Because our Pelvic Floor has an intimate relationship with our abdominals, having a healthy “Core and Floor” during pregnancy can help you find your waistline after baby is born!
These exercises are fabulous for keeping your Core strong during pregnancy, or starting back into abdominal work postpartum and are helpful in avoiding and rehabilitating Diastasis Recti (separation of abdominals) No Crunchies necessary!
(but that’s another blog series!)
Working the ‘Inner Core’ muscles should not burn like abdominal curls do. These are your endurance muscles. To challenge these muscles, we can ‘trick’ them into working with an unstable surface like a stability ball or disc under your hips or by moving our arms and legs and trying to keep our torso stable.
Watch that your belly doesn’t bulge outward or bump or tent down the centre.
*Click the links below to view these exercises in video:
Knee Stirs (elevate your torso on a soft bolster or wedge if pregnant)
During pregnancy, once that beautiful belly is starting to show, consider working your core by moving your whole body, arms or legs while using your core breaththroughout. This not only gives you a core work out but upper or lower body workout too! It doesn’t need to be strenuous to be work. We call this functional core work. Here are a few video examples of functional core work: *click the links below to be taken to the video:
Can we just be really real and intimate with each other for a moment? 1 in 4 women experience bladder problems (Leaking!)
1 in 3 experience bladder problems and/ or pelvic pain during sex P.S. a healthy pelvic floor will keep embarrassment out of the bedroom and make sex more enjoyable.
I am not an exception to any of the above statistics! In fact I once went to the hospital due to inexplicable pain and the doctors were totally stumped. It was only after learning more about my Pelvic Floor that I realized the culprit was likely Pelvic Floor Dysfunction. While incontinence and pain are very common, it’s not normal and it can be prevented and helped.
Let’s recap what we already know from this blog series. We know where the Pelvic Floor is located. We know the Pelvic Floor has a special relationship to our Inner Core and that it must be strong and flexible.
Well, if all of this wasn’t enough, it also needs to know how to move at different speeds! This final step is what is going to get us to those goals!
We need the muscles of our Pelvic Floor to maintain a constant engagement throughout our days to hold up the contents of our abdomen and we need those muscles to be able to react quickly against sudden abdominal pressure: LAUGHING, SNEEZING, COUGHING, running, jumping and all our other pregnancy and mom goals! For simplicity, lets say that we need to know how to work our Pelvic Floor in a powerful, plyometric style (exerting maximum force in short intervals), “fast twitch” and for endurance (the ability to withstand wear and tear, lengthy physical stamina), “slow twitch“ engagement.
Here are some exercises to help you find both types of engagement.
A complement to our Wide Leg Stretch last post, this Wide Leg Squat in Parallel (or Plie in 2nd) can help to build proper strength.
Separate the legs just wider than the width of your shoulders, preferably with the knees and toes facing forward (alternatively, this can be done with legs turned out, but this should be avoided if there is a known issue with any sort of prolapse) Put a little more weight into our heels than toes and squat – bending and stretching your knees. Try to keep your torso upright (this time, don’t lean forward)
Using your “Core Breath” with the squat- Inhale to bend your knees and Exhale to straighten your knees. Do these squats slowly, matching the length of your breaths to the length of the movements. Keep your Pelvic Floor engaged and lifted throughout. This works the endurance or slow twitch fibers of the Pelvic Floor.
Parallel squat Turned out squat
Let’s add on…
Pause when you’re almost at the deepest part of your squat. Push into your heels to help activate your glutes (bum cheeks) and your hip muscles, and start to come up but stop yourself from coming all the way up with a short, fast Exhale to engage your core muscles, including your Pelvic Floor, as quickly and strongly as you can. Inhale to release as quickly as you can, and drop down into the squat again. Think of this as a pulse with and accent upward. Aim to be powerful with the Pelvic Floor like a striking action on the contraction. Recruiting the extra muscles of the hip, bum and legs will assist your Pelvic Floor and give you some lower body work. Start with 3 pulses and rest, several times. As you become able to contract and release quickly, you can work your way up to 5 pulses and eventually 10 pulses.
