In my first post in this series on incontinence while running and the pelvic floor, I explained that leaking while running is common (one in three ladies!), but that it is by no means normal, and should not be something that you simply surrender to as your “new normal.” I also talked about the different types of urinary incontinence, why stress urinary incontinence (SUI) occurs with running, and how pelvic floor physical therapists are your go-to resource to help address these issues. In this post, I’ll be speaking more specifically about the pelvic floor system: how it’s constructed, how to properly execute the infamous Kegel exercise to properly strengthen your pelvic floor, how breath is important for strengthening and coordinating your pelvic floor, and how to incorporate Kegels with your breath into your workouts to address leakage issues. Lots of important info, so lets jump in! Friendly reminder, this series is geared towards females, but know that men can have leakage issues too! However, these issues are much more prevalent in females due to the anatomical differences at the pelvis and from physical changes that occur from childbirth.
As I mentioned before, many women suffer from SUI due to pelvic floor muscle weakness, a coordination issue of the pelvic floor within the deep core system (see my previous post), or a combination of the two. This can result from a pelvic floor that’s too tight from overwork due to weakness in our hips and core systems, or it can be from weak pelvic floor muscles that aren’t strong enough to provide the support that is needed to help regulate a healthy amount of intra-abdominal pressure (IAP) within the abdominal cavity properly.
We need a certain amount of IAP within our abdominal cavity for torso and pelvic stability. The amount we need is constantly changing depending on what we’re doing, lifting or carrying. Our bodies regulate IAP via our deep core system (not sure what the deep core system is? Refer back to part one of this series) based on how hard the body is working. For example, I have a low amount of IAP while I sit at my computer and write this post, because my chair is supporting most of my body. Conversely, when I’m doing kettle bell swings, I have a higher amount of IAP to support my body during this more challenging activity.
IAP directly affects our pelvic floor. In the case of someone with SUI, if IAP is too high and our pelvic floor isn’t strong enough and/or not coordinated enough to counteract this increase, leakage occurs. Pelvic floor symptoms are the result of a more global problem in our body versus simply a local issue at the pelvis alone. Remember, in part one we talked about how the pelvic floor is part of the deep core system, working together with our diaphragm, transversus abdominus, and multifidi muscles. The pelvic floor is not working in isolation, but rather in conjunction with other important systems of our body.
So what can you do to help correct leakage issues? Great question! If you’re experiencing any leakage or pelvic discomfort (i.e. pain, feelings of heaviness, instability, bowel/bladder leakage), I highly recommend seeking out a pelvic floor physical therapist (PFPT) to help you understand the root cause and develop a game plan to address these issues. Not sure where to find one? There is a wonderful directory of pelvic health professionals at www.pelvicguru.com where you can search for a provider near you. PFPTs are highly trained to evaluate and treat pelvic floor conditions, and help you get back to the activities you love without pain or fear of “accidents”. Many pelvic health issues can be easily addressed or significantly improved with PFPT interventions.
What can you do today to start improving your pelvic floor connection? Also a great question. I’m often asked…”what’s the deal with Kegels? Is that all I need to do to strengthen my pelvic floor?” Kegel exercises are a great way to strengthen your pelvic floor if weakness is your issue. As I mentioned earlier in this post, sometimes leakage is not a weakness problem but rather a coordination problem. So, if you’ve been doing Kegels consistently and properly and haven’t noticed an improvement, or if Kegels make your symptoms worse, then you may need to improve your coordination system and/or learn how to relax your pelvic floor versus contract/strengthen it. Remember when I mentioned earlier that some people have overactive pelvic floor muscles? Doing Kegels in this case would cause these muscles to continue to overwork and thus aren’t addressing the lack of coordination issue. Doing a million Kegels will never fix this issue. This is why having a pelvic floor physical therapist evaluate you is so important and beneficial.
Now, back to the case of a weak pelvic floor. As a PFPT myself, I find that a lot of my patients have heard of Kegels, but hardly anyone is confident in their ability to perform them properly. If this sounds like you, know that you’re not alone and that I had to go through specific PT coursework to learn how to do them properly myself. So, don’t feel bad! Good news is I’ve created a short informational video series to help explain this more thoroughly:
After watching the videos, I hope you now have a better understanding of your pelvis, where your bladder, sex organs, and rectum are located, where your pelvic floor lives and how it’s an incredible muscular sling that’s responsible for supporting a lot of important structures, and how to coordinate your breath and Kegels to further integrate your pelvic floor into your deep core system.
So lets review:
- When performing a Kegel, you contract from the back of your pelvic floor to the front with your exhale, and then fully relax your pelvic floor from front to back with your inhale. I recommend lying on your back with your knees bent or sitting comfortably in a chair while practicing this in the beginning. Note: it’s not as easy to do as you might think, and many people find it awkward in the beginning. That’s totally OK. With a few practice sessions, I promise it gets easier. I recommend setting a timer for 2-5 minutes and simply breathing while practicing contracting and relaxing your pelvic floor as I instructed in the video.
- Once you start feeling more confident with pairing your breathing and contraction/relaxation of your pelvic floor, practice contracting your pelvic floor on an exhale, then hold the Kegel for 5 seconds while you keep breathing. On the next inhale, relax the pelvic floor and repeat. Do this for 2-5 min, or until fatigue, whichever comes first. A longer hold challenges the pelvic floor to maintain its contraction with a gentle amount of increased pressure. This builds endurance of the pelvic floor muscles over time. Once this becomes easier, progress to 10-second holds. That’s the gold standard in the medical world — being able to maintain a solid Kegel contraction for 10 seconds means your pelvic floor has an adequate amount of physical strength. Now that strength needs to be integrated into the larger deep core system.
- Carry-over into real life: If you leak while you run, chances are you leak when you cough and sneeze. It’s an issue of too much pressure, once again. So, practice your Kegels here, too. Next time you feel the urge to cough, connect and hold your Kegel throughout the duration of your cough. This will help counteract the increase in pressure, which in turn will help you overcome leakage and also act as a strengthening exercise. Now what about when you’re in the gym or lifting that heavy bag of groceries, or maybe your cute toddler, and you’re afraid you might leak? Use your Kegel and exhale connection while you do it. Pair the Kegel with an exhale during the more challenging phase of whatever movement you’re doing. For example: squat down with an inhale and let your pelvic floor relax, then prepare to pick up your bag of groceries by beginning to connect your Kegel and exhaling as you stand back up. Do this while you do your squats in the gym, when you’re doing your abdominal work, etc. Every time you exhale, you have an opportunity to connect your Kegel with your activity.
- With practice, this conscious connection of your Kegel with an exhale and pelvic floor relaxation with an inhale will become more natural, and eventually become automatic.
Dang! We covered a lot! As you can see, the pelvic floor is quite unique and sophisticated. It’s a dynamic system that is built to respond and support us when we move, in addition to controlling bowel/bladder and sexual functions. It’s got a busy job, and it’s important to keep it strong in order for it to continue to do its job most efficiently.
In the third and final installment of this series, I’ll be sharing my favorite hip and core strengthening exercises, while utilizing the breathing and Kegel connection we learned here. Our hip and core musculature feeds into our pelvic floor system. These team members must work together for out bodies to achieve optimal loading mechanics for activities like running and jumping. Stay tuned!