Is your Pelvic Floor functioning properly?

Pilates is often touted as the best way to strengthen your pelvic floor but that isn’t necessarily true. The best way to get stronger in your pelvic floor is to make sure it is functioning properly, which means a few things:

* You need length as well as strength – your pelvic floor muscles can’t contract effectively if they are over tight

* You need your pelvic floor to work in conjunction with your diaphragm. They work in synergy and if one isn’t moving properly then the chances are the other one isn’t either.

* You need your pelvic floor to be reflexive – it isn’t just about strength. It needs to react to the movement you are making – i.e. it needs to be relaxed when you are relaxed. Conversely, it needs to switch on and offer support when you need it. This can happen both consciously and unconsciously.

Working within the realms of your body

When you are exercising it is important that you are working within the realms of your own body. If you create too much intra-abdominal pressure (or IAP – the pressure created within our core when we move) for your core to control, this can cause problems. So while Pilates CAN be brilliant for the pelvic floor, it can also be unhelpful as lifting both legs off of the floor and then lifting your head creates lots of intra-abdominal pressure and that pressure has to go somewhere. It may go out and make your abdominals dome or it may go down and cause you to bear down into the pelvic floor.

Why Pilates is effective for your Pelvic Floor

One reason Pilates is so great for the pelvic floor is that it strengthens so many other muscles – the pelvic floor doesn’t stand on its own in the way we are often led to believe. By strengthening your gluts, your legs, your abdominals and improving your posture,  you are making a difference to your pelvic floor health.

Checklist when considering doing Pilates for your Pelvic Floor:

* If you are experiencing symptoms you need to go and get specialist advice on this – any leaking, feelings of dragging/heaviness are not to be put up with

* When you are exercising, check your abdominals. If they are pushing outwards you are not controlling the IAP and you need to modify the exercise accordingly.

* Make sure you are co-ordinating the breath with the movement – exhale on the effort because when you exhale your pelvic floor naturally lifts and offers support

* Make sure you are working on releasing your pelvic floor as well as strengthening it. We are looking for a well-functioning pelvic floor, not just a strong one!

4 Must-Do Pilates Exercises for Pelvic Floor Issues

Here are my favourite Pilates exercises for pelvic floor health:

Rocking

On all 4s with a neutral spine, keep your pelvis neutral as your shift your weight forwards and backwards, making sure you don’t allow your tailbone to tuck under. This is a great way to release the pelvic floor, especially if you have spent much of the day sitting down

Pelvic lifts

Lying in neutral spine with your knees bent up and your feet in parallel. Exhale to relax and ten connect to the pelvic floor and tuck your pelvis under feeling your sit bones draw together. When you have found the tucked pelvis press into your feet to lift your pelvis off of the floor and think of peeling your spine up one vertebrae at a time. Make sure that you don’t lift your ribcage at the top. Inhale at the top then exhale to soften your ribcage and slowly peel the spine back down making sure your pelvis stays tucked until you release back into neutral. Repeat about 8 times.

Double knee openings

Lying in neutral with your feet together. Inhale to open both legs about half way to the floor. Exhale to allow your abdominals to drop then draw your sit bones and hip bones together, connect to your centre and pull the legs back together again. Think of the legs being heavy and using your pelvic floor and abdominals to pull them back to the middle. Repeat 8 times.

Clams

Lying on your side with your knees bent up and your feet roughly in line with your sit bones. Try and think of your pelvis being level so you are reaching your top hip away from you and getting a sense of lift in your underneath wait. Inhale to spiral your top leg outwards to open the knee. Exhale to close the leg (You could put a ball or cushion between your legs here and gently squeeze with your inner thighs for more pelvic floor connection). Think of the opening action coming from your hip joint so you are focusing on mobilising while keeping your pelvis stable. Repeat about 10 times on each side

I was teaching pre and postnatal Pilates for 3 years before I got pregnant and my biggest fear around birth / the postnatal period was getting a prolapse. I saw first hand the stress it can create and that it isn’t an easy recovery process. It can feel like it’s getting better and then suddenly at certain times of the month it feels worse again. It can feel totally overwhelming. And if the issue isn’t resolved within the first year, it can feel like you are stuck with it forever.

