Do you pee when you laugh or cough? If so, you are not alone. Urinary incontinence is just one of the symptoms of Pelvic Floor Dysfunction (PFD). Others types of PFD include pelvic fecal (bowel) incontinence, chronic pain, and pelvic organ prolapse — when the bladder or uterus bulge into the vagina.
Having proper control over your pelvic floor muscles allows your bladder and bowels to function optimally. And, Pelvic Floor Dysfunction is more common than most women, and men, realize.
The good news is that there are a lot of ways to keep your pelvic floor muscles healthy and avoid or reverse PFD.
Why Are Your Pelvic Floor Muscles Important?
The pelvic floor is a group of muscles, ligaments, and tissue that form a sling, of sorts, to support your pelvic organs and stabilize your pelvic joints. In a woman, the pelvic floor supports the uterus, vagina, bladder, urethra, large bowel, and rectum.
When your pelvic floor muscles are strong and flexible, you are able to control your bladder and bowels by contracting and relaxing the muscles and tissues in your pelvic floor. You also have better orgasms! When these muscles weaken due to habits, such as sitting too much and not moving your hips through their full range of motion, or from muscle tension due to chronic stress or overdeveloping the abdominal and pelvic floor muscles, you can end up with Pelvic Floor Dysfunction.
Men can also experience Pelvic Floor Dysfunction.
Childbirth, Menopause, and Your Pelvic Floor
Pelvic Floor Dysfunction usually does not occur due to one-time events such as childbirth. However, childbirth, repeated heavy lifting, and hip or back injuries can cause your pelvic floor to weaken, increasing the likelihood of PFD. In short, whenever the muscles, tendons, ligaments, or nerves of the pelvic floor are affected, you are at risk for PFD.
Menopause is associated with weakening of the pelvic floor as well, but it is not the cause. Many women ages 40-59 experience Pelvic Floor Dysfunction at some point—which can be triggered by dropping estrogen levels during perimenopause. But again—low estrogen is not the cause in those who have good muscle function and proper pelvic alignment.
Other factors that can contribute to PFD include:
- Cesarean section
- Standard American Diet (SAD)
- Lack of exercise
- Poor posture
- Wearing high heels for years
- Shortened hamstring muscles
- Tucking your tailbone under you (which is quite common and absolutely the wrong thing to do!!)
- Straining during bowel movements (which is, again, related to the wrong pelvic positioning)
The good news is there are many ways you can strengthen your pelvic floor and pelvic girdle muscles to avoid PFD and restore continence and overall health to your pelvic area.
Here are my top 10 recommendations for strengthening your pelvic floor:
- Stop sucking in your gut. Sucking in your gut does not create core strength and can actually increase downward pressure on your pelvic floor. This creates a strain on the connective tissue in your abdomen by displacing your abdominal viscera. Many people hold in their bellies without knowing it. If you do this, try to consciously relax your belly while sitting, lying down, or in a cat/cow position on your hands and knees while taking deep, relaxing breaths. And pretend you are a dog or cat with your tail out—not tucked under you. Do this several times per day.
- Develop your core. You can develop your core muscles (between your pubic bone and lower rib cage) by doing the following: Take in a deep breath while keeping your shoulders down and pulling your abdomen toward the back of your spine. Notice how this feels like engaging a corset. Hold for the count of 10—keeping all those corset muscles pulled in. Aim for doing this 10-20 times per day. This will pull up and strengthen your abdominals and take pressure off your pelvis. This is not the same as sucking in your gut unconsciously. This is consciously developing your core strength. Esther Gokhale of the Gokhale Method teaches this as part of ideal posture: Sit with a towel folded lengthwise under your sitz bones. This will automatically tilt your pelvic bowl forward so that your pubic bone is where it should be—under your pelvic contents. Think of your pelvis as a bowl—you want it tilted so water spills out the front. When you sit, make sure your tailbone is out behind you.
- Wear loose-fitting clothing. Wearing tight clothing has the same effect as sucking in your gut. Plus, if you regularly wear tight jeans or Spanx, you may be interfering with peristalsis in your gut, which could cause constipation, gas, and bloating. Finally, tight clothing can cause reduced circulation to your lower body and make it difficult to breathe properly.
