Until having kids, I didn’t know much about the pelvic floor muscles. You hear all the time how important it is to exercise and strengthen all the muscles in your body, but when do you ever hear about the pelvic floor being part of that? It wasn’t until I was pregnant with my first baby that I was even told by my OBGYN that regular exercise of the pelvic floor was important when he brought up Kegels and told me I should start incorporating them into my day to day life, but I didn’t see much of a point. How could something so simple make a difference?
Well, after having my daughter, I realized just how important those pelvic floor muscles really are and why we should work on strengthening them. Not only did I have extreme pain down there for over a year postpartum, but I noticed I didn’t have much control. I felt weak and not like myself. And even adding in daily Kegels didn’t seem to be making much of a difference. Little did I know just how much damage I had, and I was completely unaware that there were things I could do to fix that damage.
Fast forward to having my son and a second episiotomy, I started noticing more extreme issues--from leaking urine, especially when jumping while exercising, to extreme digestive issues and abdominal pain. It wasn’t until visiting several doctors for my chronic pain that my GI doctor asked me about my pelvic floor. He went on to explain that damage to your pelvic floor can cause severe GI problems and pain, and if you're already having GI issues (which I was), it only exacerbates things!
Unfortunately, pelvic floor issues are all too common, especially among women! In recent years, studies have shown that nearly 1 in 3 women will have at least one problem with their pelvic floor muscles. And I’m here to tell you--you don’t have to live like that! By learning about these crucial muscles and working to recover and rebuild them, you can once again feel like yourself and improve your quality of life tenfold.
So...What Are the Pelvic Floor Muscles & Why Are They Important?
The pelvic floor is a group of muscles and tissues that line the pelvis. They extend front to back and side to side within the pelvis, forming a basket shape of muscles. Both men and women have these muscles, and their job is to work to hold in urine, stool, and gas until a person voluntarily decides to release it.
They also work together with the lower abdominal muscles to help support and stabilize your back and pelvis, assist with sexual function and orgasm, and support the organs within the pelvis. For women, this includes the uterus, and when you’re pregnant, also includes the weight of a placenta and growing baby.
What is Pelvic Floor Dysfunction?
Pelvic floor dysfunction is when the muscles of the pelvic floor are not functioning properly or to their full potential. This could be as a result of damaged tissues or weakened muscles, but it can also be caused by muscles that are too tense/tight or an inability to coordinate or control those muscles. All of these problems with the pelvic floor can lead to pain or uncomfortable symptoms.
Causes of Damaged or Weak Pelvic Floor
Pelvic floor disfunction can be caused by a wide range of things. And sometimes extreme problems with the pelvic floor can be due to multiple factors that together, wreak havoc! For women, the following are common causes of damaged or weakness in the pelvic floor:
Genetics
Genetics have a huge impact on our health in general. Unfortunately, genetics can also play a role on the health of your pelvic floor as well. Although researchers are still working to understand this, studies have shown that you can have a predisposition to pelvic floor disfunction if you have a specific gene for it in one of your chromosomes.
Hormone Levels
Hormones influence our bodies in some pretty extreme ways. And as women, our hormone levels are literally all over the place during pregnancy and the postpartum period. One of these hormones is estrogen, which is often lower after birth due to breastfeeding. Low estrogen can cause thin dry tissues in the vagina, which can lead to small tears and damage to the area. The pain you experience as a result can cause those muscles to tense up or not function properly, especially during sex.
Obesity
Being overweight can contribute to a weakened pelvic floor. This is because those muscles are responsible for holding up the weight of everything in and above the pelvis. Those that are overweight will have more weight on those muscles, and that constant pressure can lead to weakness.
Pregnancy and Delivery
Dr. Mae Hughes, certified pelvic floor therapist, states, "It’s no secret that pregnancy changes your body in countless ways. Your pelvic floor is no exception. Over the course of pregnancy, the weight of your growing uterus and growing baby cause it to stretch. Your pelvic floor actually stretches up to three times its resting length during vaginal delivery. This is normal! But just like elastic or rubber bands, overly stretched muscles become weak. And even if you don’t have a vaginal delivery, your pelvic floor loses roughly 25% of its strength just during pregnancy."
Having More Than One Child
Every time you get pregnant and have a child, you're putting stress and strain on those muscles. If those muscles aren't strengthened in preparation for childbirth or repaired postpartum, they will inevitably become more damaged and weak. That's why it's common for women that have multiple kids to notice increased issues with each successive birth.
