Secrets about 'core' strength that your pelvic floor knows
Your ‘core’ is made up of 4 muscles, the: diaphragm, transverse abdominis, multifidus, and… THE PELVIC FLOOR. Without proper pelvic floor function, any ‘core’ workout can very well be considered ineffective, provided you desire to get the most out of your workout and have your body to function as it's supposed to. These muscles work together to stabilize your spine, generate power, force, adaptability and efficiency of movement.
Most of us know how to work the larger, more superficial muscles like the rectus abdominis (the 'six pack'), the glutes, and the erector spinae (the muscles that run along both sides of your spine), but many people have faulty breathing patterns, which affect the function of your diaphragm and pelvic floor. On top of that, if we are not utilizing the smaller, stabilizing muscles within our torso like the transverse abdominis (deeper abdominal muscles that wrap around your waist like a corset) and multifidus (helps to stabilize and articulate your spine and maintain space between joints), we are limiting the results that we are working so hard to achieve. So, the secret of true strength and resilience of your 'core' lies largely within your pelvic floor.
In an upcoming article, I will share information specifically related to exercises for 'core' strength that are applicable for everyone, especially for women who've had children or who are pregnant and recently postpartum. Planks, crunches and sit ups will NOT be on the list(!!!), and I'll explain why. This article, however, is dedicated to the subtleties and functions of the pelvic floor.
The pelvic floor is the hammock-like structure consisting of muscles, ligaments, and connective tissue that sit within your pelvis. It provides support to your organs, controls bladder and bowel function, sexual health, contributes to your ‘core’ function, etc. It is also affected by other markers of health like quality of sleep and stress. For most of your life, we hope that this muscle group acts much like your lungs; they just do what they’re supposed to do, but there are plenty of times within a person’s life that this is not the case. It's those times that you either need or could benefit from a pelvic floor physical therapist to help get things functioning as they should.
Although pregnancy, childbirth and growing older increase your chances of experiencing pelvic floor dysfunction, you do not have to be pregnant, post-partum, in ‘old age’ or even be female for it to occur. There are many reasons that contribute to the multitude of disorders within the PF. The muscles can be too tight, weak, lax ligaments, or there can be musculoskeletal imbalances of the joints in the pelvis (sacroiliac, lower back, coccyx, hip joints).
Symptoms of urinary urgency, bladder control, constipation, pain or pressure, straining during bowel movements, pain during intercourse, nerve pain, and pelvic organ prolapse are just some of the types of pelvic floor dysfunction (PFD). You could also be relatively asymptomatic or be taking the ‘oh, that’s normal’ comment too seriously and decide that there’s nothing you can do, or that it would be too embarrassing to talk about, or too much of a hassle to find a good provider. Please don’t let these experiences keep you from living a pain free – or – pleasure filled life!!!
A pelvic floor PT is the expert that can help you with all of the symptoms above, and any others that relate to the pelvic girdle (joints, ligaments and muscles of the hips, low back, etc). So, if you have low back pain and you've had a baby, you should seriously consider seeing a pelvic floor PT and potentially a chiropractor (more on this in an upcoming article!). They can help you (link below in resources section).
There is so much complexity within the PF and pelvic girdle, that conversations on these topics with other medical professionals or personal trainer’s can go down a rabbit hole of treating a symptom, but not the root cause of whatever it is you're experiencing - or - it could simply be outside their area of expertise and awareness. If these providers do not have a good referral system, have some level of shame around the topic, etc, etc, etc, they could be hesitant to engage or ask questions and miss an opportunity to refer you to a pelvic floor PT. Trust yourself when you pause and consider whether or not you think your symptoms are ‘normal' and whether or not you would like things to be better.
Pelvic floor health in the U.S. is – frighteningly underutilized. 1 in 4 women have symptoms (regardless of whether or not they've had children), and as we continue to live longer, and the longer we go untreated, the more this statistic will continue to go up. The industry is projecting the statistics will go up from 25% now to 50% in the next 30 years! Every day, people experience issues that reduce their quality of life, but because there’s both a major lack of awareness and unnecessary amounts of shame around the topic, people end up suffering instead. Sometimes, a new mom in the U.S. can be made to feel like these symptoms are just another sick badge of honor that you earn in the #blessed life of motherhood. Uhhh, no thank you.
