HOW TO FIX YOUR PELVIC FLOOR (SORT OF)
If you are here because you just finished reading all about your pelvic floor, good on ya. If you came here from some other place and have no idea where or what your pelvic floor is, you should go and find out before reading any more. You'd read the rocket ship manual before trying to reach to the moon, right? Just kidding, achieving a healthy pelvic floor is nothing like trying to get to the moon. It's more like trying to wrangle your 3 year old out of a toy store without a new toy. Difficult. But totally doable. But seriously, read about pelvic floor health before getting in any deeper.
BEFORE YOU GET STARTED.
We all want a quick fix, even when we know there isn't one. I can't help but echo this important message: THERE IS NO QUICK FIX, no magic pill or two day boot camp that will have you skipping along with a like-new pelvic floor. Like any injury, healing takes time. Muscles and connective tissue don't change over night - they need time to adapt to the new stresses, to strengthen, to relax, to re-learn. And this my lady friends takes time.
That said, you can see some improvement within one week. Note the can and some. The big if here is that your exercises are suited to you, that your exercises meet your body’s needs.
IF YOU HAVE INCONTINENCE OR PELVIC PAIN, OR ANYTHING ELSE GOING ON DOWNTHERE THAT YOU DON'T THINK IS NORMAL,
SEE A PELVIC FLOOR PHYSICAL THERAPIST OR YOUR DOCTOR.
Research indicates that strengthening your pelvic floor can reduce or eliminate stress-urinary incontinence. And the numbers are really good. Studies have shown up to 70% improvement among women who do pelvic floor exercises across ALL age groups - that's huge! The specific exercise regimes vary from study to study, but they ALL indicate some degree of improvement. The key is doing them, and DOING THEM WELL. Quality is key here. The reps, the sets, the daily and weekly frequency - all of these factors are going to vary depending on who you ask and the degree of dysfunction that needs improving.
The other great news, as I am sure you already know, is that your pelvic floor does not need a gym, or even a set of weights. You can rehab it (or prehab it if you're working on prevention) at home, in the car, in your bed, at the dentist.
HOW LONG WILL IT TAKE TO FULLY HEAL MY PELVIC FLOOR?
Of course, your return to a fully functioning, symptom-free pelvic floor will depend greatly on where your pelvic floor, core health, and your overall health.
In the short term, many women will feel some improvement in as little as one week, if they are diligent with their exercises. Yes, one week. I have seen it many, many times.
Typically 4-6 weeks is the minimum time you're looking at to see full recovery from minor issues. If there is pelvic pain, more moderate to severe incontinence or any prolapse, you will likely need months to years of rehab and guidance from a trained physiotherapist to achieve better function.
WHEN CAN I START EXERCISING MY PELVIC FLOOR AFTER CHILD BIRTH?
Right away, dear mumma! Lying in your hospital bed with nothing better to do (ya, right). No time like the present!
Some might disagree with this one, but they shouldn't. I often hear "wait until your 6 week check up". This is B.S. (pardon me). The Canadian guidelines for exercise in pregnancy and postpartum state that immediate initiation of pelvic floor exercises can reduce SUI (and other pelvic dysfunctions). IMMEDIATE, mumma. We don't wait 6 weeks for any other soft tissue injury to heal before initiating gentle exercise. Research will only tell you that muscles and tissue heal better when specific exercise is incorporated.
As long as it feels okay (ie pain-free), I encourage you to resume some gentle pelvic floor exercises as soon as you can after delivery. This will only help with healing (vaginal and C-section mummas), your overall recovery and preventing pelvic problems. Take it slow and gentle at first; progress slowly over the first few weeks.
Enough of that stuff. Lets get to it.
HOW TO CONTRACT AND RELAX YOUR PELVIC FLOOR
Here are the facts:
1. Your pelvic floor muscles work TOGETHER with your core muscles. So knowing how to engage your core muscles properly is half the battle to a healthy pelvic floor. Learn this and think about contracting and relaxing your core muscles along with your pelvic floor muscles. If it's too much to think about at first, focus on one or the other until it becomes almost automatic.
