Pelvic floor health is hugely important for all women – your pelvic floor is there for a reason: It stops your pelvic organs falling out, it helps with great sex, and it helps support and stabilise your pelvis, so you don’t easily injure yourself.
Your pelvic floor gets an absolute battering throughout life with periods and sex before it takes on 9 months of full-on pressure during pregnancy and then gets destroyed by sarcopenia (muscle wastage) as you edge towards menopause.
Unfortunately, probably because we can’t see our pelvic floor, we tend not to give it much thought until something icky happens…
The stats for incontinence and pelvic organ prolapse are 1:2 for new mums and these symptoms usually get worse or tend to reappear in menopause.
If you’re confused by those terms:
Incontinence means leaking urine.
Leaking shouldn’t happen at all and not even a little bit. Not on impact (when running or jumping), not in the shower, when you’re getting the key in the front door, not at any time – unfortunately it’s very common and so many think it’s funny but it’s not right.
Pelvic Organ Prolapse is when one of your pelvic organs (bladder, rectum, uterus) descends and protrudes through your pelvic floor, as the pelvic floor isn’t strong enough to support it.
Both conditions can really impact your quality of life: The inability to move freely, exercise without fear of leaking or worsening a prolapse, the inability to manage your weight via exercise, not being able to run after your kids or even play with them properly.
It’s so common and heart breaking when it happens, I see it all the time and I wouldn’t wish it on anyone.
It’s so important that if you’re leaking urine, you feel heaviness or dragging around the pelvis, you feel like a tampon is falling out, see or feel a bulge down there, please contact a Women’s Health Physio - get it checked out and then start a pelvic floor strengthening program immediately.
I have many options available to help you with pelvic floor strengthening, both for postnatal and menopausal ladies, so please contact me and we can decide which plan suits you best.
Luckily there is so much you can do on a day-to-day basis to help manage your pelvic floor health and reduce the risks of incontinence and prolapse.
1: Strengthen the pelvic floor muscles:
The pelvic floor is like any other muscle group, it requires strength to retain its function.
This strength doesn’t necessarily need to come from hundreds of kegels, the pelvic floor actually responds better to movement, especially movement from the muscle groups surrounding it.
Some of the best ways to strengthen the pelvic floor via movement are as follows:
• Squats
• Forward lunges
• Hip bridges
• Side lunges
• Hamstring stretches
2: Address your breathing:
Your pelvic floor and diaphragm move together in synergy - every breath you take in will make the pelvic floor relax downwards and every exhale naturally contracts and lifts the pelvic floor upwards.
Remember every breath has the tendency to raise intra-abdominal pressure, especially if you take a big breath in and bear down - directing the breath downwards to the belly and pelvic floor. This won’t do your pelvic floor or core any good, so it’s important to learn how to direct your breath across the entire torso instead– aiming for 360 expansion of the ribs, side body and back too.
On a similar note, it's important not to suck your tummy in, particularly for long periods. Your belly needs to be relaxed and to be able to expand with your breath – this’ll help prevent the intra-abdominal pressure bearing downwards on your pelvic floor. This is so common, especially with high waisted tight jeans, so please learn to let it go or elasticated waistbands only!
Make sure you’re directing your breath downwards rather than upwards.
This may sound silly but after pregnancy it’s quite common to slip into a paradoxical breathing pattern – the breath is directed upwards into the neck and chest rather than down and out. This breathing pattern causes heaps of neck and shoulder pains, tension and stress which can be horrible but it also means the breath isn’t going downwards and connecting with the pelvic floor – allowing it to naturally engage and contract.
3: Address you posture:
Your core and pelvic floor won’t function properly if parts of your body are getting in the way and preventing it from doing so!
Ideally you should be in a neutral alignment as much as possible – this means your lower ribs are stacked directly over your hip bones. This alignment allows you to breath easier, which allows your diaphragm and pelvic floor to connect and engage easier.
Some of the common postures we find ourselves in which may be preventing core & pelvic floor connection are as follows:
• Rounding the shoulders and pushing the neck forwards
• Arching the lower back & sticking the bum out (anterior pelvic tilt)
• Tucking the bum under (pancake bum)
• Putting weight on one side of the body all the time
• Collapsing foot arches inwards
So, check yourself out and make note of how you habitually stand.
4: See a Women’s Health Physio:
If you have symptoms, as outlined above, this is non-negotiable but it’s always worth having an annual check-up with a Women’s Health Physio, especially if you are 40+.
They’ll be able to check out exactly what’s going on down there: if you have too much tension and need to work on release strategies or if you’re
lacking strength and need that to be the focus.
5: Address your toilet habits:
You should be going for a poo every single day.
If you’re constipated, this will reduce your pelvic floor function due to the intra-abdominal pressure forced on it whilst you’re bearing down on the toilet.
To prevent constipation, stay hydrated and eat plenty of fibre.
Drink water though out the day and consume lots of fibre rich foods like broccoli, cabbage, sprouts, beans, lentils and pulses.
The position you poo in also makes a huge difference to how easily it passes through. Remember we were designed to poo in a squat position, which is exactly how babies poo. Once we start using a toilet, the angle we poo at makes it more difficult to pass and we’re more likely to bear down.
Try raising the knees to allow the poo to pass through without too much force and pressure – a good idea is to use a child’s potty or a stack of books to pop your feet on.
6: Try to lose some excess weight:
Being overweight can weaken your pelvic floor muscles due to the extra pressure fatty tissue places on your bladder.
If you’re overweight, losing the excess weight could therefore be enough to reduce pelvic floor symptoms.
We all know that a sensible diet and plenty of movement are the best ways to lose weight but as we edge towards menopause keeping the weight off in this way, proves to be a lot more difficult than it was in our 20’s and 30’s.
This issue is hormonally driven and can be managed via a different set of movement patterns, nourishment and stress reduction tactics - if you’re struggling with weight gain in menopause please contact me about my Movement & Diet For Menopause Program, this will set you on the path for weight loss and help your pelvic floor health too:
7. Learn correct lifting techniques:
Lifting heavy weights in a gym or when picking up your toddler puts a great deal of intra – abdominal pressure downwards on the pelvic floor unless you adapt correct techniques and make them habitual.
Try and remember the following tips:
• Always hinge at the hips
• Keep the knees bent
• Force out an exhale with the exertion as you lift, to help engage your pelvic floor.
Remember resistance training is great for your pelvic floor as you’re training it to respond to load which is a part of everyday life.
If you’re wanting to start a resistance exercise program but feel nervy about your technique, please contact me about my Menopausal Strength Training Program, this is a 4-week online program which is suitable for anyone wanting an introduction to resistance training.
It includes 2 weekly workouts and weekly coaching calls to monitor technique:
I hope this information helps and as always, please feel free to reach out via email: anna@coreconfident.co.uk if you want any help or advice.
Anna xx