Adore Your Pelvic Floor 

Adore Your Pelvic Floor 

In recent years it has become increasingly acceptable to become incontinent during a workout.  In fact, there are pads for athletes to wear and promotional videos espousing the idea that you are not training hard enough if you did not leave a puddle of urine in your wake. While it is important for society to discuss this health issue overall, making it less taboo, we continue to overlook the alarming fact that this is often signifies pelvic floor dysfunction. In the short term pelvic floor dysfunction may cause incontinence, but over the long term it can contribute to pelvic and trunk instability, balance challenges, postural abnormalities, hip joint instability, sexual dysfunction, depression, and more. The good news is this condition can be improved upon and even cured entirely.  So rather than putting a band-aid (or pad) on the issue, let’s get real about this common problem and how it can be resolved.
If you struggle with Stress Urinary Incontinence, the medical term for this condition, you are not alone. Pelvic floor dysfunction affects one-third of postpartum women and forty-nine percent of women over fifty. Although it also affects men, teenagers, and elite athletes, one in four women in the United States suffer from this condition daily. One of the major concerns for women who are struggling with this dysfunction in their thirties and forties is the likelihood that they will face greater challenges in longevity of movement, emotional well- being, overall physical health, and maintaining continence as they age. In fact, loss of continence is the second leading reason for admittance into a nursing home resulting in a reduced quality of life and surrendering one’s independence.
The pelvic floor spans the base of the pelvic bowl and is an important part of the deep core. Not only does the pelvic floor control waste elimination processes and play a major role in sexual functioning for both men and women, it is also a foundational base for all movement. Before every movement there is a pre-anticipatory contraction of the pelvic floor that is part of supporting the pelvic organs and muscles while stabilizing the spine, hips and pelvis. When the pelvic floor is weakened or de-conditioned, the efficiency and safety of our movement patterns in all of our activities is compromised. For instance, balance may diminish and the hip joint may become less stable resulting in greater wear and tear over time. Additionally, pelvic floor strength is essential to maintaining the appropriate amount of intra-abdominal pressure for optimal organ functioning, circulatory balance, digestion, and a myriad of other systemic functions.


Fortunately, pelvic floor dysfunction is largely believed to stem from a neuromuscular deficiency.  In other words, the pelvic floor often becomes a de-conditioned muscle that, like any other muscle, can be innervated and strengthened through practice and mindful movement practices. So, yes, for most people pelvic floor performance and health is a fitness issue! Just like you train any other muscle in your body, you can train your pelvic floor.

The first step in strengthening the pelvic floor is to innervate the muscle.  This simply means connecting your brain to the muscle causing it to engage or contract. Start small and simple. Lie down on a mat or the floor and practice contracting your pelvic floor using the cues below.  (Warning: these cues are a little graphic, but are proven to be the most effective in pelvic floor recruitment.)

·      Imagine trying to touch the tip of the tailbone to the pubic bone.
·      Imagine drawing a pea into the vagina.
·      Nod the clitoris towards the vagina, draw the tailbone toward the clitoris and lift a pea off the floor.
·      Connect a line from the anus diagonally up towards the back of the pubic bone.
·      Imagine a lift closing and going up.

Draw together and lift for three to five seconds working up to 10 seconds.  Relax for five  seconds. Repeat this ten times.
Do this three to fives times a week for at least three months to begin to see results. For lasting results, continued practice in pelvic floor recruitment physical activity is required. If you practice this but do not experience relief from symptoms make sure to talk with your doctor about the problems you are experiencing.

Once you make a connection to the pelvic floor on the mat, you can begin practicing engaging it in other movements. For example while doing footwork on the  reformer, practice recruiting the pelvic floor as you return to the stopper during each repetition. Next practice engaging the pelvic floor from a variety of positions, progressing from lying down, to quadruped, to seated, and finally to standing.

Now, here is where it get’s really exciting! Did you know you can train the pelvic floor for endurance and speed?  This actually helps to stimulate all the muscle fibers and builds strong neural connections from the brain to the pelvic floor. Like other muscles the pelvic floor is comprised of both fast twitch and slow twitch fibers, so  you can train the pelvic floor though plyometrics to improve the performance of the fast twitch fibers. Fast twitch fibers develop with “quick” contract-relax sequences designed to improve speed, coordination, and precision.  Try it! Lie down on a mat or the floor and practice plyometric training using the cues below:

*  Draw together and lift as quickly as possible with control 10 times.
*  Relax for five seconds.
*  Repeat 10 times, working up to 15, 20, or 30 reps at a time, as fast as possible.

Exciting new research suggests that pelvic floor exercises have a modulating effect on the autonomic nerves that supply the bladder.  This means that performing these exercises, and developing the brain/muscle connections in the pelvic floor, is likely the mechanism that improves symptoms of overactive bladder.  Through exercise of skeletal muscle derived from the same spinal cord segment, we can affect the function of the autonomic nervous system and the organs supplied. What does that mean? The autonomic nervous system supplies sensory and motor nerve input to the smooth muscle organs of the body, such as the bladder, bowel, viscera, arteries, internal sphincter. These are involuntary actions, below the level of conscious control. The striated muscle of the pelvic floor, controlled by the somatic nervous system (voluntary control) is innervated by the same spinal segments (s 2,3, and 4) as the bladder, though the bladder is involuntarily controlled by the autonomic nervous system.  Not only can you strengthen the pelvic floor through these conditioning exercises, but you can actually improve organ function of the bladder as it is all part of the same innervation loop from the brain to the muscles. 

While there is nothing to be embarrassed about with pelvic floor dysfunction, it is a sign that there is important work to be done.  Fortunately there are many exciting and fun resources available, such as Pilates work on the mat or the apparatus, aimed at improving and even resolving this challenge.  Effectively addressing this issue  is important for overall improvement in the quality of our movement – and life – in the short term and over the long term.  If you are struggling with Stress Urinary Incontinence, don’t hesitate to talk to your personal trainer, Pilates teacher, doctor or physical therapist about this and begin down the road to a healthy, functional, and strong pelvic floor!

Research for this blog post comes from a presentation by Dawn-Marie Ickes, MPT, PMA-CPT, NASM-YES, at the 2015 Pilates Method Alliance conference. You can find out more about Dawn-Marie and her programs here.