Take it up a notch
Once you’ve mastered the wide leg squat, here’s a variation that will make you work a little harder and take much more concentration on the core and floor. Switch your breath for this one – Exhale as you step out to the wide leg position and squat contracting the core and floor. Inhale to pull the legs back together (use a little inner thigh) and straighten your legs. This works for endurance and the stepping out action is plyometric for fast twitch integration. For an example: https://www.instagram.com/p/BRLVW6ZhdUi/?taken-by=ruthruttandoula
Hovering on Knees Or Bridging
Start sitting on your heels with feet together and knees apart at about a 45* angle. Using the “Core Breath” Exhale and lift your bottom off your heels (about half way between sitting and being right up on your shins) thinking of pulling the knees toward centre (but don’t actually move them) you should feel the muscles of your upper inner thigh, your glutes (bum cheeks) and maybe a little of the outside of your hips engage. Inhale and release.
For Bridging lie on the floor or a Mat, knees bent and about hip width apart. Using the “Core Breath” Exhale and lift your bottom off the Mat trying to keep your torso long not bowing, and using the glutes more than your hamstrings. Inhale and release. Maintain the contraction of the Pelvic Floor and core throughout both of these exercises.
Let’s add on…
This time hold the hover or the bridge and keep the inner core engaged. With a short, fast Exhale, engage your Pelvic Floor (in and up), as quickly as you can. Inhale to release as quickly as you can. Repeat 3 times and then release the squeeze. Work up to 5 repetitions, and then 10, as your ability and strength increases.
**Inner thigh work can be uncomfortable for some pregnant persons and could contribute to Symphysis Pubis Dysfunction. If you feel any pain in the pubic bone area with these or any exercises, stop! Likewise, not all pregnant persons will feel uncomfortable lying on their back for bridging and we do not recommend spending much time lying in this position exercising. Stop if you feel uncomfortable, breathless or lightheaded. In general, keep pregnant person’s heart above baby’s heart when reclining**
Let’s counter some of this inner thigh focus with the outer hip and thigh muscles, which work together with the Pelvic Floor and protect the pelvis and low back.
Maintain the integrity of your Inner Core and Pelvic Floor throughout and complete 5-10 repetitions of each of the Clam leg variations that you see in this: https://www.instagram.com/p/BTBxN0rhInt/?taken-by=ruthruttandoula Some movements should feel like you really have to think to keep yourself from wobbling and some will create a little burn on the outside of the thigh, hip and glute. Don’t forget to repeat on the second side!
Follow me on Instagram @ruthruttandoula or come to a class to keep crushing your Pregnancy and Mom Goals!
Did you know that many of the symptoms of a weak Pelvic Floor are the same for a tight Pelvic Floor?
I think we commonly associate weakness with slack or lengthened and stretched out muscles but tight muscles can be weak and lack integrity too. A tight or hypertonic Pelvic Floor does not mean it is strong, it means it doesn’t know how to release and function well. (to truly know if you’re weak or tight, one needs to see a Pelvic Floor Physiotherapist)
Along with some ill affects on our daily life pre or postnatally, at tight Pelvic Floor can make the pushing stage of labour much more work. Some women inadvertently “hold” the baby in during the pushing stage.
In the last posts we’ve spent time getting some awareness and engagement of our Pelvic Floor, now let’s look at giving it some down time.
These stretches should be appropriate for just about every one.
Lean forward with arms on a stable surface. This opens the distance between the pubic bone and the tailbone. Separate the legs, nice and wide and turn them to parallel. This opens the distance between your sit bones. This position in itself is a Pelvic Floor stretch. Use your core breath exercises and images from the last post to help you bring awareness to the Pelvic Floor.
Lunge gently from side to side. You should feel a stretch or lengthening feeling down your inner thigh and possibly through your Pelvic Floor. If you don’t feel any stretch, try separating your legs wider and be sure your tailbone is slightly lifted. Then try bending and stretching the knees together with the torso centered.
