5 Simple Ways to Chat with your Pelvic Floor

pelvic floor health


Not that long ago, I stood on the side of the road, 4 months pregnant, having peed my pants.

Not that long ago, I stood on the side of the road, 4 months pregnant, having peed my pants. It was not a glorious moment for me. Unfortunately, I had horrible morning sickness and well, the pressure was so strong that, yup, I peed my pants! And at the time, I thought that was normal.

You know, that’s what happens when you’re pregnant, right? I still believed it to be normal, albeit very embarrassing, when I couldn’t manage to do jumps in my postnatal exercise class because when I did, I peed a little bit.

I wanted to share this experience because I know that women are looking for answers, for help.  I see it every day! It’s not easy for me, or for any of us, to share these embarrassing moments but it’s time to get all this out in the open so we can get the help we need and lead a vibrant and healthy lifestyle.

‘Lift your pelvic floor’ she said, to which I replied ‘wha??!!’

The number of times I sat in a yoga or pilates class and was instructed in various ways to engage my pelvic floor is pretty impressive considering when I was in those classes, I had NO idea what the hell they were talking about!

I mean, I had many wonderful, knowledgeable teachers but those muscles were completely foreign to me. Even after doing my own yoga and pilates training I was still left a bit mystified. I knew approximately where they were but I wasn’t quite sure what it meant to engage, or lift, or squeeze.

But I did my best…

I clenched my butt and I imagined lifting, I went through the motions, and went through the motions, with absolute urgency during my pregnancy, yet I still wound up with pelvic floor issues. It’s not easy to share with all of you and as well as the rest of the Internet that my pelvic floor muscles were less than stellar but I know there are women out there who are right where I was a few years ago. Completely out of touch with that area of their body and frustrated with the way things are working and feeling ‘down there!’

Don’t worry, we’ve all said ‘whaa?’

Most of us have no real connection to the pelvic floor muscles. We aren’t sure exactly where they are or how they work, we just know we need to work ‘em.

It really has been a taboo subject here in Canada up until recently but in many European countries Pelvic Health Physiotherapy has been part of standard care for postpartum women for decades… amazing! Thankfully this is changing and the information women need to feel better and more confident in their bodies is slowly coming to light!

Pelvic floor meet brain, brain meet pelvic floor!

Let’s take a look at some of the contributing factors to our disconnection of the pelvic floor muscles and what we can do to increase our awareness and function of these muscles.

We assume dysfunction is normal.

I hate to use the word dysfunction… and I just used the word dysfunction. No one likes to think of themselves as broken but if there is pain, or the muscles are not working optimally, there are things that can be done to help. A lot of women figure that experiencing a little bit (or maybe even a lot) of incontinence is normal during pregnancy and postpartum. But there is a difference between NORMAL and COMMON. Many, many women are experiencing incontinence, pelvic pain and discomfort throughout their pregnancy but that doesn’t mean it’s normal. Misalignment, improper breathing techniques, increased tension and trauma of the tissues can contribute to a weakening and/or decreased function of the pelvic floor muscles.

It’s embarrassing.

When it comes to incontinence even though we may think it’s normal, most likely we’re dealing with it silently and not really broadcasting it to everyone. I mean how many people want to tell the world they peed their pants on the side of the road?

It can feel quite disheartening, especially after having given birth and not necessarily feeling comfortable in your “new” body. I know for myself I felt like something must be wrong with me and this was just something I’d have to live with.

Incontinence, painful sex, pain when inserting a tampon, even an increased pressure in the pelvic area can be really hard to talk about. If you feel uncomfortable with a certain area of your body it is going to directly affect your relationship with those muscles and most likely, you will shy away from actually working on those areas/muscles because it feels overwhelming and scary to start.

See no evil, hear no evil, speak no evil.

Another big reason we feel disconnected from that area of the body is that unlike many other muscles in our body, we don’t actually see the pelvic floor muscles because they are internal. Generally, we don’t talk about them. We don’t often touch them and we haven’t received a whole lot of education on these muscles. And our muscles can’t speak to us either. Well they can, however, if we aren’t entirely sure how to identify their stress signals, how are we to know that there’s something wrong with them in the first place?

It’s no wonder that the majority of us are walking around without any kind of awareness or relationship with these muscles!

Generally, it’s not until we experience some kind of dysfunction that we become aware of these muscles and begin to look for help. I can remember these wonderful teachers trying to cue how to engage the pelvic floor muscles but it wasn’t until a physiotherapist suggested I actually touch and feel those muscles that I had a better understanding of where they were and how they should work.

