Pelvic Floor Dysfunction: Don’t Ignore the Signs

It’s become so common, we’ve almost come to accept it as normal — that little bit of urine leakage when you cough or laugh, or that sudden urge to pee before doing some jumping jacks. We hear women (and men) say things quite frequently like “oh yeah I always pee a bit when I do that exercise.”  We just take that little leakage as an annoying, yet normal, way of life.  But these symptoms are not normal.  They are signs of pelvic floor dysfunction (PFD). PFD is a core injury, and if not addressed, can lead to other pains or complications, and certainly an impact to your lifestyle.  Read on to learn more about PFD — including how it’s caused, how to spot it, and tips on how to manage or prevent it altogether.

Understanding Your Pelvic Floor

Your pelvic floor is actually comprised of three layers of muscles (14 muscles in total), which form a sling at the bottom of your core (or the “floor of the core”). Yes — your pelvic floor muscles are critical core muscles, even though they are often not the first to come to mind when we think of the core.

A well-functioning pelvic floor is responsible for:

  • Supporting your pelvic organs (including the uterus, which grows to about 500 times its original size during pregnancy!)
  • Controlling continence
  • Helping to stabilize your spine and pelvic hip region (critical in managing the decreased stability that comes with the rise of relaxin during pregnancy)
  • Aiding in sexual response
  • Assisting in guiding the baby out during delivery

Understanding Pelvic Floor Dysfunction

There are basically two types of PFD:

  • Stress Incontinence: Accidental urine leakage during forceful movements (coughing, laughing, sneezing, impact exercise, etc) or a sudden or urgent need to pee.
  • Pelvic Organ Prolapse: When one or more of the pelvic organs descends lower than its normal position (sometimes through the vaginal or rectal openings in the most extreme cases).  It may feel like a heavy, bowling ball feeling between the legs. Pain during intercourse could also be a symptom.

What Causes Pelvic Floor Dysfunction?

Like Diastasis Recti, PFD is in short a “pressure problem.” In other words, it occurs when there is a buildup of pressure in the abdominal cavity, and eventually that pressure has nowhere else to go, but downward onto the pelvic floor muscles.  A growing belly during pregnancy certainly creates a lot of excess pressure, which is why PFD is so common with pre/postnatal women.  However, the following activities also contribute to excess intra-abdominal pressure:

  • Alignment Shifts: A growing belly during pregnancy tends to tip the pelvis forward, pulling the lower back into an excessive arch, and placing greater downward pressure on the PF muscles.
  • Weak “Core Canister” muscles: The Core Canister muscles (diaphragm, TVA, and pelvic floor) act as a pump to regulate intra-abdominal pressure.  If these muscles are weak, this “pump” doesn’t work effectively, which can lead to a pressure buildup.
  • Sucking in: One of the reasons more women experience PFD is that we are more prone to sucking our bellies in. This action of drawing your navel in as you inhale creates a pressure buildup in the abdominal cavity.  The longer you hold it, the more the pressure builds up.
  • Chronically “engaging your core:”  If you take group exercise classes, how often do you hear your instructors give this cue?  It’s become one of the most overused cues in fitness today.  However, even if we engage properly (by drawing our navel in on the EXHALE), holding this chronically engaged position “shuts off” our core canister pump, which leads to a pressure buildup that has nowhere to go but downward.
  • Breath-Holding or Bearing Down: Similar to the above, breath-holding during exertion (either in exercise or “bearing down” for a bowel movement) creates a large pressure buildup as well that stresses the PF muscles.

How to Prevent or Manage PFD

Since PFD is similar to Diastasis Recti in being a pressure management problem, the tips to addressing are very similar to DR:

  • Improve Your Alignment: It’s easier than you may think.  Read this article on neutral alignment for simple (but powerful) tips that can significantly reduce pressure on the PF muscles.
  • Learn to breathe (right): Breathing right (or 360° Breathing) is what activates your core canister pump.  It’s the first and most important core exercise to master.
  • STOP sucking in and over-engaging! While we may be doing these in an effort to strengthen our core, or make it look better, they actually have the very opposite effect, and can lead to both PFD and DR.
  • Practice Pelvic Floor Activations (PFAs): Most of us think of “Kegels” when we think of PF exercises, but there are two issues with how Kegels are often thought of today.  First, we hear them described as “stopping the flow of urine,” but this only accesses the front of your pelvic floor (forgetting the back and sides).  Second, and this is very important for PFD, Kegels have become synonymous with “clenching.” Like any other muscles in the body, the PF muscles must be worked through a full range of motion.  A focus on contracting alone, without the proper lengthening, could lead to more harm than good.  This is especially important if you’re exhibiting symptoms of PFD.  In fact, the lengthening portion of the movement could be even more important.  Watch this video for important step-by-step instructions to performing proper pelvic floor activations.
  • Avoid any movement that triggers leakage: This should be an obvious one, but if you do a move (especially during exercise) that causes leakage, try to avoid that movement going forward.
  • See a pelvic floor physical therapist: If you continue to experience pain or signs of PFD, it is best to speak with a pelvic floor physical therapist (we recommend looking for this specialty vs. a general physical therapist).

If you want more personalized support in managing through mild forms of PFD or other pains or injuries, consider working with one of our in-home personal trainers in the New York City area, or searching for a PROnatal Certified Trainer in your area.