How we heal the pelvic floor and core has changed – so why doesn’t anyone know about it?

I was sitting in a cafe the other day chatting to a lovely woman, who had 2 kids, ages 5 and 3.  She was in her late 30’s I’m guessing, with sparkly eyes and a warm smile. We got talking about our kids, who were all eyeing off the one plush Pig the Pug dog that lay in the middle of their circle. We looked at each other hesitantly. 

Play nice I said inside my head to my 4 year old.  It worked.  They were taking turns.  The woman and I smiled at each other and continued to talk. 

When I told her what I do for work she inevitably started sharing stories with me that really, she probably hasn’t shared with even her nearest and dearest.

I get this a lot – maybe pelvic floor issues aren’t talked about as much as they should be amongst friends. Or maybe she just figured I’d be interested (she was right).

So I got to hear about her experience of living with a body that was ‘unpredictable and unreliable’ (her words – although given the frustration in her voice, I think she was being polite).

She told me about the unhealed abdominal separation and her belly feeling like jelly.  About the bladder leakage that meant she could no longer chase her son on his bike (and she was getting back pain these days too, so double whammy).

Her sparkly eyes widened as she then shared the alarming thought that she was headed towards pelvic organ prolapse later on –  because things were getting…. well… worse.

I could feel her pain. I restrained the urge to step in and give her exercises right there in the middle of the cafe, espresso in hand, and kept listening.   

There was one thing she said to me that really stood out –

 

“I was basically told by my OBGYN to clench my pelvic floor  20 times every hour on the hour – and that I’d be doing that for the rest of my life”

 

I could see the disdainful look on her face.  I knew exactly what she was going to say.  “As if that’s gonna happen,” she told me.

Now I don’t know exactly what happened with the doctor. I don’t know if that was the exact advice, or if it got lost in a sea of other suggestions and that was somehow where they ended up.

HERE’S WHAT DOESN’T WORK FOR PELVIC FLOOR EXERCISE   

 

Standing or sitting around doing pelvic floor ‘squeezes’ or ‘clenches’ or whatever word you use, is pretty ineffective if you’re more than 8 weeks postpartum.

There. I said it.  You can put down the kegel now (figuratively speaking).

No other muscles in the body are treated this way in rehabilitation.  You activate the muscle for a short period, then you move on to integrating into the rest of the body. 

 

If you have a knee injury you don’t squeeze your adductor muscles or your VMO (in the quad) for the rest of your life. You do it for a few weeks – then you learn harder exercises – so that your knee learns how to handle stress.

The pelvic floor and deep core muscles need to be treated the same way.

I’ve worked in the fields of clinical rehabilitation and strength training for 18 years.  I’ve worked with hundreds of women (literally – as in my fingers in their bellies poking and prodding around) to close diastasis recti, eliminate bladder leaking, recover from prolapse and get rid of back pain.

And at no time did we sit down and tighten the pelvic floor as hard as we could, rep after rep after rep.

The biggest foible of the core and pelvic floor…

 

These muscles are postural in nature. They are, by design, there to support us all day long, in a light fashion, and then ramp up the intensity when it’s time to sneeze, laugh, lift something or run.

But, in most cases, if they haven’t been re-trained postpartum –  into a variety of movements of different levels – they don’t bother.

They sit back, dormant and asleep, and the nervous system recruits help from other bigger, stronger muscles instead.  Usually it’s the outer abs (the ones that crunch) and the erectors in the back.

Now, you’re bracing your abs and holding your breath to do even basic movements. 

Now you get pain and feel constantly tight through your shoulders and neck.

Now you notice that your butt is losing tone and becoming flat (and you blame age – but actually that tongue in cheek ‘mum bum’ term exists for a reason).

Even though you can brace your abs, your lower belly is still heavy and protruding, and you feel pressure in your lower back.

And now – even though you can clench that pelvic floor like a pro while you’re on the couch, you still leak.

Your pelvic floor is irritated, tense, and you feel urgency now in order to go to the toilet – but it’s still ‘weak’.

Here’s why you can give up endlessly squeezing your pelvic floor while you’re driving, cooking, or watching tv….

 

1 – It doesn’t teach the pelvic floor to switch on and off during actual movements

Doing this same movement  over and over doesn’t teach the nervous system to send sophisticated signals to the pelvic floor on demand.   

2 – It doesn’t learn to play nicely with all the other muscles it’s supposed to work with

The pelvic floor is not one muscle designed to do everything.  The floor itself is made up of many muscles, AND there are 4 other muscles on the same neurological loop that must work properly with the pelvic floor in order for it to support you fully.

‘Couch clenching’ as I call it, works none of these.

3 – It’s actually been found to create dysfunction over the long term

Too much isolated power in muscles that are designed to be smarter than they are strong, and  you end up with tension, trigger points and what’s called ‘hypertonicity’ (think pain during sex and urgency to pee).

 

THE BEST WAYS TO ACTIVATE AND EXERCISE THE PELVIC FLOOR AND ABDOMINAL MUSCLES

 

  • Learn how to breathe using the diaphragm, as this is a key part of activation and pelvic floor release

 

  • Connect to the deepest layer of your core  – the transverse abdominis.  This huge muscle pulls everything in our torso up and in.  It’s what lifts and flattens the stomach, and supports the internal organs (think bladder and uterus).

 

  • Stop crunching and overusing the outer ab muscles (the rectus abdominis) for a while.  Chances are you’ve accidentally created an imbalance that now needs to be corrected. Overusing these also makes abdominal separation (diastasis recti) worse.  Ab separation is a common partner problem if you have pelvic floor issues, and is worth assessing, even if your kids are adults.

 

  •   Activate the deep spinal stabilisers in the back, like the multifidus muscle, so that the large erector spinae muscles in your back learn to relax. This alone significantly reduces lower back pain.

 

  • Do a proper pelvic stability exercise program that incorporates glute activation exercises, as this is the key starting place for re-aligning the hips after having children.

 

If you’re still clenching, chances are you have some sort of pelvic floor dysfunction or you’re scared of getting one (otherwise let’s face it -why bother?). 

Unless you train the core and pelvic floor through the right exercises, done in the right order – nothing gets better (and we know from the latest reports that things like vaginal mesh are not the answer).

 

If you’re looking for step by step professional guidance, our Core and Pelvic Floor program starts in person again in February – and after hundreds of requests – our online program will be ready and launching then too!

You can find out more here

Kristy Ahale is a Clinical Exercise Therapist with 18 years experience in the fields of rehabilitation, strength training and pre and postpartum exercise.

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