When I’m working with women in the clinic who are dealing with a variety of symptoms, whether it’s pelvic pain, incontinence, or prolapse type symptoms, we first need to start by finding their pelvic floor. For a lot of women, this is a really challenging thing to do; It’s a very murky area of our body, and we always typically start our first few sessions just figuring out, “okay, how do I activate my pelvic floor, and how do I do it correctly?” There have been studies done that have looked at women who were just given a handout on how to squeeze their pelvic floor (a kegel), and what they found was that most women do it wrong. It’s important that we are able to properly activate our pelvic floor if we’re going to be trying to either strengthen it or relax it. These are a few different ways that work with my clients to start to be able to correctly find and use their pelvic floor.
Focusing on the breath is a good way to start. When you are thinking about finding your pelvic floor, we want to make sure it can do two things: we need to be able to contract, and we also need it to be able to relax. This is an important piece that I feel like we really miss – we don’t have that ability to let our pelvic floor relax and get long. When I start with clients, we’ll start with breaths: we inhale and think about letting our bellies relax, and letting that pelvic floor really lengthen and get long. We can do this in a variety of positions, but I’m typically starting in side lying or on your back. You can lay down on your side, knees can be bent, you can put a hand on your low belly to make sure you’re letting it relax, and then you can inhale – feel your belly release and feel your pelvic floor (when I say pelvic floor, what I’m referring to are your vaginal and your angel openings). You want to think about letting those go and get longer.
Your pelvic floor is three layers of muscles that sit at what you can think of as the bottom of a bowl sitting at the bottom of the bowl. They run from your pubic bone in the front, to your tailbone in the back. When we’re thinking about letting those go, you can imagine them “melting” or just getting long and relaxing.
The second piece is contraction. I’ll teach people that during an exhale we want to create engagement. When you contract, we want to think about closing first, and then lifting your pelvic floor, so our pelvic floor needs to be coordinated as well. They have done studies on women, comparing continent women (women that don’t leak) to women that are incontinent. They have them do an activity – I think one of the studies was they caught a ball in a bucket – and they studied what happened with their pelvic floor. The assumption would be the people that didn’t leak would have a much stronger pelvic floor and a more robust pelvic floor to help them stay continent, but they found the opposite; the women that were really incontinent (leaking when when they did the activity) they had the most amount of pelvic floor contraction, but the least coordinated.
This just shows us that our pelvic floor needs to be coordinated, and it needs to have fine motor control as well. When we’re thinking about engaging our pelvic floor, we want to think about closing first and then lifting up. Starting on your side again or laying down on your back with your knees bent, you can take six to eight breaths, hand can go on your belly, inhale, let things relax. As you exhale, close and lift your pelvic floor. Your bellybutton pulls towards your spine. That’s a place that you can start: using your breath to try to help coordinate that system. A few different other tricks that you can try are: using visual imagery can be helpful for some women – imagining your vaginal or your anal opening, closing around a beam. You want to visualize closing around that beam at first and then lifting that beam up. You can also imagine if you’re gonna drink a milkshake, you would imagine closing around a straw and then pulling that milkshake up. Those are a few different tricks that I use to help my clients start to really connect with their pelvic floor and with their core system.
Here at Peak Endurance Performance & Physical Therapy we help active adults in the Madison Area get back to the activities they love without pain or limitations. We see people of all ages, ability levels, and individuals trying to get back to a multitude of movements including: getting back into running, women postpartum, CrossFit athletes, climbers, gymnasts, wrestlers, overhead athletes, and your recreational weekend warrior. If you’re looking to get back to the activities that give you meaning, relieve stress, and make you feel like you again, feel free to reach out below and we’ll see if we’re the right fit for you.