Decreased function and sensation.

The one thing that most of us think of when we hear about the pelvic floor is kegels. We’ve all heard we should be doing them religiously – morning noon and night, plus every time we hit a red light!

Kegels focus mainly on the engaging aspect of the pelvic floor muscles and many of us are actually dealing with hypertonic pelvic floor muscles, meaning they are too tense. Tight and stiff muscles don’t work to their full potential and have a limited range of motion.

We can imagine that when we think of our hamstring muscles.

When we feel stiff in our hamstrings they don’t have as much yield to them and feel stuck. Well, that tension and lack of pliability can definitely occur in the pelvic floor as well. When tension builds over time these muscles will not move through their full range of motion therefore we don’t have a good sense of what they feel like when they are relaxed because they are living in a constant state of tension.

Deepening our awareness of the pelvic floor muscles (and other muscles as well) has a direct impact on how well our muscles function. Along with increased awareness comes the ability to move more accurately, ensuring that the proper muscles are working and that we’re not just compensating – this includes our glutes too! Having the pelvic floor muscles working optimally means that your internal organs, spine and pelvis are properly supported.

Let’s explore five ways that we can increase our awareness and deepen our relationship with the pelvic floor muscles.


1. Feel the Rhythm.

I have written about the Core Breath (coined by Bellies Inc. but also known as Diaphragmatic Breathing or Pelvic Breathing) before and what this really means is retraining our core muscles to work in synch with each other as they naturally should. Child’s pose can be a really helpful position to practice this breathing in as it naturally lengthens the pelvic floor muscles allowing us to feel the releasing phase more easily.

Come down onto the floor and rest your bum back toward your heels, knees can be apart or together. Place a pillow under your bum if it does not comfortably rest on your heels. As you inhale imagine the SITS bones (the bones in the middle of each bum cheek) widening apart. As you exhale see if you can feel a gentle lift. You are not squeezing on the exhale but allowing the pelvic floor muscles to naturally draw up. If that doesn’t resonate with you try thinking about the pelvic floor muscles softening or relaxing on the inhalation. If you cannot actually feel any movement just visualize the muscles moving with each breath.

avoid diastasis

2. Let it go.

For some of us the pelvic floor muscles may not actually move that much because of excessive tension. Try placing a tennis ball (or Yoga Tune Up ball) under one bum cheek, just to the inside of the SITS bones. Allow your muscles to soften and release as you stay here and breathe. You can do this sitting on a chair or on the floor.

baby & me fitness diastasis

3. Get some feedback.  

It can be really hard to sense the subtle movements of the pelvic floor, so using some kind of prop may allow you to feel the muscles better. A yoga bolster or something that resembles one (such as a few pillows or a rolled up blanket) works well. A stability ball is another great tool. If you are using a blanket or bolster you will sit on it with your legs on either side of the prop so it is directly below your perineum. Practice diaphragmatic breathing here and feel for the release of the pelvic floor muscles into the prop beneath you.

kegels

4. Get in touch.

Many of us are tactile learners so actually touching our bodies and palpating our muscles greatly increases our awareness. Oftentimes we hear or read about anatomy but if we don’t have personal experience with these muscles and bones we don’t have the clearest picture possible. External palpation of the bony landmarks around the pelvis is really helpful as is internal palpation of the muscles and tissues. Remember, education is key in helping you to feel more connected and more confident in your body and with your body!

postpartum fitness

5. See a professional.

It can be overwhelming to book an appointment with someone who’s going to take a look at your lady bits and let you know what’s going on in there. I get that. Sometimes ignorance is bliss! But I guarantee you will not regret getting a clearer idea of how your body is working, especially if you’re experiencing pain, discomfort, incontinence, a sensation of heaviness in the pelvic area, or even a feeling of weakness in the abdominal muscles. A pelvic health physiotherapist will help guide you and work on any specific issues you have but that being said I cannot stress to my prenatal clients what a great resource a physiotherapist is as you prepare your body for childbirth.  

I’m not saying this journey is an easy one. It takes time to build a relationship with these muscles. I would love for you to consider the ways that you can learn to connect to your pelvic floor so that the next time you are in a pilates or yoga class (or even some really great cardio/strength classes) you will know exactly what they are talking about. You could also jump into classes that are specifically designed to connect you to your core and pelvic floor. Many of the classes I offer are designed specifically for optimal function and alignment in the body and we get to know our pelvic floor a whole lot. Hopefully, one day we’ll even come to love our pelvic floor.