Trauma During Childbirth
Childbirth in and of itself can cause damage to the pelvic floor, but if you have extreme tearing and episiotomies, you're at an increased risk for problems. This is because episiotomies and bad tearing lead to scar tissue formation during the healing process. Unfortunately, scar tissue does not stretch or move well. This can prevent the pelvic floor muscles from stretching and lengthening in order to perform all of it's functions properly, and is a common reason for painful sex after giving birth.
Signs of a Damaged or Weak Pelvic Floor
There are a wide range of symptoms that those with pelvic floor issues can experience, and extreme issues can go on to cause severe GI problems and pain as well. Some of the most common signs, however, include:
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Leaking urine, especially when you sneeze, cough, jump, or run
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Painful sex
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Prolapse
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Feeling like you need to pee all the time (caused by not being able to fully empty bladder), or needing to pee suddenly and not being able to hold it
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Inability to hold in gas
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Gas from the vagina
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Difficulty having a bowel movement, or inability to hold it in
Dangers of Not Getting Help
Unfortunately, most women don't get help, even if the signs are there. This is because many claim that it's just a fact of life and that it's "normal" for women to leak urine or have weakness in that area with age. However, this couldn't be further from the truth. Although it is common, it's not something you have to live with. And it can go beyond embarrassing symptoms and effect your overall health as well.
Not strengthening or failing to repair your pelvic floor after damage has occurred can have life-long negative effects. Not only will those muscles get weaker with age if they're not strengthened, but not rehabilitating them between having kids can mean further damage, making them more difficult to repair.
If left untreated, women are more likely to experience prolapse, long-term incontinence, sexual pain or disfunction, and even GI issues and pain.
Luckily, there are things you can do to repair and strengthen your pelvic floor muscles, just like you can with any other muscle group in your body!
How To Strengthen Your Pelvic Floor
Foundational exercises (such as Kegels):
Before doing anything else, it's important to start with the basics. This includes finding and being able to isolate those pelvic floor muscles. Otherwise, you won't be able to move onto more advanced exercises that will help to further strengthen and repair.
If you're not sure how to engage those muscles (don't worry, MANY women struggle to find them, especially if they're already weak), start with sitting on the toilet. When you're ready, start to urinate, then stop mid-stream. Those muscles that are tightening to keep the pee inside are the pelvic floor muscles. (Note: Only do this once or twice in order to find those muscles. Doing so often can cause a UTI.)
Once you know where those muscles are, you are ready to practice a basic Kegel. Although many people will say it's fine to do Kegels in any position, many pelvic floor physical therapists recommend sitting upright and focusing on proper breathing, alignment, and muscle engagement.
To do this, sit on the floor on your knees, with your bottom resting on your feet. Make sure your ribs are above your hips, then take a deep breath in, letting your belly expand and fill with air.
While you breathe out, engage your lower abdominal muscles. You can do this by imaging there's a string on the inside of your abdomen that's pulling your belly button towards your back.
Next, lift and squeeze your pelvic floor muscles. Some pelvic floor therapists will tell you to image you're picking up something small with your vagina. It's important that you don't tighten your glutes so that those pelvic floor muscles are being exclusively worked, so focus on keeping your butt relaxed as you do this.
If this is difficult for you, keep practicing and remember, it's more important that you're doing high quality Kegels and pelvic floor exercises properly, even if it's just a few, than just trying to do hundreds a day.
Incorporate Kegels into everyday activities:
Once you're a Kegel master, make them harder! In any exercise, it's good to start with the basics so you have proper form. But if you always stayed at that level, you'd have no growth.
One of the best and easiest ways to do this is to do Kegels while you're doing every day tasks, such as lifting your child, carrying a car seat, or walking up the stairs with your laundry basket. This will add a level of difficulty to your Kegel that will encourage strengthening as well as work different areas of your pelvic floor.
Do Kegels during other workouts:
Kegels can be great, but doing other exercises that bring in additional muscle groups while still targeting the pelvic floor can be extremely beneficial. These include things like leg raises while laying on your back, lunges, squats, cat/cow yoga poses, and more. When doing these exercises, focus on engaging your pelvic floor.
Make it a habit:
Just like with anything, occasional practice is not going to lead to growth. So make it a habit to work on your pelvic floor. If you need to, set alarms on your phone that remind you to take a break from your day to do something to work on those muscles, even if it's just a few high-quality Kegel's.
