Maintaining a healthy pelvic floor is so important for your overall health. Learn how standing up straight and improving your posture can help keep your pelvic floor healthy.Read More
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Overactive bladder can be very disruptive to a person’s life. Constantly rushing to the bathroom, feeling like you need to go every time you start to do the dishes, and the occasional leakage that comes with OAB can cause frustration and embarrassment.
But did you know there are many simple behavioral changes you can make that can help you manage OAB, some of which may not even require a trip to the doctor? Read before for some new ideas to help you manage your OAB and prevent leaks.
You may not be able to function without your morning cup of coffee, or that sugary mid afternoon snack, but did you know that certain types of food, such as caffeine and sugar can actually irritate your bladder and trigger OAB symptoms? While not every known bladder trigger may be a trigger for you specifically (everyone’s different after all!), it’s worth it to start noting what you’re eating and drinking when you start experiencing symptoms. Try keeping a bladder diary to track your food and drink intake, and see how it may be coinciding with your OAB. And download our list of bladder irritants to hang on your fridge as a reminder of foods to watch out for.
Maintaining a healthy weight helps not only your waisteline – it’s good for your bladder too! Being overweight can contribute to leaks so get out there and get moving. It doesn’t have to be strenuous – walking for 30 minutes a day can do wonder for your physical and mental well-being. And a light weight routine can help you build muscle mass that will keep you strong and healthy.
And don’t forget about your pelvic floor! Maintaining a healthy pelvic floor is imperative to your bladder health. If you struggle with OAB, and especially if that includes any amount of leakage, we recommend that you see a physical therapist to get an evaluation of your pelvic floor. Pelvic floors that are too weak, or too tight, can lead to urine leakage and its important to know how to both strengthen and relax your pelvic floor for optimal pelvic floor health. If you need help finding a physical therapist specializing in pelvic floor health, use our specialist finder tool to find one in your area.
Did you know you can actually retrain your bladder to hold urine for longer increments of time? With a little practice, retraining your bladder can let you go for longer stints without needing to empty it. Try our step by step guide here.
If you struggle with Overactive Bladder, watch the second video in our Overactive Bladder video series: Managing OAB With Behavioral Modifications.
What Is The Pelvic Floor And Why Should I Relax It?
The pelvic floor is a web of muscles that acts as a sling, supporting your bladder, bowel and uterus. It is responsible for helping you control your bladder and bowel, and also plays a role in sexual intercourse. Many women experience pelvic floor issues, such as incontinence, as a result of childbirth, obesity, chronic constipation, or other strains put on the pelvic floor. Often, a weakening of the pelvic floor causes these issues, but did you know that having a pelvic floor that is too tense can also create problems? Incontinence, trouble emptying your bladder, and even pain during sex can be signs of a pelvic floor that is too tense.
Luckily, pelvic floor tension is a problem that you can do something about. Below are some simple exercises that may help you to relax your pelvic floor muscles. These can all be done in your home, discretely, and with no equipment necessary.
Note: It is always recommended to consult a pelvic floor physical therapist prior to performing exercises related to the pelvic floor. A physical therapist can provide you with a proper diagnosis and put you on custom treatment plan just for you! Find a physical therapist in your area here!
Diaphragmatic Breathing For Pelvic Floor Relaxation:
The diaphragm works in synergy with the pelvic floor and helps to promote muscle relaxation. This is important for decreasing pain and promoting optimal muscle function.
- Place one hand on your chest and another hand on your belly, just below your rib cage.
- Take a deep breath in to the count of three, and then exhale to the count of four.
- When you inhale, your pelvic floor relaxes, and as you exhale, your pelvic floor returns to its resting state.
- Practice this breathing for 5-10 minutes each day.
Note: You’ll know that you are using your diaphragm correctly if you feel the hand on your belly rise and fall.
Pelvic Girdle Stretches For Pelvic Floor Relaxation
All of the following positions are great for practicing diaphragmatic breathing!
Happy Baby Pose:
- Lie on your back.
- Open your knees wider than your chest and bring them up towards your armpits. You may hold your legs with your arms behind your knees or at your ankles, but try to keep your ankles over your knees.
- You can either hold this position or gently rock on your back from side to side
- Start on your hands and knees.
- Spread your knees wide apart while keeping your big toes touching.
- Gently bow forward, moving your torso downwards, between your thighs. Keep your arms stretched out long and in front of you.