Pilates for Prolapse

Rest assured, that you can do something about prolapse. So how does Pilates aid prolapse recovery? Pilates helps to improve your breath work, core function and posture, all of which can be instrumental in recovery from / living with prolapse. If you have a prolapse, it is important to work alongside a Pelvic Health Physio with any exercise programme.

In this blog post, I’ll be sharing my story about prolapse and the Pilates exercises I did to help me with the recovery process. I also teach these exercises in my Your Core Matters programme, available online.

Diagnosed with Prolapse

So of course I was diagnosed with a prolapse about 6 months after my first baby was born. I knew I was susceptible as I am hypermobile. I had an 8lb 9oz baby and a long pushing stage. I also got up and about within days of the birth, wearing a badge of honour that I was recovering so well (SO cross with myself for that one!). And I didn’t give myself adequate recovery time.

Luckily with all the Pilates I did and the knowledge I had, I was symptom free. But then I had another whopper at 9lb 2oz and another long guided pushing stage (the midwives got nervous because it didn’t seem to be happening on its own). After baby number two the symptoms were more noticeable.

It was never terrible but I could get caught off guard and find myself leaking if I sneezed out of the blue. Running or high impact exercise didn’t feel like an option for a while. However, over time I have managed to get symptom free again and here are some of my favourite exercises that I believe have helped me on this journey.

Pilates Exercises for Pelvic Floor Prolapse

Please see a Women’s Health Physio and get signed off by a health professional before doing any exercise, especially if you have been diagnosed with a prolapse. There is so much you can do to support it better but exercising in a way that doesn’t suit you can make things worse. It is therefore advisable to get as much support and guidance from an expert as possible.

Ball Squeeze

Lying on your back with your knees bent up and your feet in parallel. Place your over ball (or a cushion) in between the tops of your legs, up towards your pubic bone. Inhale to relax. As you exhale, gently squeeze into the ball and feel your pelvic floor and abdominals connect. Inhale to consciously release. Repeat about 10 times.

Pelvic Lifts

Lying in neutral spine with your knees bent up and your feet in parallel. Inhale to release the pelvic floor, exhale, relax first and then connect to the pelvic floor muscles and tuck your pelvis under feeling your sit bones draw together. When you have found the tucked pelvis press into your feet to lift your pelvis off of the floor and think of peeling your spine up one vertebrae at a time. Make sure that you don’t lift your ribcage at the top. Inhale at the top then exhale to soften your ribcage and slowly peel the spine back down making sure your pelvis stays tucked until you release back into neutral. Repeat about 8 times.

Double Knee Openings

Lying in neutral with your feet together. Inhale to open both knees out to the side, about half way down to the floor. Try to consciously relax the pelvic floor as you do this movement and try to keep the pelvis still. Exhale to relax and allow your abdominals to drop then gently connect to the pelvic floor muscles and lower abdominals and pull the legs back together again. Think of the legs being a weight for you to pull back to the centre. 10 reps.

Clams

Lying on your side with your knees bent up and your feet roughly in line with your sit bones. Try and think of your pelvis being level so you are reaching your top hip away from you and getting a sense of lift in your underneath wait. Inhale to spiral your top leg outwards to open the knee, allowing the pelvic floor to release. Exhale to close the leg and gently connect to the pelvic floor. Think of the action coming from your hip joint so you are focusing on mobilising while keeping your pelvis stable. Repeat about 10 times on each side.

Squats

Stand with your feet a little wider than hip width and work to bring the outside edges of the feet into parallel. Inhale to squat down, keeping the knees over the ankles and sending your bottom backwards like you are trying to sit into a chair. Exhale to push back up to standing, bringing your pelvis stacked over your ankles and your ribcage stacked over your pelvis.

When you breathe in this way with movement, it allows your pelvic floor to function in rhythm with your breath. This means you are teaching the pelvic floor to release as well as contract and learn to work with your movement patterns to function well on it’s own and support you.

Listening to your body is important. If any of these exercises don’t feel right then stop!

