The pelvic floor is a mysterious and unfamiliar part of the body for many women. There is some emphasis from providers on the importance of Kegels for a strong pelvic floor, yet a lot of misinformation and controversy around this topic. One in three women will have pelvic floor dysfunction including bowel and bladder issues and pelvic pain according to the American Urogynecologic Society. The National Association For Continence has reported that 40% of women are not performing a Kegel exercise correctly.
The best time to learn about and connect to the pelvic floor muscles is ideally before pregnancy, but during pregnancy is just as good. The pelvic floor is a group of 14 muscles. The main functions of the pelvic floor are continence (they control bowel and bladder function), support (they provide support to our internal organs pelvic and abdominal contents, and sexual appreciation. These are the muscles that contract and relax when a woman has an orgasm. They play such a vital role, which we don't often realize until we experience weakness and issues post pregnancy.
The challenge with connecting to the pelvic floor muscles is that we can't see them - they are internal. To get in touch with these muscles you can stop the flow of urine midstream. This will give you a sense how the muscles relax when we eliminate and can contract to control the flow of urine. This is not a place to practice a kegel exercise. It is also important to look at the bones of the pelvis to get a sense of where these muscles are in our body and how they provide support underneath as our under carriage. When these muscles contract they squeeze and lift our pelvic contents up and into our body. Equally important is for the muscles to be able to relax.
The pelvic floor does not exist in isolation but is one part of a system that makes up The Core. The pelvic floor has a relationship with the Diaphragm, the deepest layer of the abdominals Transverse Abdominis, and the spinal stabilizers Multifidus. We can't only squeeze the pelvic floor without considering the other components. The pelvic floor is part of a dynamic system that is strengthened through breathing. The key is creating awareness and feeling how the system works together. Once we can feel this dynamic movement, then we can coordinate our kegel exercises.
To begin we need to practice diaphragmatic breathing. When we take air in the rib cage expands and the diaphragm descends. The breath moves 3 dimensionally down to the pelvic floor. There is expansion, forward, sideways and backwards. The pelvic floor mirrors the movement of the diaphragm and lengthens. When we breathe out the pelvic floor rises, the belly flattens, the diaphragm moves back up and the rib cage returns to its starting position. Normal breathing mechanics creates a lengthening and shortening of the pelvic floor without even squeezing or doing a kegel. The kegel exercise is coordinated with the exhale or natural lifting phase of the breath cycle.
A very important aspect of strength for the pelvic floor is mobility. The pelvic floor needs to contract by squeezing and lifting up and in. The pelvic floor also needs to be able to relax fully back down to its resting baseline. The pelvic floor further needs to elongate to birth our babies. If the pelvic floor doesn't have enough mobility a woman can run into issues. This can be from musculature being too tight, a pattern of holding our belly in all the time, external stress to the body, or poor movement patterns.
A daily practice of diaphragmatic breathing is the best way to connect to the pelvic floor muscles. This practice can be for a few minutes at the end of the day. Lie on your back in a supported reclined position and tune in to the rhythm of your breath. Once you've practice reclined you can bring this practice into sitting and standing. When you have a sense of movement of the pelvic floor, you can think about strengthening (when to add your kegel). Do your muscles need more support? Do your muscles need more flexibility? A pelvic floor exercise program is specific to the individual and not one size fits all.
Developing a sense of the pelvic floor and how it relates to the rest of the core is the foundation for strengthening during pregnancy. It is also where you will begin to re-educate the core in postpartum as you return to exercise.
Do you have a question about the pelvic floor? Leave a comment below or you can Ask Solange.