- Lie on your back with the soles of your feet together and knees out to the sides.
- This should be a relaxing position. If you feel a pulling along your inner thighs or in your pubic bones, place pillows under your knees for support.
- Lie on your back with your knees bent.
- Place your left ankle on your right knee, like a figure four.
- Pull your right thigh toward your chest to feel a stretch on the outside of your left hip.
- Hold for 30 seconds, and then repeat on the other side.
I’ve experienced bladder leaks for about 5 years. After I had my second daughter, I started noticing leakage here and there. I always assumed it would go away, but it never did. I spent the first year attributing it all to childbirth, and let’s be honest, I didn’t really have the time to worry about myself much with a newborn baby. But, after my daughter’s first year, what I thought was a problem that would clear up on it’s own continued, and I began to take more notice. The leaks were more frequent, not less, and I started to feel ashamed about it. I’d never heard any of my friends talking about this side effect of motherhood – why was it happening to me?
I finally decided to visit my OB/Gyn to see what he recommended and he referred me to a Physical Therapist who solely focuses on the pelvic floor (yes! there really is such a thing!). The PT did a thorough evaluation and said the cause of my problem was due to a weakened pelvic floor that most likely occurred during childbirth.
I’ve never been what you would call athletic. I have a gym membership but don’t visit all that often. I sit at work all day, and get most of my exercise running around after my two girls. And God knows I could stand to lose a bit more of the baby weight. So when my PT said that she was going to put me on a workout program to get things back in shape, I was a bit worried. But her workout was low intensity – lots of walking to get my weight down (which would help put less pressure on my bladder and pelvic floor) and simple exercises that would strengthen not just my pelvic floor, but my core muscles too.
After 3 months of doing the workout I had lost about 8 pounds and my stomach and glut muscles were noticeably more toned. I also was noticing much fewer leaks and was able to control my bladder much better than before. And after 6 months of performing the workout, the leaks had stopped all together.
I can’t tell you what a difference this simple workout routine has made in my life – not only do I feel stronger and more in control, but it’s given me more confidence in the ability to change my body both in look and in function. I’m so proud of myself and my only regret is that I didn’t do something sooner. Ladies – if you’re experiencing bladder leaks, visit a PT and get on a workout program! It will literally change your life. It did for me!
Kimberly V., Englewood, CO
Barbara Jennings was 6 weeks postpartum when she realized that something wasn’t right. “I had been feeling some pressure in my vagina for a while, but figured it was just a part of the normal healing process after vaginal delivery.” When she finally got the courage to explore a bit, she found something that surprised her. “I felt a smooth lump protruding slightly from the opening of my vagina. I was horrified, and so scared!”
What Barbara was experiencing is called a pelvic organ prolapse, and it’s not uncommon. A prolapse happens when the vaginal walls become too week (due to things like childbirth) and the organs that are supported by them fall into the pelvic floor basket, sometimes protruding from the vagina. It’s not a curable condition, but can be improved by behavioral modifications, or surgery if necessary.
“After doing a lot of research, I learned that physical therapy could be done to help strengthen the muscles of the pelvic floor and improve symptoms of prolapse”, said Barbara. “I had never even heard of physical therapy for that part of the body, but because I knew I didn’t want surgery, I signed right up.”
Women’s Health PTs are a thing, and they treat everything from prolapse, like Barbara experienced, to pelvic pain, incontinence, back pain, diastasis recti, and more. But how do you know if you need one? And at what stage of life do you see them?
The first thing to know is that you can see a Woman’s Health PT at anytime. Whether you’re feeling some back pain during pregnancy, want to get checked out after baby arrives, or have difficulty picking up your grandkids without leaking, physical therapy is an option. Improvements can be seen at any age, and most physical therapists would agree that it should be a first line of defense against leaks and pelvic floor disorders.
Medications and surgery are often thought of first when it comes to treatment, but when you commit to a physical therapy routine, you’re making the effort to strengthen your body yourself, which can alleviate a lot of pain and/or leakage on it’s own. If you’re experiencing any kind of pelvic floor, back or hip pain, or if you have bladder leaks, call a physical therapist and get set up an appointment for an examination.
So, what can you expect when you visit? As with most doctor’s visits, you’re PT will ask you lots of questions about your medical history, and the symptoms you’re currently experiencing. You’ll also likely get a musculoskeletal evaluation, and if you are experiencing any pelvic floor dysfunction, an internal exam.