2. Your pelvic floor muscles need to be able to CONTRACT AND RELAX well. BOTH of these actions need to be perfected. Simple as that.
On that note, here's what it should happen during each of these:
CONTRACT: The pelvic floor muscles should lift upwards (towards your head) and a bit forward (towards your pelvic bone). The muscles tense and become taut. That's right, TAUT. This creates a strong base of support for the organs that sit directly on top and resists pressures that build up in the pelvic and abdominal cavities. This keeps the contents of these structures from sneaking out. Yes. Please.
RELAX: When you relax your pelvic floor, the muscles should return to their starting position. Remember that the ideal starting position is one in which the muscle fibres can quickly slide along each other to contract when needed, it's neither too loose or too tight.
Below are my suggestions for specific pelvic floor exercises and progressions. They worked for me and it's what I generally use with my patients with pelvic floor issues in my clinical practice. If you do not see progress after one week, talk to your doctor or midwife. Many women need supervision from a pelvic floor physio to get things working properly. Get the help you need - they are there for you!
Play with the reps, sets, frequency and speed of your exercises. Your starting point and progress will depend on the state of your pelvic floor and core health. Remember that there are numerous factors that will contribute to dysfunction in this area, and that you should NOT HAVE ANY PAIN WITH ANY OF THESE EXERCISES.
STEP 1: FIND IT
This is the most important step. This is about contracting and relaxing your pelvic floor muscles CORRECTLY. If you cannot do this or question your abilities, do not move on until you are confident that you can do this well.
DO IT:
Lie on your back with your legs supported - pillow or bolster under your knees.
Make sure you are fully relaxed. Connect to your breath. IN. OUT.
Now connect with your pelvic floor.
INHALE: RELAX (EVERYTHING)
EXHALE: CONTRACT (ONLY YOUR PELVIC FLOOR)
Here are some cues that might help you engage your pelvic floor better:
think of connecting your tail bone (in the back) to your pubic bone (in the front) - think of a line between these two coming together, getting shorter.
think of your pelvic floor as a drawstring bag, cinching together in the very centre
think of your pelvic floor as a flower closing on contraction, or blooming on relaxation (I know, how lovely, right?)
Research indicates that an optimal contraction is achieved when a "posterior" cue is involved, which means don't forget about the anal part of your pelvic floor. Just watch that you don't squeeze your glutes!
If you are having difficulty connecting to your pelvic floor, you can always try the tried and true way of connecting to it: the next time you go pee (where and when peeing should happen), try stopping mid-flow. If you can stop the flow of urine, you can voluntarily contract your pelvic floor muscles. This isn't an ideal way of connecting to it, nor should it be used as a strengthening strategy, but it is a simple way for a lot of women to get it. If this is the case, move to the floor after and try again in a more relaxed position.
THE CATCH (DUN, DUN, DUN):
You should be able to contract your pelvic floor muscles in this position WITHOUT ANY OTHER MUSCLES CONTRACTING. The glutes (aka butt, bum, buttocks) often fire up to help the pelvic floor muscles out. Don't let this happen. Your core and/or thigh muscles may jump in to help out as well. Your goal is to contract your pelvic floor muscles on their own right now - belly and butt relaxed. Make sure you are not holding your breath too! We will add core to the mix soon.
WERK IT:
Once you've got it, connected with it, woken it up, it's time to challenge it. Try the two exercises below in the same relaxed lying position as above. Do these 2-3 times/day.
EXERCISE #1: HOLD THAT
Hold your pelvic floor muscles steady (contracted) as you inhale and exhale for 30 seconds (set a smaller time goal if 30s is too much initially). Relax your pelvic floor fully on an inhalation. Repeat these static holds 2-3 more times, always coming out of the hold on a big inhalation. Remember, glutes relaxed!
EXERCISE #2: BREATHE INTO IT
Inhale, relax your pelvic floor FULLY; exhale, contract it MAXIMALLY. Follow your breathing cycle, with synchronized contract/relax of your pelvic floor for 60 seconds. Relax for 30 seconds. Repeat 2-3 times.
EXERCISE #3: FRONT, BACK, MIDDLE
Focus on different areas of your pelvic floor, trying to contract each area separately.