Pregnancy Posture: What You Need to Know!

Pregnancy posture

How to help your body feel and function better!

I don’t know about you but I felt like a total celebrity during my pregnancy! No, not because the paparazzi wouldn’t leave me alone or because I rocked my baby bump in designer gowns. I felt like a celebrity because I had an entire team of people trying to keep me from falling apart. There was the chiropractor, massage therapist, naturopath, doula, and midwives, the whole nine yards.  Okay, well maybe it wasn’t as glamorous as Beyonce’s pregnancy, but all that attention did feel great. It wasn’t until after my first son was born that I started to realize that I couldn’t purely rely on the professionals to keep me feeling good. It was something that I would need to be aware of and work on everyday… all on my own.


Pain is just a normal part of pregnancy, right?!

A woman’s body undergoes a ton of changes during pregnancy and it is incredibly common for women to experience pain and discomfort. Most women just assume that pain is a natural part of pregnancy; that it’s par for the course. What’s interesting is that most women move into pregnancy with some existing physical imbalances, that they may not even be aware of, and are then exacerbated by the fact that they are carrying around another human…. All. Day. Every. Day. These pre-existing imbalances may contribute to common issues we associate with pregnancy. 

“It’s not actually pregnancy that is causing these issues but the fact that our body is already misaligned and then compounded with extra weight and pressure.”

Here’s the thing – the way we use our body on a regular basis GREATLY affects not only the way our body FEELS but also how it FUNCTIONS. By making a few changes to your alignment, you can reduce the amount of tension and pain you experience and even positively affect the way your body works during labor.

NOTE: This is NOT to say that there isn’t a DEFINITE need for health care and wellness practitioners! Sometimes a treatment, adjustment or a massage is exactly what our bodies need!

“We absolutely possess the ability to create change in our body and I firmly believe that we need to be engaged in our own health and wellbeing, not solely relying on the professionals. And here’s a little secret: the professionals are relying on you to do your part so they can celebrate your success with you!”


Now let’s look at the most common misalignment we fall into during pregnancy and postpartum and how it affects our body.

For the sake of a visual I’ve added a couple pics of my two-year-old son and I so we can take a look at a very common posture that both pregnant women and new moms (and really anyone who carries around a bunch of weight out in front of them) tends to slip into.

Take a look at my legs in the photo on the left. Notice how the line starts at my hip (the outer hip bone, also known as your greater trochanter for the anatomy enthusiasts) and falls down in front of my knee. This shows that my pelvis is not properly stacked on top of my legs and that I’m actually pushing my pelvis forward. This is a very common stance during pregnancy and postpartum because women are carrying a lot of weight out in front of them and generally we don’t possess the strength and support needed to counteract the weight of a growing or wiggly baby/toddler.

 

mamaalignment4


This misalignment can:

  • Wreak havoc on our body because it overloads certain areas of the body while other areas become underworked and a little bit lazy. When we are properly aligned, our weight is evenly distributed through our feet, legs and pelvis, but this pelvic thrusting posture places excessive pressure on the front of the foot, the hips and lower back. As a result this excessive pressure on our body contributes to joint and muscle pain as well as some other major issues including plantar fasciitis, decreased circulation, varicose veins and diastasis recti.
    .
  • GREATLY affect the function of the pelvic floor muscles. These muscles act like a sling to support our internal organs and keep them in place while also working to keep us continent which is just a polite and fancy way of saying, it helps us not pee our pants! They also create stability and support for our pelvis and spine, they’re kind of a big deal.Both the pelvic floor and abdominal muscles naturally undergo increased strain during pregnancy (as they are meant to) but poor posture can work to increase this pressure. The pelvic floor muscles also play a HUGE role in childbirth and postpartum healing so reducing the amount of pressure and tension in the pelvic floor is incredibly important!.
  • Cause long lasting dysfunction. Not only does this pelvic thrusting posture place excessive pressure on the pelvic floor but it can also shorten the muscles. The pelvic floor muscles attach from the tailbone at the back and to the pubic bone in the front so when your pelvis is pressed forward it pulls the tailbone forward slightly as well and shortens the pelvic floor muscles. Over time, short and tight muscles become stuck and stiff and can’t function very well.We’ve all experienced this in one way or another, like tight hamstrings from walking more than usual or a stiff lower back after moving a lot of heavy objects. This tension coupled with the excessive pressure placed on these muscles (not to mention the 30, 40, or 50 extra pounds of baby weight) can lead to incontinence, organ prolapse (falling down), back pain, pelvic pain, pubic symphysis (the separation of the two halves of the pelvis), compromised breathing, diastasis recti (the over separation of the abdominal muscles) as well as unyielding pelvic floor muscles.
    .
  • Cause mum bum. Ah, the infamous Mum Bum. A lot of my friends and clients complain that somehow after the birth of their babies they “lost” their bum. Well good news is, it’s still there. It’s just hiding. Or more accurately, it’s being squished! Like I said above, when we press our pelvis forward our pelvis tucks under and therefore our glutes get flattened a bit. We also tend to grip our glute muscles in an attempt to create some support because our body is being pulled forward when the pelvis is thrust forward like this, further con
    tributing to tight flat bums. Read on to find out how you can help get your bum back!