The internal exam sounds scarier than it actually is – rest assured your PT has performed many internal exams and there is nothing to be embarrassed about. It’s a necessary step for them to determine the state of your pelvic floor muscles, and your treatment plan.
Multiple visits are usually required to assess your improvement over time, and to ensure that you are performing your exercises correctly. Treatment is considered complete when your symptoms have improved, although you may need to continue with your treatment plan even after you stop visiting your PT.
If you experience any type of pelvic floor related dysfunction, including pain, bladder leaks, or even if you experience back pain (those muscles are all connected after all!), don’t hesitate to see a PT. It’s often a good first line of defense for these issues and may resolve them better and more naturally than medications or surgery. “Even though my prolapse will never be completely “cured”, I have seen tremendous improvement in my symptoms since I started physical therapy”, says Barbara. “I’m so glad I looked to this option first.”
It’s estimated that a whopping 6,000 women reach menopause each day in the US. Menopause happens to every woman, and is the shift in hormonal changes that result in the cessation of menstruation.
While many women know about the common symptoms of menopause (Hot flashes! Insomnia!), there are certain changes that come about in menopause that are often surprising to women. One of these is loss of bladder or bowel control.
A number of things occur during menopause that can contribute to you suddenly experiencing a bit of leakage
Weakening Of Pelvic Floor Muscles
Your pelvic floor muscles play a huge role in controlling your bladder and bowel. As the muscles weaken, it can lead to more urgent needs to use the restroom, and more leaks. Weakened muscles can also lead to an increased risk for pelvic organ prolapse.
A Less Elastic Bladder
Changes that occur during menopause can cause the bladder to lose it’s elasticity and the ability to stretch. This can cause increased irritation in the bladder when it fills with urine, and can impact the nerves that regulate bladder function, which can sometimes cause overactive bladder (OAB).
During and after menopause, the body produces much less estrogen, which results in an increase of vaginal dryness. This dryness has a number of consequences, which can include an increase in the amount of urinary tract infections.
While anal trauma is usually the result of childbirth, many women may not see the results of it until menopause, when that, combined with a weakened pelvic floor can increase the risk of fecal incontinence.
It’s important to know that while these changes can lead to bladder or bowel leakage, the symptoms can also be avoided or eliminated by taking proper care of the pelvic floor. It’s never too late to start strengthening things up.
Here are some ways to increase the strength of your pelvic floor as you go through this period
As simple as it sounds, simply staying active is great to keep your weight, and overall health in check. Gentle exercises, like walking, that don’t place too much pressure on the pelvic floor are best.
Squats are a great way to build up your glute and core muscles. To perform one, stand with feet shoulder with apart. Keeping your knees over your feet (don’t let them move past your toes), lower your bottom down as if you are sitting in a chair, being careful not to lean too far forward. Raise back up to starting position. Aim for 10 reps per day. (Note, if these feel too difficult for you, try wall squats, which use the same movement, but are performed with your back to the wall for extra support.)
When done correctly, kegels can do wonders for helping women with incontinence. They help strengthen the muscles that prevent bladder leakage and also help to avoid or reduce the symptoms of pelvic organ prolapse. Remember that when performing a kegal, learning how to relax the pelvic floor is just as important as learning how to tighten it. In some cases, women have pelvic floors that are too tight and cannot relax, and if this is the case, kegels can end up aggravating your condition. If you’re concerned about your pelvic floor, or just can’t get the hang of how to do a kegel, visit a pelvic floor physical therapist for help.
Thinking of trying for a baby soon? Now is the perfect time to start strengthening your body in preparation for pregnancy and childbirth. And even if you’re not quite at that stage yet, the moves listed here are great for anyone to improve pelvic floor and core strength.
The pelvic floor acts as a basket of muscles that help support the pelvic organs (your uterus, bladder and bowels). Keeping them toned can not only help ease pregnancy discomforts (like urine leakage and hemorrhoids), but it can also help you later on in life as your body naturally changes due to hormones, and age. The moves below work not only the pelvic floor, but also other important muscles connected to it to ensure overall core strength.
Four Moves To Firm Up Your Pelvic Floor Before Pregnancy
There’s a reason that you’ve heard again and again that kegels are important. This exercise has long been touted by professionals as one of the most vital exercises in increasing your pelvic floor strength. Follow the instructions below to be sure you’re performing them correctly.
