THE WONDERS OF THE PELVIC FLOOR

I wonder how many of us moms are wondering during exercising our pelvic floor muscles – as we are very importantly told that we have to – if we are doing it right? What are we supposed to feel? Are we really doing anything at all…?

 

                       

 

Well, I know that awareness of that area comes with a lot of practice and patience. And also I am very pleased that nowadays women are given plenty of advice, and the taboos regarding this topic are fading (even if slowly).

Generally when leaking, which is – it is always important to emphasise – very common, but not normal, and should be in every case addressed and treated, we get the advice to train the pelvic floor muscles. This is absolutely good advice, the question is how to do it – because in a lot of cases Kegels and other available programs are not enough, not felt, or not helping at all.

What a wonder 

The pelvic floor is comprised of layers of muscles, ligaments, and the sphincter muscles themselves. This muscle group has postural functions, plays a part in the breathing pattern, and even has a relationship with our emotions (like anxiety or fear). It also holds the lower parts of the inner organs (rectum, urethra, vagina and the uterus) in place with a strong, but elastic, trampoline-like resistance – when healthy.

How do we notice that the pelvic floor is not functioning properly?

Obviously, the most common sign of a dysfunctional pelvic floor is leaking. Losing some drops of pee when sneezing, coughing, jumping, or when we are having to hold it too long, etc. It can also happen with passing winds. This kind of problem definitely means that the muscles of the pelvic floor are weak. We can measure this weakness by trying to hold the flow of the urine. Caution! This is not an exercise, it is not healthy to practice it as a training! But can help to become aware of the actual state of the function. 

Once we are aware of the weakness of the pelvic floor muscles, the interesting question is if they are weak because they are underactive (never working properly), or because they are overactive (too tight and holding all the time, and because of that, functioning poorly).

A muscle is considered well-conditioned when it is able to both relax and tighten completely. This stands for the pelvic floor as well. So it is crucial to work on both of these capabilities if we want to get results.

 

 

How do I know if my pelvic floor is overactive or underactive?

To specify the exact situation, a PT is needed who is specialised for pelvic floor issues. But this is not available for everyone, and in mild cases no one likes to run to a specialist first hand. So here is some advice for those who experience only some mild dysfunction and weakness. 

Please note that these are only very generalized descriptions of types! Every person is unique, and – like in anything else – there can be mixed issues, or there can be other factors to consider. Also please see my advice for more serious issues below.

Signs to consider in case of mild issues

So in case we are speaking in general, we can say that a pelvic floor is underactive if, when the mom is practising Kegel exercises, feels the muscles working, but also experiences them not holding strong enough, or trembling, or giving up after a very short time. Usually these are the persons who benefit a lot from the Kegels and other, great, but a bit old-fashioned pelvic floor regimens, which focus only on strengthening exercises. In their cases, strength can be regained with regular practice and by that they experience progress.

On the other hand, we can say in general that a pelvic floor is overactive, when Kegels are not making a big difference, or the mother cannot really differentiate the feeling of the muscles when exercising. These persons usually also have issues with proper breathing, tightness in the diaphragm, not being able to take a really big breath. The ideal exercises for these women address the pelvic floor through breathing, for example sitting on a ball, letting the diaphragm work completely and letting the pelvic floor drop gently (never ever pushing out hard though!).

It is important to know that very often an overactive pelvic floor and tight diaphragm are behind a non healing diastasis recti. So when that is present (separation of the rectus abdominis muscles along the linea alba), it is very important to use pelvic floor exercises incorporating relaxation and correct breathing.

 

What is the best type of exercise in each case?

Obviously for the underactive type it is important to practice strengthening exercises regularly, and for the overactive ones, we cannot miss relaxation. But, as we agreed, none of us are specialised PTs with an exact diagnosis, and also, we never want to forget the above mentioned concept of  the "well conditioned muscles".  This leads to a consideration where I suggest practicing a balanced regimen, where you have breathing exercises, relaxing of the pelvic floor, and also strengthening exercises, preferably for each region of the pelvic floor musculature (front, back, and centre.) 

We must mention: the more serious issues

When the symptoms are not this mild, or when pain or dragging sensation is present in the pelvic area, we need to see a therapist or a doctor. A lot of different health issues can relate to pelvic floor dysfunction, and these cannot be diagnosed by ourselves from home, or through a Pilates, Yoga or gym trainer – however dedicated and experienced they can be. Luckily, as I have noticed in the history of my clients, a lot of times even the bigger issues are treatable with exercising – but these moms need to get a personalized approach! 

Don't forget: pelvic floor dysfunction and discomfort is treatable. You never should grow old with it, it is no more a taboo, and everyone deserves to get better. So don't hesitate to seek help.

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