Pelvic Floor Myths: The Exercise Edition

The main way to do pelvic floor exercises is to lie on your back and lift your bottom up

When women come to me with the goal to strengthen their pelvic floor, get strong for pregnancy or recovery post-natally and get back to exercise, I always ask them what they have been doing thus far. A lot of women reply with “I lie on my back with me knees bent, feet on the bed and lift my bottom up”. This is an exercise called bridging. It is a great exercise, but unfortunately not the specific pelvic floor exercise that we are aiming for. To start pelvic floor exercises, we start with trying to get the pelvic floor and deep abdominal muscles to activate, starting with short holds and slowly building up the length of time you can hold for. Adding in bridging once you have mastered this is a great exercise but you need to start with a good foundation. You wouldn’t build a house on a weak foundation, and you don’t skip to half way through a book without reading the start. This is why you need to begin with the pelvic floor along, and then add in other movements to make it harder.

The best way to check my pelvic floor contraction is to stop the flow of urine on the toilet

We know that your pelvic floor plays a strong role in maintaining continence – what that means is that it prevents you from leaking urine, wind or faeces. So it makes sense that if you can stop your urine mid-flow, that your pelvic floor is working. The issue is that your bladder is a very complex piece of art, it is made up of layers of muscles which are controlled by voluntary and involuntary motor and sensory nerves. When you urinate your pelvic floor should relax so you can completely empty your bladder. So when you are going to the toilet, if you often stop your flow of urine this will send mixed messages to your bladder as to whether it should be urinating or not and can lead to issues with complete emptying down the track. You may like to assess your pelvic floor control every now and then by stopping the flow of urine for a couple of seconds, but do not make this a habit. The best way to to assess your pelvic floor function is to have an internal exam performed by a women’s health physiotherapist. Another tool you can use is a “Pelvic floor Educator”. This is an inexpensive tool which you insert into your vagina when lying down and then perform a pelvic floor contraction. The contraction of the muscles moves the educator so you can see when you are contracting and relaxing.

I lift heavy weights so I have a strong pelvic floor

Some people who lift heavy weights do have a pelvic floor. These are often people who know how to brace correctly when lifting and have wonderful technique. Some people lose technique as they go up in weights and this is not a great idea. The best advice I can give to someone is to make sure they know how to brace their deep abdominal and pelvic floor muscles during heavy lifts such as squats, deadlifts, chest press and over head exercises. As you lose technique or position in an exercise, it can make it more difficult to brace, and vice versa if you forget to brace you can lose technique. So if you are unsure, get someone to spot you and check your technique. Also, if it doesn’t feel right, sometimes it is better to perform more reps at a lower weight until you perfect it and then increase the load.

I forget to breathe while I exercise but that doesn’t matter

Breathing is one of the most important things we can do! Yet it is often the thing that goes by the way side when we are concentrating, especially when concentrating on exercise. The great news is that exhaling on the effort is a great way to remind yourself to breath and it also facilitates your deep abdominals and pelvic floor contracting. When we don’t breath, or if we hold out breath during an exercise (this is called a “valsalva”), the pressure in your abdomen (intra-abdominal pressure – IAP) applies a force downwards on your pelvic floor. With such strong force downwards, this can make it very difficult to brace, as mentioned above, but it can also put a lot of pressure on the ligaments which attach your pelvic floor to the pelvic bones. You do not want to put too much pressure on the pelvic floor ligaments, as although you can strengthen the muscles, you cannot undo stretch to the ligaments under these kind of pressures. So just think, exhale on the effort, slow down and focus on your breathing, and this will take a lot of pressure of your pelvic floor.

Emily Georgopolous (APAM)

Physiotherapist

Featured in the Top 50 Physical Therapy Blog

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