Identify your pelvic floor muscles by attempting to stop your urine flow mid-stream. If you can do this, you’ve found the muscles! (Note – don’t practice your kegels in this way on a regular basis – it should only be done to identify the correct muscles.)
Performing with an empty bladder, your first goal should be to tighten your pelvic floor muscles for 5 seconds. Then relax them for 5 seconds. Try to do 5 reps on your first day. As you gain confidence from your new routine, aim for 10 seconds at a time, relaxing for 10 seconds between contractions.
Be careful not to flex the muscles in your abdomen, thighs, or buttocks. Also, avoid holding your breath. Breathe freely during the exercises to keep from stressing the rest of your body.
Aim for at least 3 sets of 10 repetitions per day. The beauty of kegels is that they can be done anywhere, anytime. Try performing them during your downtime, such as waiting in line, or sitting at a stoplight.
Give yourself encouragement. These exercises will feel foreign in the beginning. But the longer you stay with this, the better your bladder health will become. As a bonus, Kegels have been reported to increase sexual pleasure as well.
Strong glutes and hamstrings are very important to the overall health of your pelvic floor. And one of the best exercises to develop these muscles is the deep squat. Squatting is actually one of the most natural forms of movement there is, however our modern-day lifestyle, characterized by long hours of sitting at a desk or on a couch, has made the squat virtually extinct. By strengthening your glutes and hamstrings, you’ll be adding additional support to your pelvic floor. Follow the instructions below to make sure you are performing squats safely and correctly.
Stand with feet slightly wider than your hips, toes pointed slightly outward.
Keep your spine in a neutral position – don’t round your back, and don’t over accentuate the natural arch of your back.
Extend your arms out straight so they are parallel with the ground, palms facing down.
Balance your weight on the heels and the balls of your feet.
Taking a deep breath, begin sending your hips backwards as your knees begin to bend.
Keep your back straight, and your chest and shoulders up.
Be sure to keep your knees directly in line with your feet as you squat.
Continue lowering your hips until they are slightly lower than your knees to perform a deep squat.
Use your core to push yourself back up, keeping your bodyweight in your heels.
Congratulations! You have just completed 1 rep!
It may help to watch yourself in a mirror as you first perform this exercise, as it is easy to perform squats incorrectly. Some things to watch for are not dropping low enough, leaning your body too far forward, allowing your knees to drift inward, and performing the exercise too quickly. Aim to complete about 2-3 sets of 10 reps daily.
Finding Your TA
Your transverse abdominus, also known as the TA muscle, is the muscle that is located deep within your core, below the six-pack muscles. This muscle is often overlooked, but it serves a vital role. The TA muscle helps to stabilize the core, pelvis and lower back, and is recruited almost anytime a movement is made. Strengthening your TA muscle will ensure that you are protecting your back and spine from extra force or pressure when you move, and will help aid in pelvic floor stabilization.
The following steps provide a very basic way to locate your TA muscle and give it a workout:
Lie on your back, with your knees bent.
Place your hand on your stomach, just over your belly button.
While you exhale, tighten your stomach muscles and pull your belly button inward. You should imagine that you are tightening a corset and flattening your stomach.
Repeat 3 sets of 10 reps each.
Once you have a good feeling for where your TA muscle is and how to activate it, you can begin incorporating the action into your everyday life - while sitting at work, standing in line, etc. Also try to practice tightening your TA muscle, like a brace, every time you perform a movement such as lifting, sneezing, squatting, etc. With practice, this action can become automatic and will aid in your core stability.
The multifidus is one of the most important muscles in aiding spinal support. The muscles are attached to the spinal column and are called upon when bending backwards, turning, and bending side to side. These muscles work with the rest of your pelvic floor muscles and TA muscle to help you hold good posture, and to stabilize your lower back and pelvis during movement. Try the exercise below to strengthen the multifidus muscle:
Lie on your stomach, with your forehead on your hands, or a towel, looking straight down. (Not to the side)
Very slowly, rotate your pelvis back slightly so that your tailbone lifts toward the ceiling. This should be a very subtle movement.
Hold for one second, then rotate your pelvis back to the floor.
Complete 3 sets of 10 reps each.
Practice activating your multifidus muscle throughout your day by keeping good posture.
