CHECK IT
Suss the signs you might
have a weak or hypertonic
pelvic floor■ (^) Any bladder or bowel incontinence
■ (^) Any sensation of heaviness or
drawing down (this could indicate
a prolapse so see your GP)
■ (^) Pelvic pain
■ (^) Painful sex
YOU’RE COMMITTED TO YOUR
ABS WORKOUT, and even legs day gets
a nod in your fit calendar, but when was the
last time you gave your pelvic floor its own
dedicated sesh? Whether you’re child-free,
pregnant, have been through multiple
labours or had C-sections, have symptoms
such as stress incontinence or occasional
leakage, or you feel A-okay down there,
your PF (that’s your pelvic floor) still needs
some love. Here’s how to whip those
forgotten muscles into shape...
BACK TO BIOLOGY
“When we talk about your pelvic floor,
we mean a group of muscles that stretches
from your pubic bone at the front to your
tailbone at the back, forming a ‘platform’
between your legs,” explains physiotherapist
Elizabeth Ebelthite. “Its job is to support
your pelvic organs, bowel, uterus and
bladder. When the PF muscles are weak
- something that can happen as a result
of pregnancy, childbirth, intense exercise,
or being overweight – the consequences
can range from backache to the odd leak
to bladder and/or bowel incontinence,
or even pelvic organ (uterus, vagina,
bowel or bladder) prolapse.”
It’s important to define weakness
though, says pelvic floor recovery expert
Wendy Powell. “The muscles may be slack,
especially directly after childbirth when
sensation may be limited,” she adds.
“But muscles that are overly tight are
also weak, because they’re not able to
do what they’re supposed to. Too tight
muscles are called hypertonic and are
common in people who’ve been doing
pelvic floor exercises wrong or sporty
women who do a lot of training. You learn
to squeeze inwards all the time (especially
if you’ve been prone to leaking) and the
muscles end up permanently contracted.”
A lot of women also tuck their pelvis under,
says Powell, because they think it’s better
posture. “But this actually just shortens
the PF muscles, so again they’re contracted
all the time,” she says. “Regularly wearing
high heels does the same thing.”
Recent research suggests pelvic floor
weakness is even more common than
hay fever – and athletes, as well as those
who favour high-impact, high-intensity
exercise might be just as much, if not
more at risk of PF problems than those
who’ve popped out babies.
The-thing-no-one-wants-to-talk-about - incontinence – is especially common
in endurance runners and those who lift
weights, causing them to hit pause on
their training. “Incontinence can affect
your mood, confidence, sleep, work, sex
life and more,” says GP Dr Julian Spinks.
“And it can worsen if not addressed. But it’s
not an inevitable consequence of having
children, doing sport or ageing. And there’s
lots women can do to prevent or treat it.”WORK IT OUT
A healthy pelvic floor can have a positive
impact on posture, core stability, ease
of movement and sexual sensation (the
muscles wrap around the clitoris) as well as
the more obvious role of keeping urine in.
We’ll take our PF strong, thanks –
so that’s where pelvic floor exercises
come in. They’re nothing new – there
are mentions of them in ancient Chinese,
Indian, Greek and Roman texts – but the
term ‘Kegel exercises’ wasn’t coined until
the 1940s, when US gynaecologist Dr
Arnold Kegel published an article on the
importance of exercising the PF to treat
incontinence following childbirth.
This method, which generally involves
tightening, lifting, pulsing or holding the
pelvic floor muscles, is recommended by
GPs, gynaecologists, physiotherapists,
personal trainers, and yoga and Pilates
instructors. The trouble is, they can be
hard to describe and even harder to know
if you’re doing them right. And if you’re
lacking in sensation down there, engaging
with them in the first place can be difficult.
“We’re often told to ‘think about
squeezing the muscles that stop you having
to pee’,” says Powell. “But it’s better to
think about drawing upwards than inwards.
Imagine trying to draw a tampon up higher
inside you, or picking up a grape with your
vagina. Don’t just squeeze your glutes and
try not to scoop your pelvis under. Then,
think about relaxing and releasing.” See
‘Your daily PF workout’ to the right.AAAAND RELAX...
According to personal trainer Jane Wake,
the endless repetitions recommended
by many experts aren’t realistic for most
women. “Lots of PTs fail to teach people
to connect with their PF properly,” she says.
“You need to develop residual strength in
the muscles so that when you lift or sneeze,
for example, you’re protected.”
Heavy weights or high-impact classes
aren’t great for a weak PF, particularly for
new mums, Wake adds. “Doing planks,
crunches and sit-ups can damage the PF
by pushing down on it. You need to work
from the inside out. If you just work your
exterior, you’ll be weak on the inside.”
However, there’s no reason not to
exercise if you have a weak PF – unless
you regularly need to wear a pad to gofor a run or hit the gym, in which case you
should take some time out to work on
improving your PF rather than your PB.
“When you’re running, be aware of your
PF, lifting it on each exhalation,” advises
Powell. “When you’re lifting weights, don’t
be tempted to hold your breath and brace.
Get into the habit of protecting your PF
and core with each lift. Exhale, lift your
PF to protect yourself as you inhale, then
exhale and lift your weight. Always exhale
on the exertion. Do this in your daily life too- before you lift your child or shopping.”
If you’re really having trouble
connecting with your PF, see your GP.
“Ask to be referred to a pelvic or women’s
health physiotherapist, who can offer
more specific advice,” says Powell. “And
remember, your PF doesn’t need to be
super-strong, just fully functional.”
Your daily PF
workout
Get your strongest pelvic floor
with Powell’s routine■ (^) Find a comfortable position – lying
on your back with your knees up and
feet flat on the floor will work.
■ (^) Make sure your pelvis isn’t
tucked under.
■ (^) Close your eyes and take a few
long, slow breaths.
■ (^) As you exhale, draw up your
pelvic floor.
■ (^) As you inhale, fully relax – try to
completely let it go. This bit is just
as important as the lifting.
■ (^) Now think about lifting and
relaxing each of the three openings
in turn (i.e. urethra, vagina and anus).
■ (^) Think about a lift going up and
then down five floors, stopping at
each one on the way.
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WORDS
HANNAH EBELTHITE
PHOTOGRAPHY
THINKSTOCK
LiveFIT