The front - where you would stop urine. Hold for a count of ten. Relax fully.
The back - where you would stop gas. Hold for a count of ten. Relax fully.
The middle - where your baby maker is. Hold for a count of ten. Relax fully.
Repeat this (full, front, back, middle) 5 times, holding each for 10 seconds.
Make sure you relax your pelvic floor FULLY after each contraction. Don't forget to breath easy. And keep those glutes relaxed!
PROGRESS THESE:
If you feel well connected to your pelvic floor, you can try doing these in different, progressive positions: seated, standing, on all-4s. Try to be mindful of good body alignment. Focus on contracting/relaxing your pelvic floor along with your breathing: inhale, relax; exhale, contract.
These exercises get you to focus on isolating your pelvic floor muscles, and working them through slow and steady contractions. Once you can do this easily, with other muscles relaxed and breathing easy, you can progress. Don't jump the gun! It could take a week or more to feel really comfortable engaging and relaxing your pelvic floor all on it's own.
EXERCISE #4: THE ELEVATOR
Lie on your back with your legs supported - pillow or bolster under your knees.
Contract your pelvic floor very lightly - imagine an elevator, and you have just contracted it up to level ONE. Hold here and take a breath in and out.
Pull it up a little tighter to level TWO. Take a breath in and out.
Tighter still, to level THREE. Take a breath in and out.
And finally to level FOUR (by now you should be squeezing it maximally). Do 10 QUICK PULSES here. Finish back at level FOUR.
Relax to level THREE. TWO. ONE. And fully relaxed. Pause at each level long enough time to take a breath and make sure everything else is relaxed.
Repeat this 5 times.
You are doing GREAT if you've made it this far! You can engage your pelvic floor on it's own, while breathing easy, and are able to vary the degree of tension. Time to progress in more dynamic ways. Exercise #5 will help you connect your pelvic floor and your core muscles in the simplest way. The idea of these two areas working together, along with your diaphragm through your breathing cycles, SHOULD BE APPLIED TO ANY OTHER EXERCISE that you do, and even throughout your day.
EXERCISE #5: CORE CONNECTED
Lie on your back with your legs supported - pillow or bolster under your knees.
Recall how to engage your CORE properly - this means tightening your front, sides and back of your abdominal area WITHOUT hollowing your stomach, flattening your back or moving your spine or pelvis. An engaged CORE means NO movement from your neutral spine starting position. If you have no idea what I'm talking about read this first, then come back!
INHALE: RELAX EVERYTHING. Chest rises, belly expands, pelvic floor "blooms" (haha).
EXHALE: CONTRACT PELVIC FLOOR AND CORE MUSCLES. Start with your pelvic floor, as you've been doing. Feel that contraction rise up into your lower abdomen, and continue to contract all of your belly muscles. CONTRACT MAXIMALLY here; your belly and pelvic floor muscles should be rock solid steady. You got it.
Hold for a count of 10.
INHALE: RELAX.
EXHALE: REPEAT.
Repeat this through 10 breath cycles.
Phew, done. That wasn't so bad, right? Whether you got all of these in one go, or have been working on these for a week or so, good on ya! Remember that the most important thing is to achieve a great connection between your brain and your pelvic floor. Get that pathway fired up, and then progress to more challenging exercises.
Any core exercise (planks, bird-dog, ball work, etc.) that you do from here on, think about your pelvic floor muscles helping out with the overall stability.
PEANUT BUTTER + JAM.
BACON + EGGS.
ROMEO + JULIET.
GIN + TONIC.
THELMA + LOUISE.
PELVIC FLOOR + CORE.
The great thing about working your pelvic floor muscles is that you don't need any equipment. Practice any place, any time. Here are some suggestions for places and times to think about using your PELVIC FLOOR + CORE throughout your day:
lifting
in the shower (sing too - can you keep core and PF engaged at the same time?)
during sex
listening to music (don't tap your foot, pulse your pelvic floor, it's less annoying for those around you)
when you cough or sneeze (yes, please)
throughout exercise class/yoga/swimming/etc.
Happy pelvic floors, mummas!