- Breathe from your diaphragm. Your inner core is made up of your pelvic floor, your transversus abdominus and multifidus, and your diaphragm. When everything is working optimally, your diaphragm and pelvic floor move in sync. However, when you suck in your gut, slouch over your computer, or experience chronic tension, this pattern gets disrupted. To practice diaphragmatic breathing, lie down on your back. You can put a pillow under your knees, but you want a neutral spine. Place one hand just above your belly button. Breathe in slowly through your nose, allowing your inhale to expand your belly. Feel your upper belly rise under your hand. Keep your upper chest, shoulders, and neck muscles relaxed as you inhale. Then release your breath without forcing it out. Feel your chest and belly drop. Do this for 1-2 minutes and work up to doing this for 5 minutes and several times per day.
- Try squatting. Biomechanical specialist Katy Bowman points out that the gluteal muscles are the ones that are most important for pelvic floor function. Doing regular squats elongates your pelvic floor muscles and makes them more functional. Squats also help re-position your pelvis by balancing out the anterior pull of your sacrum. When you have a flat butt and no curve in the small of your back, that’s a sign that your pelvic floor is starting to weaken. Humans used to squat to eliminate urine and feces. Some cultures still use squat toilets. And, many cultures use the squat as a sitting position instead of using chairs. To do a deep squat (called malasana, or garland pose, in yoga), you may want to start with a towel or yoga mat rolled up under your heels, then lower yourself slowly until your tailbone is as close to the floor as possible with your heels still flat on the floor or your towel. You can practice deep squatting at home, at the gym, or at the yoga studio. You can also practice deep squats while playing with small children (notice how they do this!), gardening, and while using the toilet with the help of a Squatty Potty or something to lift your feet. In addition to strengthening your pelvic floor, you may notice fewer problems with your gut function, and may even avoid hemorrhoids. Note: many Westerners cannot do the deep squats that other cultures are brought up doing. We tend to lose this ability after childhood. Don’t worry about it. Just squat as low as you can while keeping your knees in alignment with your toes. I personally can’t do anywhere near the kind of squat that my 3-year-old granddaughter can do.
- Exercise. There are a number of exercises you can do at home or at the gym to help strengthen your pelvic floor. Some of the best exercises include bridge pose, wall squats, jumping jacks, and dead bug crunch. For instructions on how to do these exercises, ask a knowledgeable trainer. You can also search online for video instructions. I also recommend that you Google Katy Bowman, who has many good resources for pelvic floor exercises.
- Practice yoga or Pilates. My Pilates teacher has had countless clients over the years who have healed their urinary incontinence in a few months after starting classical Pilates. And, many pelvic floor physical therapists use Pilates reformers as part of their practices. Both Pilates and yoga can help strengthen your core, which helps improve pelvic floor strength. Pilates targets the deep core and helps you develop both strength and flexibility. You can try a Pilates mat class or seek out an instructor who is well-versed in using the equipment. In yoga class you can practice your root lock, or mula bandha, to target your pelvic floor.
- Use vaginal weights. Weightlifting strengthens your muscles. You gain the same effect when you use vaginal weights. Inserting cone-shaped weights into your vagina helps to train your pelvic floor muscles. You simply contract your pelvic floor muscles to keep the weight in place. You can find vaginal weights, such as Yoni Eggs, or Lelo balls, online. I find this approach far superior to the standard Kegel exercises which, in far too many women, just make the one small pubococcygeus muscle tight and don’t do much of anything with the rest of the pelvic floor.
- Try Biofeedback. Biofeedback can help you learn how to strengthen or relax your pelvic floor muscles. Using special sensors that track your pelvic floor muscle function, you can learn how to activate the correct muscles to keep your pelvic floor toned. This is typically done in an office setting by a nurse or trained therapist. The sessions are usually about an hour. You sit in a comfortable chair with your clothes on after the sensors have been put in place – usually one on your abdomen and the other in your anal canal. The sensors measure the electrical activity of your pelvic floor muscles – especially the ones that control bladder and bowel function – while you contract and release the muscles. There are also home biofeedback devices you can purchase, but you should still have a pelvic floor assessment by a professional before using.
- Get therapy. A women’s health physical therapist (WHPT) can diagnose and treat pelvic floor issues. They often perform manual therapy where the therapist gently massages, stretches and releases the spasms and trigger points in the deep tissue of your vagina. This, alone, can sometimes be enough to resolve symptoms of PFD, including urinary incontinence and pelvic pain. Some WHPTs partner with OB/GYNs, urologists, and other specialists. Your first session may include an internal exam to assess your pelvic floor. Then your therapist will create a program that is right for you. Women who have PFD and have practiced Kegels with little or no results typically benefit from seeing a WHPT. You can search the American Physical Therapy Association website for a licensed WHPT.
Have you ever experienced Pelvic Floor Dysfunction (PFD)? If so, what have you done to resolve it? Please leave your stories in the Comments section below.