If you’re noticing pelvic floor symptoms like leaking during daily activities or exercise, you’ve probably heard advice like “just do a Kegel” However… doing kegels alone does not build a strong system. Here’s why:
Kegels focus on contracting (squeezing and lifting) the pelvic floor muscles, but not on gaining control. The pelvic floor, similar to other muscles in our body, has a range of motion that it moves through for optimal function. The pelvic floor can:
- Lengthen (eccentrically loading)
- Relax (midrange position, able to respond to demand in any direction)
- Shorten (concentric activation).
Along with be able to squeeze and lift (the contraction), relax and lengthen, it needs to work in coordination with your diaphragm to create and regulate pressure. It never works in isolation.
You can kegel until the cows come home, but is it really going to improve your overall function? Probably not. Most pelvic floor issues are happening when you’re not thinking about the kegel. For example, when you spontaneously sneeze, laugh, cough, jump or suddenly change direction. If you’re in a constant state of clench, a rigid pelvic floor likely doesn’t not tolerate that sudden impact well. We need our pelvic floor muscles to be responsive, dynamic and move through the full range of motion.
Rather than focusing on the contraction, instead, the more you focus on how the rest of the body is working with your pelvic floor, the stronger you will get.
Better breathing: Coordinate your diaphragm and pelvic floor
Learning to breathe correctly is the single most important thing you can do for your core and pelvic health during pregnancy and into postpartum. It’s a powerful tool to stabilize and support your body during movement, manage intra-abdominal pressure and keep your body strong. However, during this season, it takes a little more intention to keep breathing in a manner that supports these key functions.
Diaphragmatic breathing (360 breathing) is breathing with the entire core stabilization system: your diaphragm (the roof of your abdominal cavity), your transverse abdominals (your corset abs), your multifidus (your back stabilizers) and the pelvic floor (the floor of the abdominal cavity). For an optimal breathing pattern, everything needs to work together in a synchronized and coordinated way.
Diaphragmatic breathing is slow, but it is not forceful. In order to make this breathing pattern happen all day long, you need to train your body how to do it. During pregnancy, as posture/organs shift, and the coordination between these muscles are jumbled. When the coordination between inner core muscles is lost, we begin to see a host of symptoms; low back pain, large abdominal separation, leaking etc.
Breathing dysfunction can also occur due to stress, anxiety, poor awareness – leading to ‘chest breathing’. This uses the smaller, weaker muscles that live in the neck and shoulders and can lead to tension and pain in the upper body.
For a proper breath pattern, you want to start by taking a long, slow breath in through your nose. When you inhale your stomach should rise while your ribs expand to the sides. This is why strong abdominal muscles are so so important, and why breathing can be way more challenging postpartum. Strong abdominals mean we are able to get more rib and back body expansion, something a lot of women struggle with after 9 months of postural changes.
I have found that visualizing drawing air into the bottom of the ribs, or visualizing sending my breath into my lats or my diaphragm lengthening downwards on the inhale, encourages that expansion. To exhale, visualize that you are scooping out the air in your body making a hook shaped pattern with your belly or zipping up pants.
Take caution not to breath exclusively into your BELLY or simply suck in your abdominals on the exhale.
Posture
As your bump size grows during pregnancy, the position of the pelvis alters, you rib cage shifts and the relaxin hormones causes laxity in your joints (needed for birth). This change in alignment puts more pressure on your low back, stretches your core muscles, adds more demand to your pelvic floor, challenges your overall stability, weakens your glutes and tightens the front side of your body.
During the postpartum period, it is so important to focus on lengthening out the short, tight muscles in the front of the body and rebuilding posterior chain (back of your body) strength. This balance will help realign your body, reduce pelvic floor symptoms and prevent some of the common bad habits we see in moms; like clenching/tucking under you glutes.
This postural habit of clenching, squeezing, gripping is to compensate for stability. If you are doing this with your glutes, chances are your pelvic floor is doing the same. Clenching your glutes tends to subconsciously happen. For example, when you’re washing the dishes, standing in the shower, cleaning your teeth, holding your baby, sitting at traffic lights in your car etc. Clenching your glutes can make them weaker and harder for your pelvic floor to respond when you really need it to.
Clenching tucks your butt under which makes it harder for the front of the pelvic floor to contract and more ineffective at dealing with stresses. It’s the front of the pelvic floor that needs the strength and range but when your posture forces the pelvic floor muscles into a shortened, tightened position its more challenging to stop the leak of urine or lift front prolapse.
If this is you, it’s so important to find some length in your glutes. Work on moving slowly through the eccentric portion of the rep with both mobility drills and strength movements. Here are some of my favourite examples:
Glute strength
Along side relaxing and releasing, you also want to train your glutes in conjunction with correctly activating your pelvic floor. Glutes help support your core & pelvic floor in both function and performance. They’re BFFs with your pelvic floor and having strong glutes can have a huge impact on how your core, pelvic floor and ENTIRE body feels.
The glutes counterbalance the pelvic floor muscles on the sacrum. When the glutes are not strong enough, the pelvic floor muscles are too tight and can pull the sacrum out of alignment, decreasing overall pelvic floor strength.
The glutes spend less time in their postural role and instead, your pelvic floor picks up the slack. When this happens you may notice butt clenching, excessive gripping, tucking under (as mentioned above) as compensation to create stability.
Strong glutes need: hip extension, internal rotation, ab/ad duction, eccentric strength, single leg strength and your solid compound moves.
Strengthen your deep core
Your abdominals need to fire correctly to support your pelvic floor. Start with the basics and then progress.
Supine drills are a great place to start in those early weeks postpartum, however progression is key! We need to challenge our body in a variety of different positions & loads to build strength.
But how do you know when your body is ready for something more challenging?
Here are some suggestions:
- You are not experiencing any pelvic pain or back pain, or excessive straining/pressure in your core
- You do not feel any downward pressure or heaviness in your vag during the movement.
- The movement should not be uncomfortable/painful.
- You are not leaking during the movement!
- You can breathe throughout the movement. The exercises should not be forcing you to hold your breath.
- The movement feels to easy!
Upper Back Mobility: A stiff mid back can decrease great breathing, be linked to low back pain & impact your pelvic floor. The thoracic spine is meant to flex, extend, laterally bend and rotate. Movement from your upper back needs to happen and if you’re locked up, your body will find a way to rotate from elsewhere.
Another consideration is your motor control (your ability to control movement). You might have the needed range of motion, but are struggling to move through the upper back without moving further down the chain.
