If I had just 1 hour with every woman with pelvic health issues....

Pelvic Health: Beyond Kegel’s

In May this year, I begin a 2 year diploma course in Women’s Health, furthering my knowledge in (amongst other areas) the pelvis, and in particular the pelvic floor (PF) - a frequently forgotten structure when we talk about the core. I am so excited to be studying this complex area in more depth, and to be able to extend the support and treatment I give for those struggling with pelvic dysfunction.

Stress Incontinence

Stats suggest that over half of all women will experience incontinence at some point in their lives, and it’s not just a case of being over a certain age or after childbirth. Even young girls, especially the extremely athletic, or those with chronic coughing conditions, such as Cystic Fibrosis or asthma can suffer.

It is incredibly common. But being common, does not make it normal, and avoiding certain activities or wearing pads is not OK.

Leaking urine or worse, hemorrhoids, separation of the abdominal muscles (diastasis recti), pelvic pain, pelvic organ prolapse, pain on inserting a tampon or painful sex, low back or hip pain are all signs there is PF dysfunction. 

Kegel’s can make matters worse

Traditionally, the advice given for stress incontinence (leaking on jumping, sneezing, running etc) is PF exercises, also known as Kegel’s. If you can do a Kegel, great, you know where your PF is, but there is so much more to PF health. Actually, just doing Kegel’s can worsen the problem, as it can reinforce misalignment, or shorten and tighten the PF too much. 

It’s vital to remember that the PF is part of the core or abdominal canister. Imagine the core like a fluid filled balloon, with the diaphragm on top, the pelvic floor as the base, and the spinal and abdominal muscles wrapping round to create the sides. 

Each component of the core is connected and therefore has the power to impact upon neighbouring, and even far reaching structures. And vice-versa. So, now you can see that in order to rectify pelvic dysfunction, we must go beyond Kegel’s. 

If I had just one hour with every woman that had pelvic dysfunction, these would be my top three recommendations:

 1.     Learn how to breathe

As introduced above, the diaphragm is critical to PF health. Think of that fluid-filled balloon again, and visualize the pressure system within. As you inhale the PF gently relaxes and bulges, and as you exhale the PF lifts and contracts. You could even liken the PF to a second diaphragm, also moving as you breathe.

Many of us have altered breathing patterns, either solely breathing in the upper ribs, with the shoulders elevated and belly sucked in, like a ‘soldier’ posture. Or breathing solely with the belly, with the upper back rounded and belly pooched out. Both of these patterns negatively affect the pressure system within the core and put too much pressure down on the PF. We must breathe with our lower ribs, feeling a 360 expansion around the lower ribs and little or no movement in the shoulders or belly. To master this takes time and effort, but practice makes permanent, and its important for your body to accept this as the new norm. Go to my video guide page for a little demo. 

2.     Learn what is pelvis neutral

The position of your pelvis is highly influential on PF health. How many of us have been repeatedly told to ‘tuck-under’ and ‘suck in your belly’? By constantly tucking our bottoms under, we are pushing our tail-bones forwards and inwards. As the fibres of the PF mostly run front to back, this inward motion of the tail-bone shortens and tightens the PF muscles, creating far too much tension and weakness. Kegel’s simply reinforce this.

Key point: Short and tight muscles are weak, and long and relaxed muscles are strong, just like Andrex!

This tucked position is also constantly reinforced by the way we sit. Generally we sit for far too long and in a slouched position, sitting on our tail-bone, further pushing it under.

Think about our balloon analogy again. If you’re spending too long tucking under and sucking in, the balloon gets squeezed, and that pressure finds the weakest point. Downwards to the PF.

We need to un-tuck, but not too far, as over-arching the back can be just as detrimental to the PF. We need to find neutral. Standing up, place the heels of your hands on the bony crests at the front of your pelvis or ‘hip bones’, and now drop your fingertips inwards and down onto your pubic bone. Look at the position of your hands. They should be in a vertical position. If your fingertips are coming forwards slightly, your pelvis is tucked under. If the heels of your hands are coming forwards your low back is too arched or swayed. Video demo here.

Practice this pelvis neutral position throughout the day when you are sitting and standing, and now you can integrate it into your Kegel’s.

3.     Learn how to activate your Glutes

The glutes are your buttock muscles that wrap around your backside and attach to the tailbone. They are your big power-house muscles that propel you forwards, get you up out of your chair and stabilize the pelvis.

The exciting relevance of the glutes to the PF, is that they can actually help balance the shortening and tightening of the PF caused by the tucking under of the tail bone. The glutes are the antagonists to the PF; they do the opposite. They can actually pull the tailbone back outwards and create the good length and strength we are looking for (think Andrex).

As we sit way too much and tuck our bottoms under, the poor tailbone is caught in a tug of war, generally with the PF winning (short and tight). So another part of the answer is to fire up and activate the glutes to hold the tailbone in a neutral position with the muscles on either side long and strong. 

So how to activate the glutes? Walking is a great start, and I recommend at least 30 minutes of a really good brisk walk every day. I would also highly recommend learning how to squat. Squatting is enjoying a complete revival, and I am also a fan. If this scares the daylight out of you, don’t be put off just yet, there are stages to squatting and much squat preparation you can do! Video demo here.

The position of squatting opens and stretches the PF, and the getting down and up activates the glutes, core and thigh muscles. It is a key movement that we are designed to do. Think of a toddler comfortably playing for hours in a squat position, or people in developing countries squatting to eat, socialize and go to the loo. We have long lost this movement, due to society dictating the use of chairs.

Relaxing and lengthening the PF is just as important as strengthening it (if not more so if all you’ve ever done is just Kegel’s). You can’t strengthen a muscle that is short and tight. Just breathing whilst standing or in the squat position, feeling that lovely bulge in the PF as you inhale, helps to stimulate the blood flow to the area, improving tone and muscle health.

So, once you have figured out this new way to breathe, stand and squat, put it together with your Kegel to create a far more effective exercise. 

You can do PF exercises lying, standing or sitting. Once you have mastered it lying down, quickly progress to standing and squatting as these are the position you are going to need PF strength the most.

Commit to exercising three times a day, not just a half-hearted attempt at the traffic lights or whilst the kettle boils. Download the Squeezy app from the NHS, set your reminders and move your way to a happy and healthy, Andrex-like PF.

If you are struggling with any of the symptoms mentioned above and find it hard to connect with your PF, don’t ignore it any more. Do get in touch, we can help.


Emma Wightman


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