So what do we do about all of this?!

It can feel a bit overwhelming for sure! Wouldn’t it be so much easier if there was a nice quick fix?!?! Unfortunately and fortunately, it’s not that simple. The great news is that we absolutely DO have the power and ability to make changes and affect the way we feel and how our body functions! Helping your body move toward a neutral alignment is key so here are a couple of tools that can help you assess your own alignment and help with your awareness of your pregnancy posture or postpartum posture. 


How to improve your alignment: A Step-by-Step Guide

  • Grab something you can use as a plumb line. A phone charger, laptop cord, or a dog leash can work. Something that is long and has some weight on the end. Now walk around, don’t think too much. Just walk. Then stop and settle into your natural standing posture, again try not to make little adjustments or stand how you think you “should”.
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  • Take your belt to the bone that sticks out on the side of your hip and let the weighted end of the belt hang down. How does the belt fall? Does it look like mine did in the picture on the left, with the line falling in front of your knee and leg? Ideally the line should fall straight down so your hipbone, knee and ankle are stacked vertically. This is not how the majority of us stand so don’t worry. Now you know and now we can begin to work on it!
    .
  • Bring your awareness down to your feet and notice where your weight falls. If you feel the majority of your weight is on the balls of your feet, shift the weight back to your heels. Not so much that you feel like you’ll fall backwards, however, it may feel very odd to you as your body is not used to being in this position.
    .
  • Let’s check in with the positioning of the pelvis as well. Now that we’ve got a good neutral alignment going on with our legs stacked vertically, which will reduce the amount of pressure on the legs, abdominals and pelvic floor, let’s check that your pelvis is in neutral alignment as well. Take the heels of your hands to the two bony protrusions on the front of your pelvis (this is referred to as your ASIS or more commonly as your hip bones). Let your fingertips point down toward your pubic bone. Check to see how your hands are aligned. We’re looking for your hands to be vertically aligned. Notice if your fingertips are in front of the heels of your hands or if your fingertips fall behind the heels of your hands.


Of course we cannot maintain perfect alignment all day everyday!

Nor should we. Our bodies are resilient and made to work in a variety of different positions BUT we often slip into habitual postural patterns without being aware of it. By starting to take notice of your alignment is HUGE! You’ll begin to:

  • reduce the weakening of the pelvic floor and abdominal muscles
  • reduce back pain, pelvic pain, neck and shoulder tension
  • encourage lengthening of the pelvic floor muscles, allowing them to work better throughout pregnancy, birth and the postpartum period


If you found that your body tended to slip into that common forward thrusting position here are a few next steps to work on:

  • release tension that is pulling your body out of alignment
  • strengthen certain areas to help keep you in better alignment
  • check in with a pelvic health physiotherapist to assess the function of your pelvic floor and core muscles

We will look at these next steps in more details in the coming weeks so that you have a better idea of how to do those things. For now, just start to notice your alignment as you move through your daily life and hopefully you’ll begin to feel a bit better. Finally, I want to add that, if you’re looking for some TLC, booking yourself a massage and having someone take care of you is never a bad thing!

‘Til next time – move well, feel well.

~Laura

 

The most simple and effective core exercise ever

Laura-97

When I work with prenatal and postnatal women, clients are always eager to work their abs. Pregnant women are looking to keep their abdominal muscles strong throughout pregnancy, while postpartum women are looking to get their flat tummies back. While they may need to work their abs, what they really need to work is their core, their whole core, not just the ‘six pack’ ab muscles.

I work exclusively with pregnant women and mothers so if there is ever a time when your midsection goes through immense and dramatic changes it’s through the childbearing years. It can be difficult to see your body changing so much, or to not feel like yourself physically (not to mention, mentally/emotionally) after the birth of your babe. So many women are drawn to intense ab exercises in order to ‘get back to their pre-baby body’ and some professionals even recommend it. 

