Having a healthy pelvic floor, doing some pelvic floor exercises, and getting the pelvic floor ready for pregnancy and childbirth, as well as postpartum recovery is a remarkably overlooked aspect of women's health. Pelvic floor exercises, going beyond the old "just do kegels" stand-by, are essential to proper bladder function, increased sexual satisfaction, childbirth, and postpartum recovery.
It is really rather astounding how limited the readily available information on pelvic floor fitness is and how rarely this information is discussed considering how significant the health of the pelvic floor is to a woman. We stand in an odd historical point here in the US where the vagina is everything and nothing all at once. No longer the complete un-mentionable it once was, discussion of the vagina has become something of a hipster staple, an armchair feminist battle-cry, and a social-media numbers wizard. The sad fact is, though, that while the titillation of talking about vaginas has made it not only acceptable but even trendy, the substance is still lacking.
We can talk about vaginas as iconic symbols of feminism* (an odd counterpoint to seeing whole women, or better yet, human beings as symbols of feminism). We can talk about vaginas and whether or not the government should control them (unless, of course, you happen to be a Michigan state representative debating women's rights legislation as pertains to abortion). We can score a few extra hits on a post about our feelings or opinions on other people's sex lives by dropping the V-bomb in the title. We can appear fearless, mature, and modern in our unflinching utterance of such a risqué term freely.
The vagina makes a great tagline, punchline, symbol, or icon. What it doesn't make, apparently, is good content. Because rarely will you see a popular article that actually talks about the vagina as a body part. You'll see ab workouts all day long - on the cover of every fitness mag and popping all over Pinterest.
Skinny legs, healthy skin, shiny hair? Yes. Yes. Yes. A good vag workout? Not so easy to come by. And when you do find it, it will likely boil down to one thing: do some kegels. Done. (Or, alternately, try this or that drug). This is not to say that articles about vaginal health and/or pelvic floor fitness don't exist. They do, but they are fewer and farther between than other health articles and you often have to look a lot harder to find the good ones. And that is complete bullocks. I mean, having a fit pelvic floor is obviously just as important to me as having sexy shoulders - actually, much more so.
Why do we need to talk more about the pelvic floor?
Because it is a major muscle group like any other, and because it has significant impact on your everyday life and health.
I JUST PEED A LITTLE:
According to Medical News Today:
Approximately 25% of young women, up to 57% of middle-aged and postmenopausal women, and around 75% of older women in nursing homes suffer from urinary incontinence. Urinary incontinence can inflict considerable and potentially debilitating lifestyle restrictions. In 2004, the United States spent around $19.5 billion on incontinence care. In addition, one estimate reveals that the annualized cost of women's nursing home admissions due to urinary incontinence was $3 billion and 6% of nursing home admissions of older women were due to urinary incontinence. [emphasis mine]
Lets think about those first numbers just for a minute. That is a heck of a lot of women having problems with leaking urine. It is important to note that this is not referring to pregnancy related incontinence. That's a completely separate ballgame. What is even more disturbing is that in many, if not most, of these cases, the incontinence is completely preventable through simple exercises that you can do in the car or even while reading this article (and I'm not talking about kegels - keep reading).
A healthy pelvic floor can completely cure stress incontinence (peeing when you sneeze) or urge incontinence (unexplained, forceful need to pee). When I was pregnant, I definitely started to get some of both. Certain books about expectations when you are expecting and my OB/GYN (the same one who told me he would give me whatever drugs he chose during my birth regardless of what I said), both said it was normal and to expect it. Thank heavens for my midwife and my yogi, who both knew otherwise.
After only a couple weeks of pelvic floor workouts, even being several months pregnant, I was leakage free.
Your pelvic floor is composed of a network of muscles which work together to support your intestines, bladder, and reproductive system (excluding the external portions of the male genitalia). They are part of the greater system of muscles that make up your core and are vital not only to proper functioning of your bladder, bowels, and sexual organs, but also to support of your posture and the overall strength of your body.
If your pelvic floor muscles become weak, the system can begin to collapse in on itself leading not only to incontinence, bowel issues, and sexual dysfunction, but also to bladder and/or uterine or vaginal prolapse in severe cases. This goes back to my earlier comments about muscle tone. Just because you can't see these muscles, doesn't mean they should get short shrift in your workouts. Indeed, they are more important than most other muscle groups much of the time! I would like to include an image of this muscle group, but at this point have not obtained the rights to one. In the mean time, I will refer you to this image.
Awareness of your pelvic floor muscles (which is actually something you may have to work to develop), fitness and strengthening of those muscles, and control of them, can greatly increase sexual potency and enjoyment IN BOTH SEXES. While this article focuses on the female pelvic floor, please note that there are many of the same great benefits to be obtained by men - the pelvic floor is a human muscle group, not a female one!
