Reaching your New Year’s Resolution with your least talked about muscles

It’s a new year. Many of us are focused on improving our strength or losing weight. How can both of those things positively impact your pelvic floor? How can you keep this resolution this year? Read on to find out how you can find the motivation (and the steps!) to improving your pelvic floor health.

First, to strengthen your pelvic floor you have to know what exactly your pelvic floor is. Your pelvic floor is a group of muscles designed to help you hold back urine, gas, or a bowel movement. They help to keep your pelvic organs, namely your bladder, uterus, and rectum, in your pelvis where they belong. The pelvic floor is an integral part of intercourse. Importantly the pelvic floor muscles also help to provide the “core” stability you need with everyday activities such as lifting, pushing, and pulling, as well as allowing you to participate in exercise (read jumping, running, kick boxing, lifting).

How do pelvic floor muscles become weakened or dysfunctional? A few ways this can occur include pregnancy, labor & delivery (even with Cesarean sections), during or after menopause, after surgery that requires general anesthesia, catheterization, weight gain, bed rest or being ill for a long period of time, chronic coughing (smoker, COPD, asthma), and with some medical conditions including diabetes & neurological diseases.

Now that you know the what and the why, you need to know how you can make these magic little muscles work, and work well. Many people know about Kegels, named after Arnold Kegel, an American Gynecologist. I prefer to call them pelvic floor exercises, as I believe it is important to know what specifically you are working on, not the name of some guy who “invented” an exercise. The idea behind a pelvic floor contraction is that you are using the muscles that hold back urine or gas and performing a squeeze and a lift. As this is a bit of an abstract idea, especially if you don’t have to pass gas or go to the bathroom at the time you are trying to do this exercise. I often instruct my female patients to imagine picking up an M&M with their labia (hence the squeeze and lift part). For men, I often instruct them to think of holding back gas, or picking up a quarter at their anus. Ideally this contraction would not be done during urination as it can increase risk of urinary tract infection.

It is important to be evaluated by a physical therapist that specializes in Pelvic Health so that they can properly perform a pelvic floor examination. A pelvic floor examination involves a gloved and lubricated finger, examining the muscles of the pelvic floor. This gives us the best sense of if your muscles have tone (non-optimal tightness which prevents them from doing their job properly), trigger points (areas of tenderness or pain), or if you have difficulty activating the muscles. In my clinical experience, approximately 40% of people who are instructed to perform a pelvic floor contraction either can’t properly do the contraction, or cannot relax once they have performed the contraction. Both of these can be addressed through physical therapy and specific exercises based on your needs.

Now, back to your new year’s resolution. Increased abdominal fat puts increased pressure on your pelvic floor, which can cause the muscles to work really hard during the day to help support your pelvic structures, which in turn makes the muscles tired. Tired muscles are less likely to be able to hold back gas and urine when it’s really needed and you may notice increased frequency of leaking toward the end of the day or during a high activity day. By decreasing your abdominal fat through healthful eating and moving/exercising more you will have less pressure on your pelvic floor, which in turn will allow it to perform its job better and easier.

By focused muscle strengthening of your abdominal muscles and your pelvic floor muscles you should notice decreased incidence of urinary urgency and frequency and less waking up in the night to urinate. You may also notice a flatter tummy and deceased back pain as your abdominal muscles and pelvic floor muscles work in coordination with your low back muscles to provide you with “core strength” during activities of daily living and with exercise. You should also feel stronger and more stable, and that you can do more of what you love doing without having to constantly run to the restroom, or worry about leakage.

Come on in to Colorado Center for Physical Therapy in Downtown Littleton where Lindsey Sandau-Tomlin, PT, DPT, CAPP-Pelvic and Margaret Woodward, MS, PT can evaluate you and provide you with achievable goals to improve your strength and function in 2018.

Not sure if you are ready to begin physical therapy? That’s okay, you have to start somewhere. A good reference is Amy Stein’s book, Heal Pelvic Pain, which you can find at healpelvicpain.com. Diane Lee, who is a pioneer in the field of Pelvic and Women’s Health is also a great resource. You can find resources at learnwithdianelee.com/resources/.

Lindsey Sandau-Tomlin, PT, DPT, CAPP – Pelvic
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