Breath easily and with a focus on stretching and opening the Pelvic floor. Keep your jaw and shoulders as relaxed as possible. This is a great example:
This should feel lovely and relaxing and is often a place women naturally want to labour. If you’re are pregnant, this is a great place to spend some time imaging the birth of your baby. Much like an athlete visualizes the positive outcome of their sport, you too can put some positives vibes out there!
Another option is to rest on a slightly elevated surface (a wedge or a soft bolster) with the legs butter-flied or up the wall. Alternatively, this can be done lying on your side with one leg up the wall and then turning over to do the same on the other side.
Since the Hip and Glute muscles often work together with the Pelvic Floor in most of our daily activities (we call them “co-recruiters”) it’s great to give them a stretch too. The “Figure Four” stretch standing, sitting or on your back is a great one.
To further release this area, the Franklin Method Pelvic Floor & Glute release with a semi firm ball is just the trick! Squeeze your glutes and press firmly onto the ball, then release. Do this several times. Then use the ball to massage the glutes, hip and hamstrings. When you remove the ball you should feel dropped and open on that side. Repeat on the second side.
**Be aware if you have piriformis syndrome or sciatica as this can put a lot of compression on the muscle and nerve. Stop if symptoms get worse**
Check out part one, here!
How do I find this mystical body part the Pelvic Floor?
In a recent study 49% of the women verbally instructed to use their Pelvic Floor did so incorrectly! Gulp! As a Pilates Instructor this is a sobering statistic!
In our last post we told you where your Pelvic Floor is located. Let’s see if we can help you feel your pelvic floor and become aware of its movement.
Sitting upright on a firm surface (like a chair or a step), see if you can feel the two sit-bones right underneath you. Aim to keep a small curve in the small of your back so that your tailbone doesn’t tuck under, but be careful not to over arch your back.
Take a few slow breaths and see what your body does naturally.
Here is what should be happening:
On the Inhale:
The diaphragm (main breathing muscle) contracts and pulls down.
The volume of the lungs increases and draws air in
(think of your torso and belly like a balloon inflating).
Abdominal pressure increases and Pelvic Floor responds (think of the boney landmarks at the base of your pelvis expanding or opening, you may even feel a little pressure downward).
On the Exhale:
The diaphragm (main breathing muscle) relaxes and moves up.
The volume of the lungs decreases and air flows out (think of deflating your torso and belly like a balloon).
The abdominal pressure decreases and the Transversus abdominis (lowest layer of abdominal muscle) contracts. This should feel like you’re gently shrink-wrapping your torso or tightening a corseted garment around your centre.
The Pelvic floor contracts (think of the boney landmarks at the base of your pelvis closing and gently pulling upward)
This breath is often referred to as “Core Breath”, “Diaphragmatic or Pelvic Breathing”.
Alternatively, you can do this on all fours. In either position, don’t change the position of your spine while doing the exercise. Just understanding this proper breath pattern is a huge step toward better Pelvic Floor health.
From some examples of “Core Breath” click here and here.
Front & Back
Exhale and imagine drawing your pubic bone and your tailbone closer together without using any leg, hip or cheek (glute) muscles. This should feel subtle and may feel more mentally challenging than physically! Inhale and let that go.
Repeat a few times until it feels more intuitive.
Side to Side
Now trying using your exhale to imagine drawing your sit bones together. Inhale to release. This one is much trickier and the Glute muscles (your bum cheeks!) will want to join the party. You can imagine curtains closing if that’s helpful.
Let’s put this all together!
Inhale and allow your belly to fill with air. Think of yourself like a balloon gently stretching all the way down to the bottom of your pelvis. Imagine the four boney landmarks opening away from each other like the balloon expanding or a flower opening. When you exhale, notice that the torso deflates like a balloon and the belly should come back in toward your centre. Simultaneously, draw the four points of the Pelvic Floor closer together and think of gently pulling them up inside you. Remember not to recruit extra muscles. . You’ll know you’re doing this correctly if you feel an equal engagement around the anus and the vagina openings and a small sensation like you’re trying to levitate off your seat. Some other images to consider are picking up a blueberry with your vagina or the idea of holding a tampon in. Remember to do the work with a sense of ease, there’s no clenching allowed.