Note: Even before you’ve had children, there may be times when certain pelvic floor exercises are not appropriate. And, it’s important to know that there is no “one” exercise alone that will strengthen your pelvic floor as it is supported by many muscles. Always check with your doctor before beginning any exercise program. And, if you have concerns about your pelvic floor, no matter what life-stage you are in, consult a trained physical therapist specialized in women’s health. Your Physical Therapist will also be able to ensure that you are performing the moves correctly so that you are getting the most out of your workout. Use the NAFC Doctor Finder to find a doctor in your area.
We’ve all heard the age-old advice that doing kegels are good for us. And for the majority of people, they are. Kegels, when done along side other workout moves, can help tone and strengthen the pelvic floor, making things like bladder leaks and incontinence less likely. And if that doesn’t mean much to you, consider this: experts say that a stronger pelvic floor can help make orgasms more intense, heightening sexual sensation.
The problem many people face is doing kegels correctly. The nature of kegels makes it hard to know if you’re tightening (and releasing!) the right muscles. That’s where kegel exercisers come in. This new-ish breed of exercise equipment helps you to know exactly how you are performing in the kegel department.
Here’s a overview of three devices that are currently on the market:
Elvie is a popular device that allows you to literally do your pelvic floor workout anywhere. It’s the smallest kegel tracker available and uses a combination app to track your progress. Elvie is made up of medical-grade silicone and has multiple sensors that measure force and help you see your efforts on screen, so women can visualize their kegel exercises in real-time. Elvie even corrects your lift technique, as 30% of women push down which can lead to damage. There are three levels – beginner, intermediate, and advanced. When you first set your Elvie up, you’ll run through a series of tests to gauge your strength, and then will begin advancing through the different levels as you progress, making the tool fun and challenging. Each work out only takes 5 minutes, and as you move up in levels you unlock more games and challenges. Elvie is priced at $199 and can be ordered online through the product’s website.
PeriCoach is an FDA-cleared medical device coupled with a smartphone app to guide women through pelvic floor muscle exercises. The exercise programs ques the user to squeeze and relax against the PeriCoach, providing real-time feedback and guidance for proper contractions of the muscles through displaying activity on the smartphone app. The app also offers a bladder diary to record such things as leaks and pad usage, this information along with exercise history allows the user to see progress over time. PeriCoach real-world user data has demonstrated that the product improved incontinence symptoms in more than 75% of users. Additionally, the PeriCoach user may connect with a doctor or PT and share their exercise data. PeriCoach is available for $299 USD at http://www.pericoach.com.
Yarlap is another pelvic floor exerciser, but this one does much of the work for you. It’s an FDA cleared pelvic floor stimulator that instructs your pelvic floor muscles to gently contract and relax in order to show you how a Kegel exercise should actually feel. The difference between Yarlap vs. Elvie and Pericoach is that the Yarlap does the workout for you. It uses a technology called AutoKegel, which perfomrs the Kegel exercises comfortably, correctly, and easily to help you regain muscle tone. Yarlap consists of a probe, which is inserted into the vagina, and is attached to a display unit, which you can program based on your needs. Yarlap is priced at $299 and can be purchased at http://www.yarlap.com.
A word of caution when considering an electronic device for kegels: Kegels aren’t for everyone, and for some women who have pelvic floors that are too tight, they can even be harmful. It’s just as important for the pelvic floor to be able to relax as it is for it to be able to contract, so use these devices with caution, and, preferably, with the guidance of a physical therapist specialized in the pelvic floor. And, because the pelvic floor connects to many muscles in the body, they shouldn’t be done in isolation. It’s important to strengthen your entire core to ensure that everything is working together, and one muscle isn’t overly taxed during your day-to-day activities. This is where a trained physical therapist can really help customize your workout. If you need help finding a physical therapist in your area, check out our Doctor Finder Tool.
Have you ever tried a pelvic floor exerciser? What were your results?
Simply stated - the pelvic floor isn’t just a female thing - it is a muscular sling supporting the pelvic and abdominal organs of men and women. The pelvic floor helps keep us dry. More than 50 percent of men over the age of 60 experience bladder control issues due to an enlarged prostate.
Before I share my best pelvic floor tips for both sexes, we need to agree on the following three truths: strengthening a weak pelvic floor may improve bladder control and confidence, utilizing my tips in conjunction with seeing your healthcare provider will create the most optimal effect, and it’s important to allow yourself to have a bad day here and there.
