Evidence shows that one in three women will experience physical problems due to the weakening of the pelvic floor muscles, so why aren’t we making time for kegel exercises, and how can we get started?
When it comes to strengthening our muscles, the pelvic floor is a part of the body that rarely gets a look in. We tend to think that pelvic floor exercises (also known as kegels) are only important for women who have had babies, those with health issues and older women, but overwhelming evidence shows that we could all benefit from training our pelvic floor, regardless of age or childbirth status.
“If you have a pelvic floor, which all women and men do, then you should absolutely strengthen your pelvic muscles,” confirms Emma Brockwell, pelvic health physiotherapist and author of Why Did No One Tell Me?. “Your pelvic floor is like any other muscle, if you don’t train it, it will get weaker and you’ll be more likely to experience pelvic floor dysfunction.”
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“One in three women will experience urinary leakage during their lifetime, one in two will experience a pelvic organ prolapse and one in 10 women will experience accidental bowel leakage – pelvic floor exercises can prevent and treat these conditions,” adds Myra Robson, physiotherapist and co-founder of #pelvicroar, a campaign aiming to break the taboos surrounding pelvic health issues.
It seems clear that training down there is vital, so why are so many of us in the dark about this part of our body? One reason, perhaps, is the shame and embarrassment around pelvic health issues including incontinence and pelvic organ prolapse. Fortunately, movements like #pelvicroar are working to smash the stigma and raise awareness.
It also doesn’t help that the pelvic floor muscles are inside your body. Exercising muscles you can’t actually see can feel a bit pointless, particularly when you’re not sure what the benefits are.
Admittedly, my knowledge of the pelvic floor is pretty poor and I know I’m not alone in this. According to a 2020 survey commissioned by Always Discreet, one in six women didn’t know where these muscles were, and of the 1,000 women surveyed, nearly a quarter didn’t know the purpose of the pelvic floor.
So, I asked the experts to shed some light on this hidden muscle group, including where it is the body, its main functions and how we can strengthen it to prevent problems later down the line.
What actually is your pelvic floor and what does it do?
Firstly, let’s look at what the pelvic floor actually is. “The female pelvic floor is made of muscles and connective tissue that form a ‘sling’ or ‘hammock’ across the base of the pelvis. The urethra (the tube that passes urine), vagina and anus pass through the pelvic floor,” explains Brockwell.
The role of the female pelvic floor, explains Dr Hazel Wallace of The Food Medic, is to keep all the pelvic organs (your bladder, uterus and rectum) in place, ensure urinary and faecal continence, and support increases in intrapelvic and abdominal pressure (when you cough or lift heavy weights, for example).
“The pelvic floor muscles also help to stabilise the spine and pelvis, they provide additional support during childbirth and finally but crucially, having a strong pelvic floor can improve your sex life by enhancing clitoral sensitivity and orgasm,” says Dr Wallace.
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It’s important to train these muscles to avoid pelvic floor dysfunction, which can impact women of all ages. This includes urinary leakage (sudden urgency to wee and increased frequency of needing the toilet), bowel incontinence (sudden urgency to have a bowel motion and leakage of wind or poo), obstructive defecation, pelvic organ prolapse, painful sex and pelvic pain.
WHAT CAN WEAKEN THE PELVIC FLOOR?
There are a number of risk factors for developing pelvic floor dysfunction, the most obvious being pregnancy, childbirth and ageing (which is associated with loss of muscle tone). According to Brockwell, other common causes of a weak pelvic floor include hormonal changes during perimenopause, smoking, chronic coughing, ongoing constipation and strenuous exercising.
Evidence shows that women who do high-impact sports such as gymnastics, trampolining, triathlon and running are at higher risk of urinary incontinence and other symptoms. This is because of the constant and excessive pressure that these activities put on the pelvic floor.
Strength training can also cause problems. “When you lift weights, pressure in the abdomen increases so your core muscles, which include your pelvic floor, have to perform a balancing act,” says Brockwell. “If the pressure from above is too high or support from below is too low, pelvic dysfunction can occur.”
Does this mean we should steer clear of the gym? Absolutely not, says Megan Vickers, physiotherapist, pilates instructor and author of Stronger. “There are heaps of new research papers which advocate weight training even in the presence of pelvic floor prolapse,” she tells Stylist.