In women, strong, healthy pelvic floor muscles hold the support the optimal shape of the vagina (narrow tube). If these muscles become weak and sag, the tube begins to sag into more of a sac, which can create a "loose" feeling during sex. Also note: "looseness" is not caused by having sex. So the term "loose" as a synonym for promiscuity is stupid. The myth that vaginal delivery causes a permanent loosening of the vagina results from women not being taught to re-strengthen their pelvic floor after childbirth. Based on personal experience (confirmed by both MacGyver and an unbiased measure, my menstrual cup), it is possible to regain the same shape and tensity in only a couple months after an un-complicated birth.
Fit pelvic floor muscles will also have increased blood flow, which will in turn lead to better lubrication and heightened sensitivity. And finally: since the pelvic floor is a network of muscles which one can, with some practice, learn to control independently, it is possible to learn to flex the different layers of pelvic floor muscles in succession. This creates something of a rippling sensation.
PREGNANCY AND CHILDBIRTH
I'd like to think it rather obvious that the pelvic floor muscles play a role in childbirth. Then again, I get several blog visits a week from people googling "where do babies come out" so maybe I should give a little detail on this. (And maybe we should give our kids some better sex education).
First off, babies come out of the vagina, which is a completely separate hole from where urine comes out, which is the urethra. Both of these passages are sphincters through the pelvic floor muscles. The pelvic floor muscles control these sphincters. A healthy pelvic floor helps control urinary incontinence because it strengthens that sphincter and supports the bladder. So, too, for childbirth.
There are many, many things I am thankful for in conjunction with the birth of my son. But one that I make a point to mention to any pregnant friend who asks for advice and some who don't is the pelvic floor workshop I was able to attend. I was incredibly lucky to be able to attend one of Leslie Howard's Pelvic Floor workshops early in my pregnancy. It was quite an eye-opener. The workshop introduced me to the whole world beyond kegels.
If you have the means to attend one of these workshops or to find one of the rare physical therapists or trainers who focuses on the pelvic floor, take advantage of it. I was empowered with a set of exercises which I tailored, adjusted, and added to over a few months to which I credit the curing of my pregnancy related incontinence (both stress and urge incontinence), and for why I never once had the feeling of having a bowling ball in my pelvis when I got close to my due date (something that many "experts" will tell you is inevitable). Of course every woman and pregnancy is different, but I really do believe that the strength of my pelvic floor made a world of difference in my pregnancy and in my birth.
During the birth itself when it came to the pushing stage, I was able to exercise and incredible amount of control. With no drugs to interfere and with my midwife walking me through second-by-second, step-by-step, I was able to ease my son's head and then body out in a more controlled manner than I had previously thought possible. My midwife credits this control as the reason I had basically no tearing at all and a very fast postpartum recovery (though genetics does also play a role in skin elasticity and my overall fitness also contributed to my recovery). I think she's right.
While I had some problems dealing with the contractions, once the pushing came, I felt in control and strong (physically and emotionally).
This has generally been covered in the preceding paragraphs, but in case you've been skimming, strengthening the pelvic floor is one key element to postpartum recovery of the pelvic region. Please note: If you had an epidural, severe tearing, or a cesarean,you need to consult an experienced health care professional for postpartum recovery. I have no experience with that topic and it was not something I covered in my research.
After a few days of rest and recovery (ask your midwife or doctor), the same exercises that got you ready for birth will get your pelvic floor ready for everyday life. For those who were working on their pelvic floors before birth, you will find your recovery exercises much easier. Muscles accustomed to training "bounce back" faster than untrained muscles. And if you're just coming to this after birth, don't worry! It may take a little more time, but the results will be just as satisfying.
Pelvic floor exercises after birth restore the shape and structure of the vagina internally. They lift the bladder and womb into the proper position within the body. They can help improve sexual satisfaction (see above). I was able to go running again for the first time two weeks after I gave birth. My overall fitness played a major role in that, and pelvic floor fitness was a huge component. Again, all women, pregnancies, births, and recoveries vary. Anecdotal evidence is no more and no less than what worked for me and what I experienced.
OK, I'M CONVINCED. NOW WHAT?
Pelvic Floor Exercises
By far the most well known (and in many cases the only known) pelvic floor exercise is called a "kegel." A kegel is a single pelvic floor exercise published by Arnold Kegel in 1948. The kegel is basically flexing the same muscles you would use to interrupt the flow of urine over and over. This exercise is better than nothing and is certainly a fine first step toward pelvic floor fitness.