Here are my best pelvic floor tips.
For a week, keep track of your trips to the bathroom, your leaks and how much and what you are drinking. Note any trends with fluid intake, time of day and activity level in relation to using the bathroom and your leaks. Your documentation may help your health care provider order tests, make a more accurate diagnosis or prompt a referral to a specialist.But, please consider what you can do with the information. Are there any trends you are seeing? Do you have more problems in the morning, afternoon or evening? Do you need to space out your fluid intake? ou may be able to cue into changes that may positively impact your bladder control and confidence.
Drink more water and consider cutting down on alcohol and caffeine
Many newly incontinent persons incorrectly assume if there is less water in the system there will be less water to pass. Cutting out water, or significantly decreasing water consumption, while continuing to consume alcohol and caffeine at normal previous levels may aggravate the bladder and make the leakage problems worse. Hydration with plain, old water is one of the keys to improved bladder function. And, revisit your diary – it may be possible that alcohol or caffeine may be a trigger to your leakage pattern. Do you need notice you have more problems with bladder control after a glass or two of coffee or your favorite cocktail?
Yes – we need to talk about this. Men can do Kegels and should do Kegels to improve bladder control. Kegels are not just meant for women. Repetitively performing Kegels will improve pelvic floor muscle function, strength and endurance. Kegels should be a habit like brushing your teeth. The truth of the matter is - if your pelvic floor muscles are in better space they will be better able to support you and keep you dry. Here are some cues that may help you or your loved one perform a Kegel.
Return to the idea that pelvic floor is a muscular sling. It supports your abdominal and pelvic organs kind of like a hammock running along the base of pelvis – front to back and side to side.
Gently pull the pelvic floor up and in towards your navel as if trying to protect yourself from a blow to the belly. When you do this – you may feel a gentle tightening of the muscles underneath your navel. Your tailbone may gently rises up and in. Continue your normal breath. Keep in mind, the Kegel, I am recommending is not 100% effort but a gentle tightening of the muscular sling.
Continue breathing and hold the Kegel for a few seconds. Then gradually relax. Repeat until you’re fatigued or have completed your goal.
That concludes my list of my best pelvic floor tips. What are your best practices?
A guest blog written by Michelle Herbst, PT
Pelvic Floor Exercises, or Kegels, is the contraction of the muscles between the pubic bone and tailbone. When a pelvic floor exercise is performed, the person should feel a gentle tightening and lifting sensation in the lower abdomen and perineum. The pelvic floor muscle contraction is complete when the muscles relax and let go of the contraction.
Please keep in mind these tips when performing a pelvic floor exercise to protect yourself from undue harm. One, you must be able to maintain your breath and therefore be able to inhale and exhale while performing a Kegel and avoid breath holding or bearing down. Two, your muscular effort should be around 75 to 80 percent. If you are exerting 100 percent effort, you are likely using the pelvic floor muscles and many other muscle groups as well.
There are many variations and progressions of a Kegel exercise.
Here are 3 ways to incorporate pelvic floor exercises into your daily routines.
Exercise One: Kegel Progression
The pelvic floor muscles are made of two muscle fiber types – fast and slow. Therefore, Kegels can be progressed by varying the hold time and intensity of the muscle contraction. One of my favorite progressions is simply lengthening the hold time followed by a few quick pelvic floor contractions. For example, a Kegel can be held for 5 seconds followed by 5 quick contractions. This Kegel Combo can be done in any position – seated, standing or lying down. It can be done to the beat of music while seated at a stop light or at the end of a cardio or lifting session when you are your mat working the abdominal exercises.
Exercise Two: Kegel with Breath Work
Yoga is the all the rage and you my find your zen when performing a Kegal with breath work. While your yoga instructor is cueing you in inhale and exhale think about what your pelvic floor. Typically, during focused breathing such as in a Yoga Class, there is always slight tension on the pelvic floor. However, you further engage the pelvic floor muscles when you forcibly exhale. During this type of exhalation, the pelvic floor muscles tighten further along with our deep abdominal muscles to push the air up and out of our lungs. Try it. It may transform your yoga practice.
Exercise Three: Kegel with Plank
Plank. It is a much loved and hated exercise. It is a great way to fully engage our core. And, to reap the benefits of the plank - you must focus on the pelvic floor. If your wrists and feet can tolerate a full plank – go for it! If you need to modify, do a half-plank on your knees. Or, try a wall plank by standing with your feet an arms-length away from the wall and placing your hands on the wall.
