EXERCISE GUIDE FOR THE PELVIC FLOOR PART 1: BREATHING
The diaphragm is a very important structure involved in breathing and it also creates the roof of your core muscles.
The diaphragm ‘opposes’ the pelvic floor, similar to the biceps opposing the triceps. Therefore, any issue with one, has an effect on the other. If one has limited movement and flexibility, the other will not be able to contract at its best. If one is over-tight and short, the other will not be able to relax and lengthen.
Shallow breathing or breathing where your chest moves up and down can lead to your diaphragm getting over-tight and short. This has consequences on your pelvic floor and both muscles get pretty stuck and have limited movement. When the pelvic floor isn’t functioning optimally this can lead to issues such as back pain, pelvic pain, incontinence, prolapse and it can slow the healing of diastasis recti after having a baby.
When you breathe in, the lower ribcage should expand outwards and backwards. This enables the diaphragm to contract and descend. The tummy should ‘give’ so an expansion of the tummy should be visible during inhalation. This process encourages the pelvic floor to lengthen and ‘let go’ ready for a contraction on the exhale.
EXERCISE GUIDE FOR THE PELVIC FLOOR PART 2: THE PELVIC FLOOR
The pelvic floor is not just one muscle. It is a group of muscles that forms a hammock attaching to the front, back and sides of the pelvis. It provides strength and stability to the spine and pelvis, and supports the pelvic organs including the bladder, uterus and bowel.
Weakness of the pelvic floor can be a result of the muscles being too under-active and lengthened (like for the first few weeks after a vaginal birth), but quite commonly, it could also be due to them being over-active and shortened.
Weakness whether due to under or over-activity of the pelvic floor muscles is associated with back pain, pelvic floor dysfunction such as stress/urge incontinence and prolapse.
Therefore, if you’re more than 6-8 weeks postnatal, prescribing yourself pelvic floor ‘contractions’ if the muscles are already over-active could actually be causing more issues for you.
Take a note today if you find yourself clenching around the pelvis regularly throughout the day...... Just like you can let your jaw relax and let go, can you do the same with the muscles around the hips? Taking some deep breaths can help with this.
EXERCISE GUIDE FOR THE PELVIC FLOOR PART 3: COORDINATION
In Part 1 and 2 of this mini pelvic floor series, we’ve discussed the diaphragm and pelvic floor. Now it’s really important to know that the diaphragm and pelvic floor should be COORDINATED.
When you breathe in, the diaphragm expands and pushes the pelvic floor down. When you breathe out, the diaphragm rises and pulls the pelvic floor upwards. It is quite common for many women to squeeze the pelvic floor when they breathe in and let go when they breathe out. This can explain why so many women experience dysfunctions in the pelvic floor.
Take a moment now to breathe...... Is your breathing coordinated as it should be? Can you sense the movement in your pelvic floor with your breath?
EXERCISE GUIDE FOR THE PELVIC FLOOR PART 4: SLOW HOLDS
The pelvic floor muscles contain muscle fibres which can contract slowly and fibres which can contract quickly. ‘Slow-twitch’ fibres are the endurance fibres. They contract slowly and are slow to fatigue. These are the fibres which support the pelvic organs all day everyday.
Once you have good coordination between breathing and pelvic floor you can target the ‘slow-twitch fibres by doing SLOW HOLDS.
Breathe out as you contract/lift the pelvic floor. Hold that contraction for an inhale and another exhale. Release on the next inhale.
EXERCISE GUIDE FOR THE PELVIC FLOOR PART 5: QUICK PULSES
In Part 4 you worked the slow-twitch fibres of the pelvic floor. Now in Part 5, we’re targeting the fast-twitch fibres.
Where the slow twitch work continuously to support the pelvic organs, the fast-twitch fibres are needed for moments where a quick reaction is required such as during coughing and sneezing.
Try now to perform 5 consecutive quick contractions ensuring you release fully afterwards. These quick pulses should not be overdone especially if you have symptoms associated with a hypertonic pelvic floor (see previous parts to this series).
EXERCISE GUIDE FOR THE PELVIC FLOOR PART 6: THE LIFT
The Lift is another way to further build pelvic floor strength but only once you’ve mastered Parts 1-5.
Imagine your pelvis has three floors like a three storey building. Lift your pelvic floor muscles up gently to floor one. Then lift up a little farther to floor two. Hold on floor two then lift up to floor three. Slowly, relax down through the floors, one by one. Once you’ve reached floor one, try to relax down to the basement level.
To begin with, you may be unable to feel the distinction between floors and it is common to feel only one or two floors. If so, go back through Parts 1-5 of this series.
EXERCISE GUIDE FOR THE PELVIC FLOOR PART 7: Functional Pelvic Floor
The next and final step of this mini-series is to incorporate and coordinate the pelvic floor into functional movement.
Taking the squat, which is a movement we all do many times a day, we should inhale, expanding the ribs outwards, feeling a release in the tummy and pelvic floor as we lower into a squat. Then exhale feeling a pelvic floor contraction/lift as we rise out of the squat.
With time this coordination will become automatic but initially you may feel you need to actively contract the pelvic floor as you lift out of the squat especially if you feel any downward pressure onto the pelvic floor during this phase of the movement.
For other functional movements whether it’s a lunge or lifting your baby up, use the concept of ‘exhale on exertion’ and lift the pelvic floor on the lifting phase of the movement, not forgetting the release on the lowering phase.