is the “CORE breath”, which focuses on a proper isolated pelvic floor contraction, as well as a full relaxation.
When people think of their “core” most people think about the classic 6pack muscle down the front of the abdomen, but we want to focus on the deep muscles of the core that lay below those more visible muscles. The deep core is more accurately described as four muscles that make a canister of the abdomen, The Multifidus (MF) muscles along the back, the Transverse Abdominus (TA) that wraps around from the back to the front, the pelvic floor muscles on the bottom, and the diagphram muscle on the top. In an ideal situation, these muscles work together and create a piston of sorts, where as your diaphragm lowers to draw in breath, your pelvic floor eccentrically lowers, and as you breath out and the diaphragm rises, the pelvic floor lifts up towards the head. There is a long list of reasons why this can get out of sync, including pelvic pain, abdominal surgery, natural changes that occur throughout pregnancy and following child birth. Even increases in stress leads to a tendency for people to breath shallowly (more up through their shoulders) and if that persists over time, that can lead to things getting out of sync, and even sometimes to pelvic floor muscles sitting in a tighter state because they aren’t going through their normal range of motion for a length of time.
To perform the core breath you want to think about inhaling to expand, and exhaling to engage.
As you inhale, you want to focus on getting a full belly breath where you can see your stomach lift and expand with the depth of the breath. As you do this, bring awareness to your pelvic floor and try to fully relax these muscles as you breathe deep to the bottom of your stomach. [The breathing diaphragm moves down as you breathe in and up as you breathe out and the pelvic floor works in synergy with the diaphragm so it also descends (expands) as you breathe in and lifts (contracts) as you breathe out.]
As your breathe out, purse your lips and blow as if you are gently blowing out birthday candles while gently contracting your pelvic floor muscles. A proper pelvic floor contraction uses only the pelvic floor muscles so bring awareness to your glutes, inner thighs and abdominal muscles and try to keep these areas relaxed. If you struggle to feel your pelvic floor contraction, try thinking of the muscles you use to stop the stream of urine, or the muscles you would use to pick up a marble with the pelvic floor. (More cues in the videos!)
Relaxing the pelvic floor on inhale and contracting on exhale may feel a little counter intuitive at first, but with a little practice it will feel more natural!
Women’s health matters and pelvic health is an essential part of women’s health. If I could wave a magic wand I would grant access for every woman to see a pelvic health PT regardless of their situation at 6 weeks post partum, but for anyone experiencing pelvic pain, prolapse at any stage of life – these are all very common experiences but you do not have to live with it – the sooner you deal with it, the better results we have. Everyone has a pelvic floor and pelvic health is an essential part of overall health so if you’re struggling with any of these issues we’ve touched on or just want more information, please reach out to a pelvic floor physiotherapist!
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