Here are a few head to toe cues to get you planking.
When in plank, the hands are stacked under the elbows and shoulders. The chin is slightly tucked lengthening the back of the neck. Your shoulder blades are pulled down and back towards the spine. The chest opens and the pelvis is slightly lifted. Your legs are hip width apart. In full plank, your ankles are 90 degrees as you weight bear through the toes. Now, draw your focus to your pelvic floor muscles. When you tighten the Kegel muscles, you may feel like your tailbone lift up and in. Hold your plank and breathe. Smile too – you just may enjoy how strong you feel.
Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.
Question: Can pelvic floor exercises really help with OAB symptoms?
Answer: Yes! The pelvic floor is a web of muscles that cradle the bladder, uterus and rectum. By keeping your pelvic floor strong and healthy, you can ensure that your muscles are strong enough to prevent leaks when those urgent needs strike. Kegel exercises are great for this. To perform a kegel, first you need to find the right muscles – a good way to do this is to try stopping urination in midstream. These are the exact muscles you should be working. (Note – do not do this on a regular basis, only to identify the correct muscle group.) To perform a kegel, tighten your pelvic floor muscles while drawing in your Transverse Abdominal muscles (TA). Your TA muscles are your lower, inner most muscles of the abdominal wall and you can pull them in by bringing your belly button back to your spine. Hold this contraction for 5 seconds, then let your pelvic floor completely relax. (Allowing your pelvic floor to relax is just as important in this exercise to ensure that it doesn’t become too tight, which can also cause issues.) Complete 10 sets of these, 2 times per day.
An important note: While kegels are beneficial to many women who have pelvic floor muscles that are too loose, it is important to note that there are some women who have pelvic floor muscles that are too tight. In these cases, the pelvic floor is already so tense that they are not able to contract or relax at a normal rate, making them weak. Kegels are not recommended in women with tightened pelvic floors. If you are experiencing any type of pelvic floor issue, incontinence, painful intercourse, back pain or constipation, you should consult a specialized pelvic floor physical therapist prior to beginning any pelvic floor exercise.
Are you an expert in incontinence care? Would you like to join the NAFC expert panel? Contact us!
A guest blog written by Michelle Herbst, PT
As a physical therapist specializing in pelvic floor rehabilitation we are referred to as women’s health physical therapists. But, this a little of a misnomer as men have pelvic floors and can have concerns too. In my experience, men participating in pelvic floor rehabilitation make the best patients. They are engaged, compliant and determined to positively affect their condition.
Kegels for Men:
Kegels for men can help with erectile dysfunction and urinary and fecal incontinence. They are most effective when performed in a consistent, specific manner and progressed slowly over time. Here are a few ideas and tips for men to consider when performing kegels.
A kegel is a contraction of the pelvic floor muscles. It feels like a gentle pulling up and in of the pelvic floor followed by a relaxation of the entire muscle group. The kegel contraction begins with a slight lift of the tail bone moving forward as a gentle tightening of the muscles between and tail bone and pubic bone. Lastly, the lower abdominals contract slightly. Then the muscles gently release or relax. There may be a feeling of a reversal of the contraction sequence.
There is no need for weights as our body weight and gravity provide resistance. The contraction is a sub-maximal in effort. If kegels are performed too hard and too fast the result may be muscle soreness and aggravation of symptoms. Performing a submaximal contraction is key and mild muscle soreness may be expected.
Avoid breath holding when kegeling. Repetitive contraction of the pelvic floor while holding the breath could aggravate prior back injuries or make pelvic floor symptoms worse. Normal breathing is the standard when kegeling. Your face should not be turning red. After normal breathing while kegeling is mastered you can further enhance the kegel during exhalation. A long exhalation during a kegel - such as you would blowing out a candle - can allow you to improve muscle performance. Here, give it a try: gently tighten the pelvic floor – take a deep breath in and slowing exhale like you are blowing out a candle while holding the kegel muscle contraction. Then release.
