It’s become so common, we’ve almost come to accept it as normal — that little bit of urine leakage when coughing, laughing, or doing any sort of impact exercise. We hear women (and men) say things 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 issue that — if not addressed — can lead to other pains or complications, and certainly have a negative impact on your quality of life. Read on to learn more about PFD, it’s causes, and what you can do to kick start your healing.
Understanding Your Pelvic Floor
Your pelvic floor is 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: uterus, bladder, rectum
- Helping to stabilize your spine and pelvic-hip region
- Controlling continence (making sure you pee when you want to, and don’t pee when you don’t want to)
- Aiding in sexual response and satisfaction
- Assisting in guiding the baby out during delivery
Understanding Pelvic Floor Dysfunction
There are basically two types of PFD:
- Stress Incontinence: Accidental urine (or fecal) leakage during forceful movements like coughing, laughing, sneezing, or impact exercise
- 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.
For a more detailed list of symptoms, check out this Pelvic Health Self-Assessment by Pelvic Floor Occupational Therapist and founder of The Functional Pelvis, Lindsey Vestal. If you answer yes to many of these questions, you may benefit from speaking with a pelvic floor physical therapist.
PFD Causes (and How to Mitigate)
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 and uterus during pregnancy certainly creates excess pressure, which is why PFD is so common with pre/postnatal women. However, the following things add even more pressure. Note the tips below to help mitigate these.
- Alignment Shifts: A growing belly during pregnancy tends to tip the pelvis forward, pulling the lower back into an excessive arch, like you see in the image below. This places greater downward pressure on the pelvic floor muscles (as well as outward pressure on the abdominal wall). Watch this video to learn how to find your body’s neutral alignment to help protect your abdominal wall and pelvic floor.
- Sub-Optimal Movement Mechanics: The deep core muscles of your “Core Canister” (diaphragm, TVA, and pelvic floor) act as a pump to regulate the pressure inside your core. However, they can only do this if you 1) align yourself well AND 2) know how to use your Core Canister effectively. However, many people have inadequate Core Canister function — an inability to regulate core pressure well — from spending much of their day like the woman below (where it’s quite difficult to access the deep core muscles). Therefore, it’s important to learn how to move in neutral during daily activities, and then to learn how to properly activate your Core Canister with the exercise we refer to as the #1 most effective core exercise: 360° Breathing
- Sucking in & chronically “engaging your core”: “Sucking in” (inhaling and drawing the navel in) is a behavior many women do for aesthetic reasons to make their bellies appear smaller. However, 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. Even if you engage correctly (on the exhale), if you walk around with your belly pulled in all the time, you are essentially “shutting off” that pumping mechanism of your Core Canister, which can then lead to a pressure buildup. Watch this video to learn more about these behaviors and how they can end up creating greater issues with Diastasis Recti and PFD.
- Breath-Holding or Bearing Down: Similar to the above, breath-holding upon exertion (either in exercise or “bearing down” during a difficult bowel movement) creates a spike in intra-abdominal pressure that increases stress on the pelvic floor muscles. Unfortunately, constipation is a common side effect of pregnancy. If needed, read this post on tips to reduce constipation.
Given these causal factors, you can see how PFD is not just a pre/postnatal issue. In fact, we often see PFD in powerlifters, or anyone doing very heavy lifting, due to the use of the “Valsalva” (breath-holding upon exertion) technique.
In addition to everything above, then there is childbirth. By the time delivery arrives, the pelvic floor muscles are already quite stressed (perhaps even compromised). Then, these muscles must endure the further trauma of delivery. In a vaginal birth, the pelvic floor muscles are responsible for helping to guide the baby out during delivery. However, if these muscles are underactive, or in a weakened and shortened state, this could result in increased tearing.
A C-section also traumatizes the pelvic floor muscles. During the procedure, the abdominal muscles are moved in order to pull the baby out. Because of how intricately connected the abdominal and pelvic floor muscles are, this major abdominal surgery also impacts the pelvic floor.
So, in summary, pregnancy alone puts a great deal of excess strain on the pelvic floor muscles, and that is why PFD is common during pregnancy. However, childbirth certainly adds to it, and that’s why PFD is even more common in the postpartum period.
In addition to taking the steps above to reduce the excess pressure in your core, you can also practice some targeted pelvic floor exercises. We call this pelvic floor work PFAs (Pelvic Floor Activations). Watch the video below carefully to learn how to perform proper PFAs. We take you through a step-by-step process to first find all the muscles of your pelvic floor, then move them together in a coordinated fashion, and finally align the movement with your breath.
It is very important to note that if you are experiencing symptoms of PFD, the lengthening (relaxation) portion of PFAs is the most important. We recognize this may seem counterintuitive. After all, why would you want to relax those muscles when you have issues accidentally peeing?! However, often when you have PFD, your pelvic floor muscles are weak, but also overly tight (yes, “tightness” does not equate to strength). Therefore, if you focus consistently on contracting overly tight muscles, you could create further issues. Like any other muscles in your body, to properly strengthen your pelvic floor, you must work your muscles through a full range of motion. You need to be able to relax and lengthen them to achieve this.
The above is one of the reasons we do not use the term “Kegels” when discussing proper pelvic floor work. Kegels have become synonymous with “squeezing the muscles used to stop the flow of urine.” Hopefully by now, you see the two issues with this:
- Your “pee-stopping” muscles are only the front of your pelvic floor
- A focus on “squeezing” or contracting only can be problematic, especially for those experiencing symptoms of PFD
Consider Pelvic Floor Physical Therapy
Working with a pelvic floor physical therapist is often the fastest, and most effective, way to heal PFD. Many times it is necessary because if your muscles are overly tight, sometimes you need manual work (that a physical therapist can provide) to help release these muscles. You can use this PT Locator provided by APTA (American Physical Therapy Association) Pelvic Health to find a qualified Women’s Health PT near you.
More Core + Pelvic Floor Training
For comprehensive core + pelvic floor training during pregnancy, as well as postpartum recovery work, explore our Programs and Services. We offer prenatal and postpartum self-guided training programs that you can do on your own, or you can work directly with one of our expert PROnatal Personal Trainers.
Are you a health and fitness professional interested in working with the pre and postnatal population? Explore our professional education and specialist course.