Progressing your pelvic floor training

While it can initially be very useful to find and activate/relax your pelvic floor muscles in supine or side lying (have you seen the free download about this on the Resources page?!), it’s really not a good long term or functional strategy – the pelvic floor needs to actively work in a number of different positions and in a number of different activities and in coordination with the breath.

Once you have mastered the art of contracting, relaxing, lengthening and relaxing the pelvic floor muscles in a supine or side lying position, try it in sitting (on a firm chair to start with – you can try sitting close to the edge so that when you contract your pelvic floor you can feel it lift up and in and away from the surface of the chair & then relaxing back down again)

In standing, try and keep even weight on both feet and really bring your attention to the movement of the breath as you close the openings, lift up and in and then relax the pf muscles back down again.

Progressing to Movement:

The Knack: Ashton Miller et al first described this pre-emptive tightening of the pelvic floor before a sudden increase in intra abdominal pressure (such as a cough or a sneeze) back in 1998 and it was reviewed again in 2008

Essentially it involves bracing the pelvic floor for a sudden increase in pressure – as stated above, perhaps a cough or a sneeze, but also applicable for going from sitting to standing. Incorporating ‘The Knack’ into every transfer from sit to stand with emphasis on breathing and pf coordination can really enhance the efficiency of the lumbo-pelvic stability system

Try this: Sit close to the edge of your chair. Fold your arms (this way you won’t be tempted to push down on the arms of the chair!)

Take a deep breath in, as you exhale, relax your pelvic floor

Take another breath in, this time with the exhale, close the opening of your pelvic floor and lift up and in as you stand up (Don’t forget to keep breathing!)

Once you are standing, relax the pelvic floor (and again, don’t forget to breathe!). Many women (especially those who do have some incontinence problems, are concerned they will leak if they fully relax their pelvic floors. This is an important mis-conception to address. By being able to fully relax their pelvic floors, they will actually gain a greater spectrum of movement when they contract their pf muscles, promoting a faster return to continence and control than simply

 ‘Tighten! Tighten! Tighten!)

We need to be able to have a full spectrum range of motion and control with our pelvic floor muscles – for continence control, for sexual health and for avoiding problems with back pain or even pelvic organ prolapse

In my next blog post we will look at how we can incorporate more dynamic and challenging movements into our pelvic floor training programmes.

See you then!

Mx

What I want women to know about bladder health…..

So many women (maybe as many as 1 in 3) have issues with their pelvic floor muscles and problems with bladder control. Despite what the ads in magazines tell us, there’s more to it than just buying pads and ignoring it. Here’s what I want women to know:

Leaking might be common but never normal

There is almost always something you can do about it – don’t just wear a pad and chalk it up to getting older/having kids/being menopausal…

You should be able to last at least two hours between trips to the bathroom – and when you go, you should have a good amount of urine – at least 8 Mississippi’s worth (One Mississippi, Two Mississippi….Eight Mississippi). Otherwise, you may have gone too soon – use that bladder capacity!

If you are going more frequently than every two hours, a bladder diary might be useful, to track how often you are going. There is a great template available from my colleagues at hermanwallace.com (full disclosure – I am a faculty member!) You can find it here

Restricting your fluid intake is not the answer – in fact it might make it worse. Some fluid are worth restricting as they can act as bladder irritants (fizzy drinks/soda/tea/coffee/ diet drinks…..I’m talking to you) but making sure you have a good water intake is super important for keeping your bladder healthy, your digestive system moving and your brain thinking clearly. Current thinking is that your urine should be clear enough to read through (not quite sure how you would test this…) but do bear in mind that certain vitamins, supplements and foods can alter the colour of your urine (eg Vitamin C and B’s)

Think ‘Kegels’ don’t work? Maybe you’ve been doing them wrong….check the RESOURCES tab for instructions on doing your pf exercises correctly. Try and do your exercises two or three times an hour rather than just once a day. Your brain learns better with lots of small reminders throughout the day rather than one large batch of exercises once or twice a day

 

Don’t hover when you pee – sit and release

Don’t strain when you are urinating – just relax and let it go….no pushing it out to go a little faster. If you haven’t got time to urinate, your schedule needs a re-boot! And while we’re here…don’t hover over the toilet seat! If you don’t sit down and relax your pelvic floor muscles, your bladder can’t empty completely. Worried about ‘germs’ on the toilet seat getting inside? The only place on your body that touches the toilet is the back of your thighs and they are pretty tough – they can handle it. Now if you want to worry about germs, think about the bathroom taps – where everyone touches after they have used the toilet…just kidding (please do wash your hands!)

No ‘Just In Case’ trips to the bathroom. If you try to ‘go’ when you don’t really need to, you are training your bladder to become over sensitive to stretch. You are in charge of your bladder, not the other way round! Don’t go t the bathroom at the first urge to urinate – do some quick squeezes of your pelvic floor (Close & lift, Relax, Close &lift, Relax, Close & lift, Relax) along with some slow deep breaths. This tells your bladder to relax and stop contracting. Never rush to the bathroom! Once you have calmed your bladder down, walk there slowly – remember: you are in charge of your bladder.

On the other hand – your bowel is pretty much in charge of you! When you get the urge to have a bowel movement, start thinking about making your way to the bathroom. If you consistently put off the urge to have a bowel movement, you can interfere with certain brain/bowel reflexes

The Bottom Line (sorry…) – if you don’t take care of yourself, from the inside out, it can affect every aspect of your life. Who wants to worry about leaking when they exercise, walk, run or even laugh? If you are having bladder problems, talk to your healthcare provider, go see your women’s health physio and take care of you.