In many places in the world, pelvic health is treated from a preventative approach. In France for example, the government PAYS for and schedules pelvic floor re-education as a routine part of treatment for pregnant and post-natal patients. (Stories below in resources). At the very least, we should strive to be like countries that share a similar perspective on pelvic health, where there are multiple entry points for both patients and providers to move toward improvement and resolution.
So, do you know how to isolate, engage or lift and release your pelvic floor? Well, I thought I did... I thought I had a pretty healthy grasp on pelvic floor function and motor control until I saw a pelvic floor physical therapist. Then I realized how subtle and complex PF control really is.
The primary reason I went to a pelvic floor PT was because I was having some ahem, leaking, when I sneezed. Not. Cute. Full disclosure: there were maybe a few times in the year before pregnancy, that I had experienced this, but after the first few months of pregnancy, it was becoming almost constant. Even if I paused to cue my PF muscles prior to a sneeze, there were plenty of times that I still wasn’t successful. Ugh.
At this point, I was barely into my second trimester of pregnancy. I wasn’t even close to third trimester where the relaxin hormone is in full force, softening tissues to prepare for childbirth, nor was I near the part of pregnancy where I have 20+ pounds of extra pressure on my pelvic floor. I wasn’t willing to accept the whole ‘it’s normal, it will go away’ thing.
Since I’ve spent much of my life educating myself on body mechanics and physical health, I like to think that I am strong and physically conscious, but the glorious experience of pregnancy has a very humbling way of stripping away what you think you can control, little by little. I was frustrated and concerned that without addressing the issue, things would likely only get worse.
I had recently finished a pre and post-natal coaching certification, with a ton of education around pelvic floor function, so I was excited to learn more from a pelvic floor PT as a patient. I knew that if I didn't utilize the guidance from a professional, I could incorrectly self-diagnose, waste my time, and/or potentially make things worse. I used a pelvic health provider search tool, asked my midwife for a referral, and have been seeing a PT at Baylor in Dallas every week since. My initial symptoms were related to urinary urgency and stress incontinence, but as I progressed further into my pregnancy, I have also been treated for sacroiliac and pubic symphysis joint pain. I will speak more about the joint pain and appropriate exercises in an upcoming article.
From here, I will continue seeing my pelvic floor PT and my treatment will change as I progress toward full-term, for things like ideal body positioning and other preparations that can help with childbirth. After birth, I will be one of the lucky women in the U.S. who have a pelvic floor assessment and appropriate treatment after birth. I say lucky, because in the U.S., this is surprisingly not routine. Most women just see their OBGYN or midwife as a follow up and maybe they ask a question or two about how things are going down there, but they aren't necessarily checking your pelvic floor function - and whatever they do won't be done on the same level at which a pelvic floor PT can assess things. It's a completely different practice and area of expertise.
You can think of your pelvic floor like a trampoline. It needs to have just the right amount of ‘give’ both in the springs and the fabric of the trampoline for things to work just right. If you load up a trampoline with heavy rocks and then try to bounce anything on it, it's gonna be all sorts of a hot mess. Consider then, that during pregnancy, when a woman is completely at rest, there is a massive amount of additional load placed on the PF for prolonged periods of time. Yes, that load does accumulate over time with the growth of the baby, and yes, your body in theory can adjust to it, but it doesn't always work that way. Toss in anything that increases intraabdominal pressure: a sneeze, a ‘light’ jog, and you are a hop, skip and a jump away from multiplying that pressure to a percentage that’s hard to fathom. Fun times!!!
Speaking of trampolines... I won't ever get a chance to be a trampolinist in a Cirque du Soleil show, but I am certainly not giving up any trampoline time or any other activity just because I've gone through childbirth. Jumping on a trampoline is an example of an activity that increases pelvic floor pressure immensely. So, I'm passing on trampoline time for now, but know that I won't have to in the future thanks to prioritizing pelvic floor health.
On the topic of pelvic floor health, a lot of people say, ‘oh just do some kegels’, but that is NOT a helpful generalization. Doing kegels without a proper diagnosis and evaluation of motor control within the entire PF would be like just going to the gym but doing exercises that aren't appropriate to progress you toward your goals, or doing a whole bunch of shitty reps in any sort of exercise without any understanding of it's purpose or attention to form. Kegels can exacerbate issues if say, you have a hypertonic (too tight) pelvic floor - which is actually quite common - or dysfunction in part of your pelvic floor. Even if kegels are appropriate, if you have any sort of imbalance (most people do), you’re just working backwards by re-patterning poor motor function, and delaying or potentially eliminating your chances at progress or resolution. The same thing goes for the muscles of the core and pelvis...
