7 Ways To Rehab Your Pelvic Floor That Isn’t Just Kegels
Angela Rake, mum of 3, Pilates teacher specialising in women’s health and co-founder of Zing Wellness with her massage therapist husband, James, shares her top 7 ways to rehab your pelvic floor beyond just traditional kegels.
Many things can weaken the pelvic floor. High impact and combative sports, weight lifting, persistent coughs, the drop in oestrogen during menopause and neurological conditions that affect cognitive function can weaken the pelvic floor however in this blog I am focusing on one of the biggest pelvic floor weakeners which is pregnancy, childbirth and motherhood.
Let me start by saying, I am by no means dismissing kegels. They have their place but in my experience women that come to me experiencing pelvic floor dysfunction have tried to do their pelvic floor exercises to no result. I believe that if women are experiencing urinary incontinence when coughing, sneezing, running, jumping or even shouting then we need to train the pelvic floor to cope with big changes in intra-abdominal pressure and this isn’t going to be achieved by just doing pelvic floor squeezes there is more to it. In this blog I intend to delve a bit deeper with regards to what else you can do. I really hope you find it helpful and enlightening.
1) Establish if you are even doing your pelvic floor exercises optimally
The pelvic floor is a huge sling of muscles and it can be very easy to not be using the whole sling or just engaging the superficial muscles or even just your anal and vaginal sphincter muscles. The best way to do this is to see a Women’s Health Physiotherapist like Erica Lewis or Becky Aston who are specialists in pelvic health and can do an internal examination to assess your pelvic floor function. I can’t see your pelvic floor muscles so this is hugely useful not just for you but also for a Pilates teacher like myself as the type of words I use to cue your pelvic floor will be guided by what they say. For example, many women actually suffer symptoms not because their pelvic floor is weak but because it is tight, and you are holding onto the muscles all the time and find it hard to let go. In this case, I would be initially working with you to let go of your pelvic floor without fear. You can’t strengthen a muscle that is in a constant state of tension you see! In fact, try holding your arm in a bicep curl and then try and engaging it and see what I mean.
Becky Aston, Pelvic Health Physiotherapist says: “An increasing number of women in clinic have hypertonic pelvic floor muscles and need to learn how to let go and work on the relaxation part as much as the contracting. Frequently women have a symptom that is related to a weak pelvic floor muscle such as stress urinary incontinence and have been told or assume they need to strengthen the muscles, but this can just make symptoms worse”
2) Work with a postnatal specialist Pilates teacher or exercise professional
If you are keen to get back to exercise after having a baby then first of all, please please don’t rush it. Cultures that have a period of confinement or ‘rest and recovery’ in the postnatal period have much lower rates of pelvic floor dysfunction. Resting up and giving your body the time and nourishment it needs to recover will in the longer term improve your recovery no end. When you do come to return to exercise look for a postnatal specialist Pilates teacher or exercise professional who can work with you gently and safely with a graduated return to exercise. There is a big difference between someone who has done a two-day course and someone who layers course after course and has chosen this area of specialism as their vocation. Look at their website, talk to them, read testimonials, ask other women, look at their training, the difference will be clear.
3) Take time to understand your anatomy
Your pelvic floor has a hugely important function. It supports our pelvic organs (rectum, bladder, urethra & cervix). It supports faecal and urinary functions. It plays an integral role in sexual arousal and orgasm and plays a key role in childbirth. It also plays a vital role in managing intra-abdominal pressure. I always ask clients to think about their core as a cylinder with the pelvic floor at the base of your core, the diaphragm at the top of the core and abdominals round the front and back extensors at the back with the whole core pumped by your breath. Urinary incontinence, prolapse, pelvic floor dysfunction are mainly symptoms of mismanagement of intra-abdominal pressure. So, based on this it is absolutely vital to start with your breathing and understanding the connection between your breath and your core. This can take time to re-establish after childbirth too so takes time and patience. It is also vital to put this into practice through out day to day life rather than just when lying on the mat.
4) Manage your posture
This can be a really simple one as posture can be dramatically affected by pregnancy and motherhood. Since your posture and pelvic positioning has a huge influence on your pelvic floor engagement it is a vital thing to be aware of. If you tuck your bum under you often can only engage with the back of your pelvic floor and an over arched lower back means engagement only around the front of the pelvic floor so actually just thinking and working on your posture can be a big step in feeling a better connection with your core.
5) Invest in postnatal massage as part of your postnatal recovery
I have already touched several times on the negative impact that tension in the pelvic floor or postural tension can have on the body. The body can’t move freely if it is in a state of tension so reducing tension to establish full range of movement is so important and we are not just talking about the pelvic floor but the whole core so tension in your back, your rib cage, your abdominals, let’s face it your whole body will be having an impact on your pelvic floor. Again, cultures that practice confinement in the postnatal period strongly believe in the benefits of very gentle restorative postnatal massage daily (!) and I absolutely concur. I actually teach myo-fascial release techniques using a ball to complement hands on massage or to enable those where hands on massage is not a preference or is financially out of reach.
6) Nourish your body
As someone who has had lots of surgery in my life it was a real ah ha moment to learn the importance of nutrition, soft tissue massage, stress management and sleep in supporting the healing process and even more important to learn the things that go against healing and perhaps are slowing the process down. It is not rocket science but to have it spelled out in a scientific manner really helped me. This could be a whole blog in itself but quite simply nourish your body by getting high quality rest, eating real and nourishing food and avoid stress, alcohol, caffeine, sugar and processed food in order to promote healing in your body.
7) Understand how your pooping habits can help or hinder your pelvic floor
I know, I bet you weren’t expecting this one, right?! But absolutely getting constipated and bearing down when emptying your bowels is not great for pelvic floor at all. Sitting with your feet on a stool in a squat like position so knees above your hips really helps with your ano-rectal angle enabling you to empty your bowels with more ease. Drinking enough water and lots of fibrous foods helps lots too. Also remembering not to ignore the call to empty your bowels. The longer you wait the more your colon reabsorbs moisture making your stools even harder to pass.
If any of this sparks your interest, please check out Zing Wellness and our postnatal massages and Core Care & Pelvic Floor Repair Postnatal Pilates & Wellbeing course which helps you put all of this into practice. It is accessible in a 6 week group class format, 1-2-1 format and online course format, something for absolutely everyone. I even have a more progressed Mums That Move class that is for maintaining pelvic floor function and transitioning to higher impact exercise (if you wish).
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