Images to help you picture the actions of your pelvic floor
Egg in a nest – gently pick up the egg, place it back down. Remember to do the work with a sense of ease, there’s no clenching allowed.
picking up and place down an egg .
the movement of a jellyfish or the idea of holding a tampon in
a flower opening (and closing)
using the boney landmarks- pelvic bones (opening wider, coming closer together)
a balloon inflating and deflating
It may take some time to feel the awareness or to get the coordination. There’s no rush! The use of images can be really helpful. Your muscles have three times more sensory neurons than motor neurons which means that if you use a variety of images while practicing, your brain will mirror back to your body what you want it to do and you’ll have an easier time finding some sensation.
Once you’ve mastered this breathing in coordination with Pelvic Floor awareness we’ve got some other ideas for you to play with too!
**the following ideas/ exercises are meant to create awareness and are not exercises that should be done everyday as part of a practice**
The next time you urinate see if you recognize when your Pelvic Floor is open and when it closes. (HINT: it opens to let things out and closes to hold thing in!) Are you able to keep it open for a few seconds after the stream of urine has ended? Are you then able to close it slowly as you did in the previous exercises?
When having a bowel movement, also take time to become aware of the pelvic floor. Notice your body’s own willingness and urge to push without any excess, intentional help from you. Can you support the urge to push with your Core Breath exercise (above) but this time keep your pelvic floor open both while inhaling and exhaling? This is a very calm gentle version of what it’s like to push during birth!
Egg Photo: Artist – MaryJo Hoffman
Jelly Fish: http://www.worldatlas.com
Lotus Flower: Artist – Florence W Deems
Pubic Arch: https://en.wikipedia.org/wiki/Pubic_arch
Balloon Lung: https://basicmedicalkey.com
Bowel posture: https://suecroftphysiotherapistblog.wordpress.com
What needs to be as flexible as your tongue, as strong as your abdominals and is incredibly important to the pregnant and postnatal body?!
Well, yes, but I was referring to your Pelvic Floor!Along with the transversus abdominis, multifidi and diaphragm, the Pelvic Floor is considered part of the “Inner Core” or “True Core”.
What does the Pelvic Floor do?
These muscle systems work together to stabilize the pelvis, lumbar spine and rib cage when stress is placed on them… ummm, like during pregnancy or when carrying a newborn baby around.
The Pelvic Floor muscles help to hold the pelvis together and connect the pelvis to the femur (thigh bone). Daily, they work against gravity to hold up the contents of the abdomen and control what comes out, and when!
During pregnancy, the weight of a growing uterus and baby put a great deal of extra load on these muscles. Two of the most obvious and uncomfortable issues with a weakened Pelvic Floor are incontinence and hemorrhoids. A strong Pelvic Floor is needed for a more comfortable pregnancy.
Looking into the pelvis at the muscles of the Pelvic Floor.
Why do we need a healthy Pelvic Floor?
A healthy Pelvic Floor is also essential for childbirth. Equally as important to a strong Pelvic Floor is a flexible Pelvic Floor. During birth it must know how to release, relax and expel! This flexibility can make pushing more effective, and therefore, possibly shortening this stage of labour and making it less exhausting.
After the birth of a baby, including a Caesarean birth, the Pelvic Floor is compromised and needs special attention to heal and function well. We highly recommend all postnatal bodies to see a Pelvic Floor Physiotherapist within the first six weeks of recovery.
A physiotherapist will be able to let you know specifically what to address within your body. If unattended, a dysfunctional Pelvic Floor can lead to a host of uncomfortable and undesirable affects including:
Urinary Stress & Urge Incontinence .
Pelvic organ prolapse .
Chronic pelvic pain .
Dyspareunia (painful intercourse) .
And can even contribute to back pain and cause mummy tummy. .
Don’t panic! Appropriate and safe exercising will help with blood circulation and delivery of oxygen to these important muscles as well as exercising the muscles themselves.
Let us show you how to show your Floor some Love!
Make sure you stay tuned, all week, for the rest of this great 4 part series all about your Pelvic Floor!
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.
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.
Ihave 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.
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.
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.
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!
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.