Is all this pelvic floor content just fearmongering? (Part 2)
The truth about Kegels, and why your pelvic floor hates your pants
Last week, we talked about the pelvic floor — a lot.
It’s an important subject, and worth really spending time on, so I’m back this week with part 2. This is not about to turn into a pelvic floor blog, although it is not the last time you’ll hear from me on this subject. However, if you are interested in a pretty-much-entirely pelvic floor–focused newsletter, the Substack gods served me an excellent one a few days ago, written by a knowledgeable pelvic OT named Cait Van Damm. It’s called Adventures in Vaginas (and other parts), and it’s great. Check out Cait’s (free!) post all about kegels here:
Let’s keep it moving with just a few more Qs and As about the pelvic floor. Please ask any additional questions you’d like to see addressed in a future post! Audio version above.
Are Kegels bad?
Truly, I’d direct you to Cait’s post above to learn almost everything you might need to know about Kegel exercises. The jist, though, is this: No, Kegels are not bad — but they’re also not the be-all, end-all treatment for every single pelvic floor issue. They also aren’t something every single person needs to be doing all the time for pelvic health maintenance. Kegels can be quite helpful for folks whose pelvic floor dysfunction (PFD) stems from weakness — this tends to be people with stress incontinence and prolapse. But they need to be done correctly, and it may not be as cut-and-dried as just squeezing and releasing. It may be that you’d benefit from Kegels done in a certain position much more than others (say, standing); or that you need a longer or shorter hold time; or that it’s important for you to combine your Kegel with another kind of movement, like a squat, a lunge, a step-up or step-down, or jumping. In general, it’s very hard to know for sure whether and how you should be doing Kegels if you haven’t been assessed by a pelvic PT or OT.
And wait, why are tight pelvic floor muscles not good?
OK, we started talking about this a bit last week but didn’t go into a ton of detail. Some PFD comes from muscles that have trouble relaxing and stretching (or a combination of weakness in some places and tightness in others). Too much tension can lead to pelvic pain — whether it’s a constant pain or a sudden pain during certain activities (like penetration, pooping, etc.). It can also contribute to urge incontinence.
How?!
I personally find this very interesting so please indulge me!
Basically, your bladder is a stretch organ. It’s like an elastic pouch that slowly fills with urine. When it reaches a certain point of fullness, it begins to send a message to your brain that it’s time to go to the bathroom. But if the surrounding muscles are overly tight, this tension can mix those signals up, making your brain think your bladder is full when it isn’t really. And the more you go to the bathroom when you don’t actually need to, whether your bladder-brain connection is mixed up because of muscle tension or because you’re doing a lot of “just in case” bathroom trips (which many people with urge incontinence do — vicious cycle!), the more your brain gets trained to think a small amount of liquid in your bladder means it’s go time.
If you’re peeing more than once every two to four hours, and if the amount of time it takes you to empty your bladder is less than about 8-10 seconds, it’s a good sign that you might want to try some techniques for slowing things down and turning down the frequency and intensity of that brain-bladder signal. A few ideas:
When you first feel the urge to pee, take a few slow, deep breaths. Find some gentle movement — get up and walk around, do a few calf raises, stretch a bit, etc. — to distract your body. See if you can gently let that urge dissipate, or at least quiet down for a few more minutes.
Try not to pee “just in case.” This is easier said than done when you’re, say, about to go on a long road trip, but think about times when you go to the bathroom just because you happen to be walking by it. Those are great opportunities to skip the just-in-case pee and see how long you might be able to go before your next bathroom break.
It may take some time, but even if you just stretch out the gaps between bathroom breaks by 5-10 minutes every few days, you can really make progress and turn down the intensity of those urges.
Disclaimers here that, again, I am not a pelvic PT or OT, and this should not be considered medical advice. And of course, if your bladder is truly full, waiting until you’re absolutely bursting or even leaking is not the goal either! We’re talking about minor, gradual change that your body can adjust to over time.
What is diaphragmatic breathing?