See a pelvic floor physical therapist:
If you're struggling to find your pelvic floor muscles at all, can't seem to engage them despite your best efforts, or just don't feel like your at home exercises are helping at all, definitely get a referral from your doctor to see a pelvic floor physical therapist! They go through extensive training and are extremely knowledgeable about that region, and can help repair even the most damaged pelvic floors.
Pelvic Floor FAQ's
Is a weak pelvic floor normal?
I often hear jokes about leaking urine or gas sneaking out after having kids. I've also noticed an increase in commercials for liners, pads, and even underwear that you can use so that leaking isn't such a problem, and so that you can "feel normal again".
Although it’s common for women to get a weakening of their pelvic floor after having kids, which is why we hear about it in TV ads or in chat with fellow moms, that doesn't mean that you have to live with it. And using pads and special undies really just covers up the problem rather than truly getting us back to normal again.
Just like if you had weak muscles elsewhere in the body, you’d work to strengthen them. Which is what we should do with our pelvic floor as well.
Are Kegels enough?
Many providers will say that if you have a weak pelvic floor, that you just need to do as many Kegels as you can throughout the day, and that the great thing about Kegels is that you can do them anywhere-from sitting in a chair at work to laying in bed at night. Unfortunately, Kegels aren't enough. And here's why:
If you were going to work on strengthening a muscle group, you'd want to do a variety of exercises. That way, you'd target different parts of the muscles, while also giving you new challenges that will ultimately provide greater progression on that target muscle group.
Kegels only focus on a basic contraction and release, but they don't offer the variety let alone the challenge needed to truly strengthen those muscles. Kegels are a GREAT place to start, but ONLY doing Kegels and nothing more won't provide the results you're looking for.
Will my pelvic floor heal on it's own even if I don't do Kegels or physical therapy?
Muscles cannot strengthen or heal if you don't put in the effort to make it happen. So if you have signs of pelvic floor disfunction, you need to put in the work if you want to improve your quality of life and prevent further issues in the future.
Can I see a pelvic floor physical therapist when pregnant?
Yes! And in fact, doing so can be incredibly beneficial! Not only will it help you prepare those muscles for delivery, but it can help prevent major pelvic floor damage as well!
When is the best time to visit a pelvic floor physical therapist?
Visiting a pelvic floor physical therapist can be beneficial any time you are experiencing symptoms, whether it's during pregnancy, right after birth, or years down the road! You don't need to wait until you're done having kids or until symptoms get severe to get help.
Does insurance cover pelvic floor physical therapy?
For insurance to cover a service, insurance will often require it to be something that is deemed necessary for your overall health. Although the pelvic floor is crucial for our health and well-being, many insurance companies do not see it as so, meaning they will not cover it.
However, EVERY insurance company is different, and there are insurance companies that will cover a certain amount of physical therapy. So reach out to your health insurance company to find out if they will cover it. You may be pleasantly surprised.
What online resources are there for me if I don’t have a pelvic floor physical therapist in my area?
Unfortunately, pelvic floor physical therapists aren’t available in every area. It’s a niche area of expertise, and finding a highly-trained and knowledgeable provider can be difficult. Luckily, there are some great resources online for those that can’t see someone in person!
Many pelvic floor physical therapists have developed online programs and courses that you can take on your own time from the comfort of your own home, or you can follow along on their Instagram accounts for daily tips and advice. I took a free course from Dr. Marcy Crouch just yesterday, and her tips and advice were extremely helpful.
These courses can also be extremely beneficial for women that have a pelvic floor physical therapist in their area, as the classes are pretty affordable and some insurances won't cover pelvic floor therapy.
Here are a few of my favorite pelvic floor therapists that offer online resources to women:
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Instagram: @thedowntheredoc
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Website: thedowntheredoc.com
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Resources: Free videos, workshops and tutorials; Paid full-length courses and one-on-one support; Informational blog
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Instagram: @dr.maehughes
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Website: drmaehughes.com
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Resources: Paid pregnancy and postpartum pelvic floor exercise courses; Informational blog
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Instagram: @the.vagina.whisperer
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Website: thevagwhisperer.com
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Resources: One-on-one virtual consultations; Free informational downloads; Paid pelvic floor fitness programs; Informational blog
Motherhood truly puts us through the ringer in more ways than one--from the emotional toll it takes as we battle toddler tantrums, to the wear and tear on our bodies from pregnancy and birth. Just remember, there's always help, and you can get back to your normal self again!
For more info on healing after birth, be sure to check out our blog at babycubby.com!