The pelvic floor is a mysterious and unfamiliar part of the body for many women.
There is some emphasis from health care providers on the importance of Kegels for a strong pelvic floor, yet a lot of misinformation and controversy surround 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. These muscles’ main functions are continence (they control bowel and bladder function), support and sexual appreciation. These are the muscles that contract and relax when a woman has an orgasm. They play such a vital role in our health, one we often don’t recognize until we experience weakness and issues post-pregnancy.
The challenge with connecting to the pelvic floor muscles is that we can’t see them. It’s not like with your biceps, which you can look at while you flex. But to begin getting in touch with the muscles, simply stop peeing midstream. This will give you a sense how the muscles relax when we eliminate and can contract to control the flow of urine. 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. When these muscles contract, they squeeze and lift our pelvic contents up and into our body. Equally important is for the muscle to be able to relax.
The pelvic floor does not exist in isolation. It’s one part of a system that makes up the core.
The pelvic floor has a relationship with the diaphragm; the transverse abdominus, aka the deepest layer of the abdominals; and the spinal stabilizers known a multifidus. We can’t 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 to become aware of the system and feel how it 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 in air, the rib cage expands and the diaphragm descends. The breath moves three-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 create 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, relax fully back down to its resting baseline and elongate to birth our babies. If it doesn’t have enough mobility we can run into issues. The lack of mobility can be caused by musculature being too tight, a pattern of holding in our belly 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. You can practice this technique for a few minutes at the end of each day.
1. Lie on your back in a supported reclined position and tune in to the rhythm of your breath. You can place a pillow under your head and another one under your knees. (Once you’ve practiced reclined you can bring this practice into sitting and standing.)
2. Place one hand on your upper chest and another below your rib cage so you can feel your diaphragm move.
3. Inhale slowly through your nose and feel your stomach expand (the hand on your chest should remain mostly still).
4. Tighten your abdominal muscles as you exhale slowly through your mouth. Keep the hand on your chest as still as possible.
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 after pregnancy, as you return to exercise.