Taking Care of Your Pelvic Floor During Exercise

You may not have known anything about pelvic floor muscles until pregnancy or after having a baby. Most likely, you’ve heard two things 1) you should do kegels to strengthen them, and 2) problems with these muscles can cause incontinence. 

Those two things are a good start, but I’d love to provide you with a bit more education so that you feel empowered to care for these muscles and/or continue to exercise if you’re dealing with pelvic floor muscle dysfunction. In this post, we’ll talk about where the pelvic floor muscles are located and their function, common problems that can occur, and four ways to engage and protect them during your workout routine.

What are pelvic floor muscles?

Your pelvic floor muscles form a hammock-like layer across the base of your pelvis. They stretch from your pubic bone in the front to your tailbone in the back. I’ve also heard them referred to as a trampoline, which should be taught and durable. Here are a few things to know about their function:

• When these muscles contract, they lift up and support your pelvic organs. 

• When you bear down, like when sneezing or lifting something heavy, the pelvic floor stretches and lengthens to accommodate the pressure created in your abdomen.

• Additionally, your pelvic floor muscles play a role in sexual function. When these muscles are too tight you might experience painful intercourse. Strong functioning pelvic floor muscles can help you achieve greater sensation during orgasms.  

• Pelvic floor muscles play a role in continence, allowing you to have control over elimination, including passing gas. 

• Lastly, they play a role in spinal and pelvic stability as a member of the core muscle-stabilizing team. 

Common Pelvic Floor Issues in Moms

Factors like pregnancy, childbirth, and aging can impact the function of these muscles. They may weaken due to the weight of the uterus, or they may become too tight due to the birthing process. Either way, if they’re not functioning as they should, it can lead to incontinence, prolapse, and impact your core strength. 

Most of you are probably aware of the connection between pelvic floor muscle function and incontinence. Did you know that there are two types of incontinence? 

• Stress incontinence causes leaking of urine when you cough, laugh, sneeze, or during exercises that involve impact, breath holding, or bearing down.  

• Urge incontinence is when you have the sudden urge to urinate and may not be able to hold it. An example often given is that you know you have to use the bathroom and right before you get to the toilet the urge gets stronger and you can’t prevent urinating.

The majority of incontinence for moms is stress urinary incontinence, however, some moms will also struggle with fecal incontinence which is the inability to control bowels. This can happen due to trauma during the delivery process.

Another condition that involves the pelvic floor muscles is pelvic organ prolapse. Because the pelvic floor muscles support your organs, if there is a dysfunction this can cause organs like your uterus or bladder to drop into the vaginal wall. Picture a hammock or trampoline that can’t support the weight of the person on it…it begins to sag toward the ground. In some cases, the organs can extend outside of the vagina.

The good news is that pelvic floor physical therapy is more widely available and we’re learning more about lifestyle changes and exercise that can treat, improve, or help you cope with these conditions. Additionally, qualified exercise professionals should be able to prescribe exercises that support your efforts to improve pelvic floor function.

Four Ways to Engage, Strengthen, and Protect Your Pelvic Floor During Exercise

As I mentioned, either while you’re in pelvic floor physical therapy, or after you’ve been discharged, a qualified exercise professional can help you engage, strengthen, and protect your pelvic floor during strength workouts. Here are a few strategies you can implement during your workouts:

1. Coordinate your breath: Your pelvic floor muscles are the basement of your core, where the diaphragm is the ceiling. The cylinder which is your core will function optimally when both of those muscles work in synergy. When you exhale your pelvic floor muscles are lifted and when you let the breath out your pelvic floor relaxes. The diaphragm should move in the same direction, descending on your inhale and rising on your exhale. Coordination of these two muscles isn’t always easy, especially when movement is involved. However, it’s important enough to master so that you’re not putting excessive pressure on the pelvic floor muscles. 

2. “Close the holes” or "Blow before you go”: I can’t take credit for these terms as I’ve heard them from several pelvic floor physical therapists. The strategy is to engage the pelvic floor muscles right before you’re about to lift something heavy. Imagine closing your anus as if you’re trying to not pass gas. This will activate your pelvic floor right before there is increased abdominal pressure. You can also try “blow before you go”, which means that right before you’re going to lift, you begin the exhale. Again this can help manage pressure pushing down on the pelvic floor muscles.