“This is because our pelvic floor doesn’t function on its own, but with all of the other muscles in our body. Having strong abdominal walls, muscular thighs at the entrance and strong glutes at the rear is important.”
But Vickers says that our pelvic floor needs to be strong enough for the task. This means putting in the time and the effort to train our kegels is vitally important.
Finding your pelvic floor
What can we do to keep these muscles strong? The first step is to find out where they actually are. Brockwell says you can do this by stopping the flow of wee when you’re on the toilet. “This shouldn’t be used as a way of exercising your pelvic floor as it can be harmful to your bladder,” she warns.
Robson offers another technique. “Pretend you want to pass wind but you’re standing in front of the Queen! Imagine pulling the muscles around the anus and vagina up and in to stop you from passing wind – that’s your pelvic floor squeezing.”
How to protect your pelvic floor while strength training
As we’ve already established, having a strong pelvic floor is crucial before you start lifting heavy. Once you’ve strengthened your pelvic floor, Vickers says you can incorporate it into lifting activities such as squats and lunges.
For personal trainer and fitness influencer Carly Rowena, barbell squats are one of her favourite exercises to activate and strengthen the pelvic floor. Here’s how to make sure your form is correct:
- Stand in an upright position with your feet slightly wider than shoulder-width apart and your toes pointed outwards. Ensure the barbell is rested behind your neck on your trapezius muscles.
- Bend your knees and push your hips and your bum back as if you’re sitting down. Keep your chin tucked in and your neck neutral.
- Drop down until your thighs are parallel to the ground, keeping your weight in your heels and your knees bowed outwards slightly.
- Straighten your legs and return to an upright position.
- Complete 15 reps.
To protect your pelvic floor while lifting, Rowena says it’s important to be mindful of your breathing. “A lot of the time when we’re in the gym, we hold our breath,” she says. “When you’re doing the most challenging part of an exercise, for example when you’re pushing up in a squat, you want to exhale, leaving your mouth slightly open.”
To reduce excessive downward pressure on your abdomen, avoid straining when lifting a weight as this puts excessive pressure on your muscles, explains Brockwell. “Don’t hold your stomach in, just relax and let it go, and avoid bracing your abdominals and pushing down on your pelvic floor when you lift,” she adds.
Do remember to take things slowly with lifting weights, says Vickers. “Leaking urine and feeling pressure down below are signs that our pelvic floor can’t cope with the load we’re putting on and we should back off,” she explains. If you’re experiencing any symptoms, take the weight down to a level your pelvic floor can cope with to avoid injury.
EXERCISES TO STRENGTHEN your pelvic floor
Here is Brockwell’s step-by-step guide to kegel exercises:
- Make sure you’re comfortable. The more upright you are, the better. Standing is best but you can start by lying or sitting if you feel more comfortable.
- Squeeze the muscles around your vagina and anus as if you’re trying to stop yourself from passing wind.
- Try to hold this squeeze for a few seconds, then let go and relax. As you’re holding this position, try to breathe normally.
- Repeat this 10 times. Over time, you can work up to holding each squeeze for 10 seconds.
- Follow this with 10 short squeezes, each for about one second. Make sure to slowly release and relax between each squeeze.
Aim to do these exercises at least once a day and up to three times a day if you have any symptoms. Check out the NHS Squeezy app where you can set up daily reminders and find a range of pelvic floor exercises.
How do you know if you’re doing it correctly? “Being able to feel movement of the area around your perineum is a good indication,” says Brockwell. “Avoid holding your breath, gripping abdominals and don’t squeeze your bottom or inner thighs.”
“If you are aware this is happening or if you have pelvic floor dysfunction and the symptoms aren’t improving with pelvic floor exercises alone, you may benefit from seeing a pelvic health physiotherapist and getting help with your technique.”
Brockwell also offers an important reminder that while pelvic floor dysfunction is common, it’s not normal and it should be addressed. “If women are experiencing problems, they should seek help and treatment from a pelvic health physio.”
For more training tips, workout ideas and healthy recipes, check out the rest of the Strong Women Training Club library.
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