Other things that will help you to improve your pelvic floor function are:

Looking at your breathing patterns

When we breathe we create intra-abdominal pressure and it is important to make sure that this is as balanced as possible through the torso. Make sure you are able to breathe into the whole ribcage and that you aren’t using a ‘belly breath’ which increases the pressure going into your pelvic floor.

Addressing your posture

When your bones are well aligned it makes it easier for the muscles and fascia to function well. For example excessive rounding of the upper back has been shown to correlate with pelvic organ prolapse – this makes sense because it is likely to cause the person to bear down and put extra pressure into the pelvis. Ensuring that there is balance throughout the body, the legs are aligned within the hips and there is a sense of lift throughout the torso rather than bearing down can all help.

Looking at your toilet habits

Constipation and bearing down to go to the toilet can contribute to pelvic floor dysfunction. Make sure you drink lots of water, increase the fibre in your diet and look at the angle at which you sit on the toilet. Ideally your knees would be higher than your hips so you are almost in a mini squat position. You can use a squatty potty or toddler step to help with this.

 

If you feel like you would like some more help and guidance around this do feel free to get in touch. You may be interested in our Your Core Matters online Pilates classes or a regular Pilates class to help support your pelvic floor.

I have just started the latest live classes for the Your Core Matters course for pelvic floor health. Following the webinar and screening I have told sooo many women that they need to be seen by a physio who specialises in the pelvic floor. Although our classes are amazingly helpful, whenever someone is experiencing symptoms such as leaking, heaviness or dragging around the vagina, the best thing to do is ALWAYS to seek professional help. That can take the form of a Mummy MOT or another pelvic floor specialist.

So what pelvic floor support is available, and why do I need it?

Every single person who has ever had a baby would ideally be checked by a Pelvic Health or Women’s Health Physio for pelvic floor function, posture and alignment and abdominal function. In France this is standard practice and women are also given an exercise programme to help assist with their recovery but unfortunately in the UK many people aren’t even aware that this kind of specialist physiotherapy exists. You can also visit a Women’s Health Osteopath for a postnatal check where they can assist you with fascial release, scar release if necessary, postural assessment and work to improve your alignment and movement patterns.

It is so common to have concerns about your pelvic floor postnatally and getting specialist help and tailored advice is really setting yourself up for a lifetime of better health. Don’t underestimate how taking steps now could be a game changer in years to come. You don’t just have to accept it at any stage of life. There is so much you can do but most people need specific advice to help them.

Basically if you have ever had a baby but haven’t had this level of support in your postnatal recovery, you will find it very helpful to make an appointment and get advice, especially if you are experiencing any pain or symptoms such as leaking or dragging around your vagina. You can get one of these checks by a specially qualified Mummy MOT practitioner but you can also see a Women’s Health or Pelvic Health Physio who can do all of the same checks.

Mummy MOTs in Hertfordshire

If you are based in Hertfordshire, I can recommend Erica Lewis from Herfordshire Women’s Health in St Albans and Becky Aston who has a clinic in Berkhamsted.  If you’re based outside of Herts, you can find someone suitable through the Squeezy Directory.

What happens during a Mummy MOT?

Your appointment will vary depending on what issues/symptoms you are having (if any) but your therapist will start by taking a detailed medical history and discussing your reasons for making the appointment. It can feel a little embarrassing talking to someone you don’t know about such intimate issues but remember they do this every day and there is nothing to be ashamed of.

Your therapist is likely to assess your abdominal muscles, pelvis and lumbar spine and you may be offered an internal examination to understand how your pelvic floor is functioning. They will be looking to understand the tone, strength and control of your pelvic floor muscles as well as any signs of injury or scarring, signs of pelvic organ prolapse and muscle tone. They can also test your pelvic floor muscles for strength and endurance, co-ordination and any imbalances.

Ideally they will also look at your posture and movement patterns to help them (and you) to understand what changes you can make to best support your pelvic floor health on a daily basis. All of these assessments will help them to develop a specific exercise programme that is tailored just for you and explained so you can have a better understanding of what you need.