The truth is, you will need to work the core as a whole to regain strength in your body, from the inside out. Strengthening your core is a great way to reduce back pain, to help your balance, stand taller, even flatten the tummy after baby. I mean, it seems like a strong core can pretty much fix anything but what does “strengthening your core” actually mean? And what does that look like during pregnancy and postpartum?

What exactly is “the core”?

First off, let’s take a look at what your core actually is. There’s a lot more to your core than just your abdominal muscles. Your core, or Inner Unit, is actually comprised of 4 muscles, the transversus abdominals (TvA for short), the pelvic floor muscles, the diaphragm, and multifidus muscles.

Whoa!

Hold up!

I know right? I’m guessing there’s some muscles in there you’ve never even heard of! Well that’s what makes core training more complicated than just doing some sit-ups or planks.

These 4 muscles work together as a system to provide support and stability to your body and that is why it is essential to train this system throughout pregnancy. Your body undergoes a TONNE of changes during those 9 (plus) months and often your body gets pulled out of alignment because of these physical changes. Over the next few weeks we’ll explore these changes in more detail and how they affect our core muscles as well as our overall physical wellbeing throughout pregnancy and the postpartum period. 

 A dynamic system 

Julie Wiebe, is a leading physiotherapist focusing on women’s health and describes the core muscles as 4 parts or gears of a system. She speaks of the importance of training these 4 muscles together as a team instead of focusing on each muscle individually.  Each muscle works better when in conjunction with the others and the reason for this is that our natural breathing mechanics is a dynamic and constant system.

Every time you inhale, your diaphragm drops in order for your lungs to take in air. The diaphragm pushes down on your abdominal cavity and in order to make room for all of your abdominal contents, your belly expands outward slightly and your pelvic floor has to lower as well. On the exhale your pelvic floor draws back up, your belly draws inward slightly creating some tension around your spine for support and your diaphragm moves back to it’s original position as well.  Pretty cool right? I find this process so amazing.

The Diaphragm

The diaphragm can become compromised throughout pregnancy due to postural changes as well as a growing baby that tends to push up on the lungs and diaphragm. It is common during pregnancy for women to shift their weight onto the front of their foot which can cause us to instinctively lift our ribcage  as a way to stop us from falling flat on our face!

When we lift the ribcage the diaphragm is further compromised and taking a full breath is much harder. Give it a try. Julie Wiebe uses the image of a bell for this. Think of the bell ringing forward (ribs lifted) and try taking a breath in here. Then ring the bell back (ribs dropped) and try breathing in, in this position. Think of the bell being still and quiet (ribs in neutral alignment) and see if the breath blows easier and more full here.

Pelvic Breathing

Now that we’re encouraging the diaphragm to work more optimally, let’s check in with the pelvic floor.  In order for the pelvic floor muscles to work their best we want to find a neutral position for the pelvis. You can try this by either sitting on a stability ball or sitting cross legged with your bum up on the edge of a blanket or yoga block. Feel for the tripod of the pelvis here, the two sitting bones on either bum cheek and the tail bone, and feel for equal weight in all 3 of those points.

With the pelvis set in a good neutral alignment and your ribcage stacked on top (bell quiet and still) take a breath into your ribcage.  It may be helpful to place your hands around your ribcage (bra line area) and feel for expansion out into your hands as you breathe in. As you breathe in see if you can sense your pelvic floor muscles relaxing. If you’re on the ball you may feel a bit of heaviness as you inhale. On the exhale, do nothing and let your pelvic floor draw back up naturally and feel the ribcage deflate. Your belly will expand on the inhale and gently draw back in as you exhale.

Simple Yet Effective

There’s a great quote by Wendy Powell, creator of the MuTu System, a postnatal reconditioning program, who says, “You can’t strengthen muscles that you aren’t even talking to”. And to me, pelvic breathing is a basic and fundamental exercise and is a great way to start talking to muscles you probably weren’t even aware of.  It also gets the 4 core muscles communicating with each other which may be new to you. This exercise is safe and super effective for pregnant women, new moms, not so new moms….well basically everyone!

A healthy and well functioning core is essential as your body changes throughout pregnancy and the postpartum period and helps to reduce back pain, pelvic pain, weakness of the pelvic floor and abdominal muscles, to mention a few things but is also essential in the birthing process and postpartum recovery. Moving forward we’ll look at some exercises to help your core muscles work together better so you can feel your best throughout pregnancy and motherhood.