The problem is that many people stop right there, and that's really not enough. It's similar to saying that doing fast bicep curls with your right arm is all it takes to have toned arms. As mentioned above, your pelvic floor is a group of muscles, and some of them can be moved independently of each other. They can and should be strengthened independently of each other (as well as in a group). What follows is a completely non-exhaustive list of pelvic floor exercises and strengthening techniques I have used:
IDENTIFYING THE MUSCLES
Identifying the muscles can be the most challenging part of the process. Once you've identified the muscles you need to flex and strengthen, most of these exercises are easy to do anywhere. Do them in the car on the way to work. Do them while you're listening to NPR. Do them while you check your voicemail. Pick something you do every day and commit to flexing your floor at the same time.
Women are often taught to identify their pelvic floor muscles for kegel purposes by beginning to pee, then stopping before they are finished, paying attention to which muscles they are using to do so. This can be a useful place to start, but there should be more to it. And also note that this is NOT something you should do regularly. Routinely interrupting the flow of urine can lead to UTIs and related unpleasantness.
I'm going to talk about three different layers, so to speak, of muscles - overall (which isn't really a layer but whatever), front-back, and side-side:
This will be most similar to the kegels described above and is the easiest to do. Using a muscle contraction very similar to what you would use to stop the flow of urine, tighten the muscles around the vaginal opening, pulling in and up. Do this WITHOUT clenching your abs or butt and without holding your breath.
If you are unsure, you or a partner can insert a finger into the vagina. You should be able to feel it tighten and you may be able to feel some lift. The feeling may be very weak at first but will get stronger!
One layer of the pelvic floor muscles runs from your pubic bone back to the bottom of your spine. Focusing your attention here, you should concentrate on the feeling of pulling the front of your pelvis and back in toward each other. Much of the feeling centers around the urethra, though there may be a tug near the anus as well. This is a much more subtle sensation than the overall flex and may take some time and concentration to identify.
As may appear obvious given the title, this contraction is perpendicular to the front-to-back contraction above. The focus of this movement is to pull your two sit bones in toward each other. It may help to have a partner place one hand under each of your sit bones while you attempt to pull them together (without clenching your butt!). Your partner can tell you when they feel the movement, which is very subtle.
Could I take any longer to get around to it? The basic exercises are essentially the same as the identification, but with timing mixed in. It is important to do both held contractions and quick flexes. For the held contractions, flex, hold for 10 seconds, then release. Each week or two, add 5 seconds to the length of the hold. Some people go as high as five minutes sustained hold. Build up to 100 repetitions per day (divided into sets as you feel comfortable). BE SURE TO RELAX FULLY AND BREATHE IN BETWEEN.
For the quick releases, flex and release quickly. Relax and breath in between. Start with 30 repetitions in one to three sets. Build up to 100 repetitions per day (divided into sets as you feel comfortable).
Your pelvic floor functions as part of your whole body. While it is very important to focus on the concentrated pelvic floor exercises above, there are many other ways to integrate pelvic floor exercise into your overall fitness regime.
SQUAT! I'm not talking doing squats in the gym (though those are good, too). I'm talking about squatting in place of sitting on your butt or otherwise lounging. The fact that sitting is bad for you has become fairly well publicized in recent years. A study cited by the Mayo Clinic linked extended periods of sitting (in front of a TV, computer, or steering wheel) with a nearly 50% increase in risk of early death from any cause and a 125% increase in risk of cardiovascular disease. So I've taken to squatting. This started when I was pregnant as part of my pelvic floor fitness regime.
The "native squat," also referred to as the malasana or garland pose in yoga, is a "sitting" pose that is much better for your body, your overall health, and your pelvic floor. The pose is simple. Place your feet slightly more than hip width apart, heels flat on the floor, and squat down until your bottom is nearly on the ground (I've been doing this for so long that sometimes my bottom IS on the ground/chair). Image and detailed directions here.
For seasoned chair-sitters, this pose may take some getting used to (especially the heels on the floor part), but once you get into the habit, your body makes the benefits clear. Rarely a day goes by when I don't become uncomfortable in my office chair and pop up into malasana. My coworkers - after a bit of an adjustment period - have come to expect it. Maybe one day I'll get a shot of my own masalana pose for this post...
BUTT LIFTS, which probably have a more common name, but I don't know what it is. Lay on your back, bending your knees to bring your heels (feet flat on the floor) toward your butt. As close to your butt as is comfortable. With your arms flat on the floor, palms down, and your abs and pelvic floor muscles tensed, raise your pelvis straight up toward the ceiling. Hold for 10 seconds. Lower down. Relax, breath, repeat. Pictured here.
YOGA is great for pelvic floor strengthening exercises like these, and I find that most yogis these days are extremely aware of the pelvic floor and it's vital relationship with overall health. If a yoga studio isn't in your budget, there are gobs of decent yoga classes available on sites like YouTube. And if you're in the Detroit area, there is free yoga at the Tuesday Market at Eastern Market.
And that, my friends, is just the beginning of the pelvic floor!
Who knew a post about vaginas could be so un-titillating? I'd love to hear about your pelvic floor experiences. Please drop a comment below.
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