Part of my PT treatment includes education and assessment of the 4 quadrants of the pelvic floor on both the primary and secondary layer of muscles within the PF. The muscles here should all work equally and together, and have a balance of both strength and flexibility - but often times, parts of each quadrant are tight, or have a faulty connection when firing. Variations on kegels that were specific to my needs were prescribed; lifting and releasing on inhales, exhales, sustained holds or releases while breathing normally for endurance vs. quick lifts/releases for rapid fire/fast-twitch muscle fibers that come into play during things like a cough, sneeze, or jump. If you are open to a holistic view, Tami Lynn Kent's book 'Wild Feminine' provides some good information to educate yourself on this topic, as well as establishing a better creative flow in your life (link below).
In my PT sessions, we also focus a lot on proper transverse abdominis recruitment and pelvic floor activation in multiple scenarios, which of course are things I thought I already had a mastery of, but there was room for me to work on the subtleties of isolation and 'tension to task'. Sometimes after we spend some time in the gym, I get an free massage for tightness in my lower back, hips or thighs! I'll take it. There are days where I leave with kinesiotape on my abdomen to relieve some pressure from the baby off of my pelvis and PF. We've talked about recommendations on a maternity belt, to help stabilize my pelvis and relieve the pressure when my stomach is even bigger. There is also plenty of talk and tips on proper body mechanics for basic, habitual things like posture, getting in and out of the car, sitting down and standing up, getting in and out of bed. These are all things you do without thinking that require some modifications during pregnancy and postpartum.
We can expect pregnancy and post-partum to be a time of constant, daily change - much of which is physical and all of which can affect sleep and stress - so, please know that a pelvic floor PT can give you individual guidance based on your current needs, and prehab/rehab exercises that are specific to your body at that time. Even if you aren't pregnant, your body changes daily whether you want to believe it or not. It's a reflection of your current level of sleep, stress, daily biomechanics, and of course progression through any treatment or physical exercise program; which is why one-on-one training is always so much more effective than a group class, a Google search, or a recommendation from a friend of family member who has provided their perhaps unsolicited 'expert' opinion.
If you have any symptoms related to this topic, use the provider search tool and take the first step. If you have insurance, these visits should be covered. Generalities can sometimes be helpful, but generally speaking :-) you should stay motivated to find professionals who will lead you toward the care and cues that are applicable and accessible to you - on that day, on that rep, in that moment. Because of my personal experience and pre-post-natal training, I have modified the way I approach physical training, and can now rely on a referral system and network of trustworthy providers to help people seek change that can create a better daily life experience.
Change is constant, and the work it creates is worth it.
The views expressed in this article intend to shed light on my own personal experience and invite conversation. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment and should never not be relied upon for specific medical advice.
Find a provider - https://pelvicpain.org/patients/find-a-medical-provider.aspx
information and symptoms of pelvic therapy - https://pelvicpain.org/patients/find-a-medical-provider.aspx
Baylor Dallas Pelvic Health interview and information - http://www.apta.org/PTinMotion/2017/12/Feature/WhatToExpect/
low back pain and pelvic floor disorders - http://www.apta.org/PTinMotion/2017/12/Feature/WhatToExpect/
What the French get right about taking care of new moms - https://www.huffingtonpost.com/entry/what-the-french-get-so-right-about-taking-care-of-new-moms_us_587d27b4e4b086022ca939c4
Perineal re-education in France - http://www.slate.com/articles/life/family/2012/02/postnatal_care_in_france_vagina_exercises_and_video_games.html
Tami Lynn Kent's 'Wild Feminine' - http://www.wildfeminine.com
Sivanaspirit - Meditation, breath, stress, kegels and the pelvic floor - https://blog.sivanaspirit.com/hh-listen-pelvic-floor/
Why Kegels are not the catchall fix - http://www.getmomstrong.com/2017/12/01/kegels-arent-the-catchall-fix-weve-been-sold-we-need-to-retrain-the-brain/