Diaphragmatic breathing is a great way to let your core muscles contract and relax along with your breath in a way that benefits your pelvic floor. It’s basically belly breathing! When you breathe in, you allow your ribcage and belly to expand and feel your pelvic floor relax. When you breathe out, you feel your ribcage and belly naturally drawing slightly in and your pelvic floor lifting slightly. (It’s not about “sucking it in” or forcing a huge pelvic floor contraction — it’s about making space for the gentle, natural movement of your belly, ribcage, and pelvic floor as you breathe deeply.)
Here’s a great post all about it, from Origin.
What does your belly have to do with your pelvic floor?
A lot, actually! Your abdominal muscles, diaphragm, and pelvic floor are all part of what’s called the “core canister”: this is a pressure system in your torso that’s designed to lower and expand when you breathe in, and lift and contract when you breathe out. When one part of that pressure system is a little “off,” whether it’s weak or has too much pressure on it, it can throw the whole thing out of whack. This is why I often say that your pelvic floor hates your taste in pants: Very tight, high-waisted pants can put a lot of pressure inward on your belly, which often gets rerouted downwards, placing excess downward pressure on your pelvic floor. (Seriously, next time you put on a pair of uncomfortably tight pants, check in with your crotch. I bet you’ll feel a weird pressure or pain down there.) It’s also why “sucking it in” and trying to create the illusion of a flat belly as you move through your day can backfire by worsening symptoms of PFD. As can doing millions of crunches and situps.
That said, very weak or deconditioned core muscles can also cause pelvic floor trouble, so thoughtful core work (like, cough, Pilates) can be really helpful for your pelvic floor.
AND ALSO. There’s one last thing I want to say here. It’s this! People often conflate diastasis recti, a very very common prenatal and postpartum condition, with core muscle weakness. The two often do intersect, BUT! You can have very strong abdominals and have diastasis recti. You can have diastasis recti and do a beautiful job of managing intraabdominal pressure. Diastasis recti does not automatically mean you have a functional issue. We’ll talk about this in more detail in a future post on fitness during the perinatal period, so let me know what questions you have about it.
Finally, why bother caring about the pelvic floor?
Pelvic floor issues are super common — something like a quarter or a third of people assigned female at birth will experience them at some point. And often, this leads to the idea that these problems are just normal: they’re to be expected, especially if you’ve had a baby or you’re aging. But living with pelvic floor dysfunction can be super hard. It can slowly chip away at your confidence and even how safe you feel in your own body. Personally, when I received treatment for my own pelvic floor dysfunction, it felt like my stress levels took a nosedive. I didn’t even realize how much anxiety I was holding about my lack of safety and trust in my own body until it was gone. Just knowing that I’m not going to have to find a bathroom everywhere I go may not sound like a huge deal, but honestly it’s been life-changing.
Thanks for reading! If you’d like to learn even more about the pelvic floor, aside from Cait’s Substack, I’d like to place a small plug here for a podcast I produced for my client Hinge Health. The podcast is called Taking the Floor, and you can listen on YouTube.
Thanks as well for your support for this newsletter. We’re three months in, and How to Move just passed an exciting milestone yesterday: 100 paid subscribers, making this newsletter a Substack Bestseller. This is a wonderful indication that this project may actually have a chance of becoming a viable part of my business before too long, and that I’ll be able to keep it going long-term. Please consider becoming a paid subscriber if you haven’t already — it’s just $5/month or $50/year to support my work and gain access to my weekly, customizable workouts, which I send each Sunday in video and text/gif formats.
As usual, please share your questions and comments below. Talk soon!
xo
Anna
About me and How to Move:
How to Move is an anti-diet newsletter about exercise. Each Sunday paid subscribers receive Workout of the Week, a customizable workout (in both video and written/gif format) that you can make 15, 20, or 25 minutes. Other posts come about once a week and are free to all subscribers.
I am an award-winning journalist, former magazine editor, and certified personal trainer and Pilates instructor. I train clients, write articles for publications like The New York Times, and work as a content strategist for clients such as Hinge Health.
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2) Men also have PF issues. ED, of course, but also Prostatitis is how it tends to manifests in men.
Nicely done. You express this information beautifully and I’ll be reading Cait’s posts.
Two things: 1) you can have uneven tension in your PF. That is: one side is hypertonic and the other side isn’t. I have a lot more gripping around my right sit bone than left. Perhaps a cause for my mild scoliosis, which may because I tend to be stuck in “flight” on my right, and “freeze” on my left.