Exercise + your pelvic floor

After over 13 years of teaching Pilates to women and men of all ages, I have made it my passion to empower and encourage my clients to live healthier, more confident, pain free and physically & mentally fit lives. Whether they be elite athletes, new mums or mums to be, clients recovering from surgery or injury, my job is to allow them to exercise in a way that is beneficial, safe and long lasting.

One of the areas that I find myself growing particularly interested in, is Pre and Post Natal exercise and recovery and this includes Pelvic Floor health and function. I have often been one of the first points of contact for clients who are affected by compromised bladder control and also pelvic floor prolapse, and so I would really love to boost awareness about about pelvic floor fitness - a topic that is too often not talked about or overlooked. Even if you have never had a baby, you should be aware of the importance of a strong pelvic floor.

For this post I would like to focus primarily on women's pelvic floor health and fitness issues, simply because these issues are much more common in women and the risk factors are also greater.

SO WHO IS AT RISK?

• Women who are pregnant or have ever given birth, especially those who have had multiple births, severe perineal tearing or particularly large babies are at a greater risk of pelvic muscle damage. (Continence Foundation of Australia 2014). In fact 1 in 2 women who have ever had a baby will experience some degree of pelvic organ prolapse.
• Heavy lifting -  people in certain professions such as nursing where heavy lifting is required or in those who perform heavy weight training at the gym can be at risk of pelvic floor prolapse.
• Chronic coughing and sneezing can create increased pressure on the pelvic floor and can in some cases lead to increased urinary incontinence and prolapse. 
• Chronic back and pelvic pain can be associated with immobility and lack of exercise which can lead to weakness of the pelvic floor. 
• Obesity and being overweight as increased weight will place more pressure and strain on the pelvic floor, as well as the rest of the body.
• Women going through menopause. As the tissues become more and more deficient in oestrogen, they become thinner and less supportive, women experiencing menopause may also reduce their physical activity.

HOW DO I ACTIVATE MY PELVIC FLOOR?
Here's how I best like to cue pelvic floor activation as it's simple and easy to understand.
"Imagine you are trying to stop weeing and farting at the same time! Tighten your pelvic floor muscles gently, drawing up and in." Hold this activation for as long as you can (ideally up to 10 seconds). It is then important to let go and relax afterwards. Be sure not to hold your breath, tense the buttocks, thighs or upper abdominals during activation - all of these should remain relaxed. Incorrect pelvic floor activation or "bearing down" can actually be counterproductive and worsen symptoms as it increases strain on the pelvic floor muscles and intra abdominal pressure.

It is important to practise your pelvic floor exercises regularly and establish a routine. You may wish to practice whilst in the shower, brushing your teeth or even cooking! And even stick a little reminder note or use your phone calendar to set reminders to do it regularly.

HOW DOES MY PELVIC FLOOR AFFECT THE WAY I EXERCISE?
The pelvic floor makes up part of your "core" and works together with the Transversus Abdominus and deep back muscles to support and stabilise the spine and maintain intra-abdominal pressure. When you exercise, this intra-abdominal pressure changes and ideally when load is placed upon your spine, the pelvic floor muscles should lift, deep abdominals draw in and breathing should remain relaxed.
Activation of the TA's or transversus abdominus (abdominal bracing) is especially important in post natal recovery, and it is also important to be first lifting the pelvic floor, then activating TA's. 
Always ensure that the Pelvic floor is activating correctly as research has shown that when the pelvic floor is being pushed down or placed under too much strain during exercise, it is not able to withstand the force being placed upon it and may lead to worsening symptoms of prolapse or incontinence.
If you are experiencing pelvic floor issues, it is important that appropriate care and recovery exercises are implemented into your exercise program and that you seek help from a continence professional or women's & men's pelvic health physiotherapist. 

HOW CAN I PROTECT MY PELVIc FLOOR DURING EXERCISE?

Some helpful tips...

• Be sure to maintain good posture throughout your exercises
• Activate the pelvic floor before and during resistance exercises
• Perform exercises in a safe and supported way, where you are able to perform the exercise correctly
• Take adequate rest when needed.
• Pay close attention to your fatigue levels 
• Avoid exercises that increase intra abdominal pressure. Exercises that increase intra-abdominal pressure can potentially place more stress on your pelvic floor. For example: Abdominal crunches, double leg lifts, lifting heavy weights, jumping exercises, running and squats can place pressure on the pelvic floor.

AFTER HAVING A BABY - RETURNING TO EXERCISE
Returning to exercise too soon after pregnancy can lead to reduced pelvic floor strength, long term bladder and bowel problems and pelvic organ prolapse, so it is extremely important to exercise caution and not resume until you are recovered.

Remember that no matter how fit you are, or were before it takes a minimum of 8 weeks before your abdominal muscles are strong enough to support your back and pelvis. You may feel fine on the outside but there is simply no way that your abdominal muscles can go from being overstretched during pregnancy to shortened and strong enough to provide support for your body without time and appropriate postnatal abdominal exercises. 

Please be sure to check with your doctor, midwife or physiotherapist before returning to exercise to ensure that you are cleared to return to low impact exercise under the guidance of a fitness professional that has experience in post natal exercise.

Post Natal Exercise guidelines:
0-3 weeks post natal
Walking, post natal TA activation, pelvic floor exercises
3-12 weeks post natal 
(after your 6 week postnatal check with your doctor)
Low impact post natal class such as Pilates or Yoga, walking, pelvic floor exercises, light weights.
12-16 weeks post natal 
Check in with your physiotherapist for a checkup and pelvic floor testing before returning to higher impact activities such as running.
16+ weeks post natal
Return to previous activity levels provided your pelvic floor muscles have returned to normal and you are not experiencing any pain, heaviness or urine loss during or after exercise. Consult your pelvic floor specialist if symptoms persist.

For more information on pelvic floor safe exercise and where to get help if needed, we recommend visiting the Pelvic floor first website. Please visit http://www.pelvicfloorfirst.org.au/

BENEFITS OF A STRONG AND HEALTHY PELVIC FLOOR

• Improved bladder and bowel control and function
• Reduced risk, level and symptoms of prolapse
• better recovery from surgery or childbirth
• Increased sexual sensation 
• Increased quality of life and confidence

I hope that you have found this information helpful and that you can implement some of this into your daily life and exercise routine to live with more confidence and awareness. My wish for you is that your coffee, your intuition and your pelvic floor be strong!

​Ellesse x

HELPFUL INFO & LINKS:

• National Continence Helpline 1800 33 00 66
• Pelvic Floor First Website www.pelvicfloorfirst.org.au/
• Continence Foundation of Australia Website www.continence.org.au/
• Australian Physiotherapy Association Website australian.physio/

​Written by Ellesse Hawkins

DISCLAIMER:  This blog post is intended as an information guide to Pelvic Floor safety in relation to exercise and is not intended as a treatment guide for any individual pelvic floor issues. I highly recommend those with pelvic floor dysfunction or uncertainty please seek help from a GP, continence professional, Women's & Men's Pelvic Health Physiotherapist or continence nurse.