By Dr. Blair Green PT, DPT
Do you leak urine when you cough, sneeze, run or jump? Do you experience pressure in the pelvis that feels like something is falling out? Do you struggle with chronic constipation? Do you experience pain with intercourse or with wearing tampons? If you can answer yes to any of these questions you may suffer from pelvic floor dysfunction (PFD).
PFD affects at least 25% of women, and the prevalence rises in an athletic population to nearly 40%. While pregnancy and childbirth are risk factors for PFD, many women who never become pregnant may also experience these symptoms.
The pelvic floor muscles (PFM) connect from the pubic bone to the tailbone and form a hammock-like structure on the underside of the pelvis. PFD occurs when these muscles are not able to perform their normal function. The PFM assist with urinary and defecatory function, sexual arousal and orgasm, and pelvic organ support. In addition, the PFM make up the most inferior part of the core, working with the diaphragm, abdominals and low back muscles to provide central core control.
Alleviating and preventing problems with the PFM can sometimes be as simple as incorporating specific exercises. Research shows that one of the best ways to prevent urinary leakage is to work on strengthening the PFM. However, to maximize function and improve problems, the PFM must also learn how to relax as well as contract, and work alongside the other muscles in the deep core, as well as with the muscles of the hips and legs. If you are experiencing symptoms of PFD, consider trying the following exercises:
- Deep Diaphragmatic Breathing – The diaphragm and PFM work as a team. Deep breathing through the diaphragm can help the PFM relax, and can also help them contract properly. When you inhale, the PFM relax and lengthen, and when you exhale they contract and shorten. Try lying on your back with your knees bent. Place your hands on the outside of the rib cage. As you inhale, the ribs should expand and the chest and belly should rise. As you exhale, the ribs should move down and in, and the chest and belly should fall. Continue to breathe for up to 10 – 20 repetitions. This can also be done sitting, standing, lying on your side, or on all fours.
- PFM Activation, aka “Kegel” exercises – This exercise serves to contract the PFM, which is an important mechanism to assist control of bowel and bladder function, and support for the pelvic organs. While the PFM should be strong, to counter high forces that the body encounters with lifting, jumping and running, It is just as important that the muscles can fully relax between contractions. Begin with deep diaphragmatic breathing. Inhale to prepare. As you exhale, imagine a kidney bean at the opening of the vagina. Squeeze and lift the kidney bean, contracting the PFM. Hold for up to 10 sec as you continue to breathe. Relax. Repeat up to 10 times. For variety in the PFM Activation exercise, try to imagine that the muscles are an elevator. As you exhale, the elevator is rising from the first to the fifth floor. As you inhale, it lowers back to the first floor. You can also practice quick contractions where you hold the muscle tight for one to two seconds and then let it go. It is important to keep breathing through all of these exercises.
- Bridging – This exercise incorporates breathing, PFM activation and spinal movement. It lifts the hips above the shoulders which can help assist gravity to improve pelvic pressure. Lie on your back and begin with diaphragmatic breathing to prepare. As you exhale, contract the PFM and begin to curl up one vertebra at time, lifting the hips off the floor. At the top, the trunk should form a straight line from the shoulders to the hips. Inhale to pause at the top, and exhale to reverse the movement, rolling the spine and hips back to the floor. Repeat 10-20 times.
- Happy Baby – This yoga pose is a great way to coordinate breathing with pelvic floor relaxation. Lie on your back. Lift your legs, bending the knees, so that the feet are facing the ceiling. Grab under your feet with your hands. Hold this position as you take 5-10 deep breaths.
- Assisted Squatting – Deep squatting may exacerbate signs of urinary leakage or pelvic pressure. Using a strap or holding onto a door for assistance, or limiting range of motion, are two ways to complete a squat movement with less downward pressure on the PFM. Stand, holding onto the back of a chair, doorknob or strap. Take one breath to prepare. On the next inhale, lower down toward the floor, bending at the hips and knees. As you exhale, activate the PFM, and use the glute (buttock) muscles to stand up. You can use your arms for assistance to pull up to reduce pressure on the pelvis. Repeat 10-20 times.
Not every problem with the PFM can be fixed with exercise, and not all exercises are appropriate for every person. If you feel like you are not improving, or these exercises make your symptoms worse, please consult a pelvic health physical therapist or your doctor. The best way to treat PFD is a multi-disciplinary approach combining physical therapy, medical management, behavioral strategies and exercise.
BLAIR GREEN, PT, DPT, co-author of Go Ahead, Stop & Pee: Running During Pregnancy and Postpartum, is a Doctor of Physical Therapy with a focus on pre/post-natal health and wellness, the founder/CEO of Catalyst Physical Therapy, and a board-certified orthopedic specialist. Known as the “go-to” expert in her field, Dr. Green is also a Polestar-trained Pilates instructor and a Certified Manual Trigger Point Therapist. She serves as an instructor in the Physical Therapy program at Emory University, and as a faculty member for several Physical Therapy continuing education companies.