3. Avoid impact exercises postpartum until you’ve dedicated time to resistance training: The postpartum running guidelines suggest a minimum of 12 weeks of progressive exercise, including resistance training. However, if you’re having symptoms of pelvic floor muscle dysfunction, this may take longer. When you’re ready to add higher impact activities, start with fewer reps and shorter duration. Take your time to progress and build up. You wouldn’t go from lifting a 5-pound dumbbell straight to 50 pounds, would you? It’s worth mentioning that there aren’t prenatal running guidelines and plenty of moms do run during pregnancy, but if you’re noticing symptoms, that may mean your pelvic floor muscles can’t handle the impact and it’s probably best to move to low impact options. 

4. Remember that pelvic floor muscles are muscles: We all understand the concept of challenging a muscle in order to make it stronger and stretching muscles to relax and lengthen. The same goes for pelvic floor muscles. If you have a weak pelvic floor, you don’t want to avoid core training altogether because it’s going to need the challenge of the exercise to get stronger. If you’re not having symptoms, it’s also important to learn how to contract and relax those muscles. The easiest way to do this is by focusing on breath and core stabilization during strength training. If your core muscles are working together, your pelvic floor muscles will maintain/gain strength. If you prefer isolated exercises, you can throw in kegels of different durations (long contractions and quick contractions). 

Education should be empowering. As you learn more about your body, don’t let it cause fear. Research around core stability exercises benefiting the pelvic floor muscles is increasing, which is an incredibly positive thing. So whether you’re experiencing any of the named conditions, or if you’re concerned about atrophy as you age, or if you just want a well-rounded core program, take the time to become familiar with your pelvic floor muscles. 

If you’re ready to put core training to reduce your risk of incontinence and back pain into practice, consider my free 5-day core course. If you’ve seen a pelvic floor physical therapist, check out my free download on the Dos and Don'ts when it comes to exercise after pelvic floor physical therapy. 

Happy training!

3 Ways to Incorporate Pelvic Floor Training into Your Strength Routine

Your pelvic floor muscles can be considered the basement of your core and play a key role in managing intra-abdominal pressure (pressure within your abdominal cavity that helps stabilize your spine). When your pelvic floor muscles work with the rest of the core to manage the pressure, you'll feel stable and strong. When one area of your core is weak, your ability to manage and create pressure for stability changes. During pregnancy breathing, abdominal muscles/wall, and pelvic floor are impacted by the changes to your body-which is why training each of them properly is so important.

Pelvic floor muscles also play important roles in sexual function, organ support, and sphincteric control (holding urine, gas and poop). During the natal period (pregnancy and postpartum), weakness or overactivity of these muscles can impact your core strength and function, as well as cause conditions such as urinary and fecal incontinence, or pain with intercourse. By now most of us have heard of kegels, and some of you may even manage to fit in a few sets while brushing your teeth or driving. However, like most muscles in our body, pelvic floor muscles need to be functional during movement and not just at rest. The best way to do this is to coordinate the activation of your pelvic floor muscles with other core muscles during movement. Here are some ways to train those muscles with common exercises:

1. During squats: As you descend into a squat this is when your pelvic floor muscles should relax. During this lowering movement, you will inhale. As you ascend up to standing with an exhale, this is when you can contract your pelvic floor muscles (think of trying to tighten your vagina around a tampon). Additionally press through your heels to activate glutes, and draw in your belly button (to hit your transverse muscles).

2. During a front dumbbell raise: As you lift the dumbbell exhale and draw in your belly button (to hit your transverse muscles), while at the same time visualizing your pelvic floor rising along with your arm toward your belly button. As you lower the dumbbell, gently release your abdominal contraction and relax your pelvic floor.

3. Wall sit: While you're holding your wall sit (back against the wall, knees bent at 90 degrees with your knees over your ankles), challenge yourself for endurance pelvic floor contractions-one set of three 8-12 seconds long holds (make sure you’re not holding your breath, just the pelvic floor lift). And then follow that with a wall sit of quick pelvic floor contractions-strong flickers of your muscles for 10-15 reps. Think quick “contract, relax, contract, relax”. (similar to an orgasm)

For most pregnant people, pelvic floor training is recommended and will help you maintain a strong and functional core. Remember to always relax between contractions...you don’t want a tight pelvic floor during delivery.

It can be helpful for everyone to get a pelvic floor assessment postpartum, as many people will need to retrain the muscles, and although common, pelvic floor dysfunction is not normal. Weakness is not the only concern, sometimes birth trauma can lead to overactive or spasmed muscles...so don’t just jump back into kegels.

Happy training! If you’d like a strength program that incorporates pelvic floor, get started with Active Mom Fitness!