Hidden in Plain Sight: Pelvic Floor Dysfunction (Part 2)

This is the second post in a 2-part series on the common core injury: pelvic floor dysfunction (PFD).  Before reading this post, be sure you’ve read Part 1 on understanding the pelvic floor and what constitutes PFD.

How to Identify Those with PFD

Now that you have an understanding of good pelvic floor (PF) functioning and what constitutes pelvic floor dysfunction (PFD), it’s important to determine how to identify if someone has PFD so you can begin to help that individual.  There are two ways to do this: 1) observing your client’s behavior and 2) asking specific questions.

Behaviors to observe
Recall that the “sudden or urgent need to pee” and “accidental urine leakage during forceful movements” are both signs of PFD.  Therefore, if your client needs to run to the restroom to preemptively urinate before jumping, this is an obvious example of PFD. As is stopping in the middle of an impact exercise (like a set of ploymetric movements) due to a need to pee, or even accidental leakage during that movement. Other behaviors may include a resistance to even participate in impact activities (another attempt to prevent the problem) as well as crossing legs or bending over when sneezing or coughing.

Questions to ask clients
We encourage you to ask ALL your clients (new and existing) the questions below, as PFD is many times overlooked, or often taken as a “normal way of life,” especially for postpartum women.  However, just because PFD may be common, it is NOT normal.  Ask your clients the questions below to get a good sense of their PF integrity:

  • Do you ever feel a sudden or urgent need to pee?
  • Do you have any leakage when sneezing/coughing/laughing/upon exertion?
  • Do you ever feel like your bladder doesn’t fully empty when you go?
  • Do you get constipated frequently?
  • Did you ever give birth? If so, did you ever do any core recovery or see a pelvic floor physical therapist?

While these questions go beyond the typical “gym” assessment, the answers can shed light on a client’s pelvic health (and are likely the only time they will be asked these questions). The more information we have, the better we can serve them.

How to Prevent or Manage PFD

Since PFD is primarily a pressure management problem, the techniques for helping to address it are very similar to managing the other notorious pregnancy-related “pressure problem,” Diastasis Recti (DR):

  • Focus on neutral alignment: The greater the anterior pelvic tilt, the greater the pressure on her PF. Read more about neutral alignment, including how to help your clients find it in a static posture and during movement.
  • Develop strong Core Canister Functioning: A properly functioning Core Canister is critical for managing pressure. The first step to achieving this is mastering proper breathing, or 360° Breathing.
  • Avoid Over-Engaging: There is often an over-focus in fitness on “engaging the core” or “drawing in.” These cues can be problematic for two reasons.  First, it is essential that the drawing in, or engaging, occur on the exhale (navel draws in as a result of the exhale).  If you just cue people to draw their navel to their spine, many will do this on the INHALE (a sign of deep core weakness), which actually increases intra-abdominal pressure, and can therefore lead to PFD or DR. The other reason the above engagement-focused cues can be problematic is that even if a person engages properly on the exhale, we still don’t want a focus on chronic engagement.  Keeping the core chronically engaged shuts off the core canister pump, which also create an increase in intra-abdominal pressure.
  • Avoid Sucking In: Sucking in involves drawing the navel in on the inhale, which (per the above point) creates a pressure buildup in the abdominal cavity.  This is an important topic to address with your clients, especially your female clients.  Women may be inclined to engage in this behavior in the earlier days of pregnancy (before they’ve announced it) when they might be trying to hide their bellies, or in the earlier postpartum days (when they might be trying to minimize their postpartum belly).
  • Avoid breath-holding on exertion or “bearing down”: Breath-holding on exertion (or Valsalva) is a technique designed to INCREASE intra-abdominal pressure (especially when lifting max loads). “Bearing down” on the toilet is another form of breath-holding upon exertion. This creates a significant amount of excess intra-abdominal pressure.
  • Avoid any movement that triggers leakage: Always instruct your clients to let you know if they experience any leakage during movements, or an urgent need to pee, and avoid these movements going forward.
  • Teach your clients proper Pelvic Floor Activations (PFAs): When we think of pelvic floor exercises, we often think of Kegels.  However, there are two reasons we avoid using this term.  Watch this video to understand why, and to learn how to perform proper pelvic floor activations.
  • Refer to pelvic floor physical therapist if necessary: If your client continues to experience stress incontinence, or other signs of PF issues, after 4-6 weeks of consistent PFA practice (in and out of your sessions) it is best to refer her to a pelvic floor/women’s health physical therapist. These professionals are specially trained to do internal work and their manual techniques can help the muscles achieve the full ROM, especially when a woman is overly tight.

Want to learn more about managing pregnancy-induced pains and injuries like PFD?  Become a Pre/Postnatal Performance Training Specialist.  Check out our Live and Online Training Options.