Kegels should be progressed gradually and can be progressed by increasing the hold time and number of repetitions. For example, when you first begin kegeling, you will want to measure how long you can hold the muscle contraction before the muscles ‘give away’ and release the kegel. If you can hold one kegel for 3 seconds, without breath holding, use that as your benchmark for holding time. Next, work your way up to 10 contractions of 3-second holds. Repeat another set of 10 later in the day. Eventually you may work up to completing multiple sets of 10, 3 to 5 times per day while advancing the kegel-hold time to 10 seconds. And, please remember to relax between each consecutive kegel to avoid moderate muscle soreness.
Try kegeling in different positions. Use the above suggestions of progressing the kegel hold time and repetition and apply to your place in space. The combined effect of body weight and gravity can increase the resistance and difficulty of the kegel. For example, if you have been performing your kegels while lying down, try to perform them in a seated position, followed by standing and during your daily activities.
Lastly, consistency and patience are key. If you don’t take your medicine you will not get well. Continue to perform your kegels daily while your symptoms are improving and to maintain your gains. Be creative and patient with progressing kegels. Depending on your starting point it may take weeks or months to progress to performing multiple repetitions in functional positions. Do not give up too soon. Kegels - they are not just for women and can greatly improve a man’s overall health and quality of life. Give them a try.
We all have health goals. They are often about being more health conscious and physically active. I’ve heard varying goals from “I want to lose 15 pounds” to “I want to be able to run my first marathon,” but rarely do I hear “I want a stronger pelvic floor” or “I want to be able to jump or exercise without leaking urine every time.” In fact, most people don’t even know about these muscles and how essential a strong pelvic floor is for everyday function.
The pelvic floor is an amazing set of muscles that span inside your pelvis, from your pubic bones to your tailbone, that act as the base of your core. They work to control your bladder and bowel and maintain continence, allow for pain-free and enjoyable intercourse, hold up the pelvic organs and help stabilize the pelvic girdle and spine…that’s a lot of responsibility for muscles that are often neglected in the daily workout plan.
As a pelvic floor specialist, I am often asked “How do I work out my pelvic floor?” The fact is, most people don’t know how to turn on their muscles the RIGHT way. They are often trying so hard to squeeze as tight as possible that they are engaging everything but their pelvic floor! They will hold their breath, clench their butt, squeeze their inner thighs, tighten up their abdominals and totally miss the boat.
A pelvic floor contraction, or Kegel, is a very subtle feeling. It includes a compression and lifting of the muscles deep inside the pelvis, like you are trying to suck a marble up with your vagina or lift your testicles in fear of walking into ice cold water! Too frank? Well then imagine that you are stopping the flow of urine, which is actually a good test to see if you are engaging the RIGHT muscles. You can always tighten your pelvic floor mid-stream and see if you can stop, or at least slow down the flow, but this should just be a test, and never a means to actually exercise these muscles.
Although the pelvic floor is the star of this article, you have to also understand that these muscles don’t work in isolation. Remember that the pelvic floor is the BASE of the core, but also works with other muscles as an integrated system. The major supporter of the pelvic floor is the diaphragm, which is the dome-shaped muscle at the bottom of the rib cage that is essential for breathing.
When you take a deep breath in through your nose, your rib cage expands and the diaphragm moves downwards, changing the pressure system in your abdomen so your pelvic floor muscles RELAX. As you exhale through your mouth, the diaphragm moves upwards, and again, the intra-abdominal pressure is changed, and the pelvic floor returns to its resting position. Wow! Who knew that just practicing breathing could also be working the pelvic floor!
If you want to get fancy, you can coordinate the two muscle groups together:
Start lying on your back with your knees bent. Place each hand on the side of your rib cage. Inhale deeply through your nose, imagining your rib cage is expanding in all directions into your hands, and keep your pelvic floor relaxed. As you exhale through your mouth, let your rib cage return to resting position and gently tighten your pelvic floor muscles and hold for up to five seconds, then release. Repeat this sequence for a good 5-10 minutes each day…it’s more about the quality of the breathing and pelvic floor contractions, not just the quantity. (If you are a numbers kind of person, then try to shoot for 30-50 contractions a day.)
It is essential that you allow for the relaxing aspect of this exercise. Like any other muscle in the body, we need to make sure the pelvic floor is able to go through its entire range of motion, which means it should be able to tighten, and then release or relax, so it can be able to contract again. Remember that these muscles are working 100% of the time, and in order to maintain a strong pelvic floor, you need to let these muscles RELAX in between each contraction.
As you feel more comfortable with this exercise, try it sitting or standing, so you can start working out your pelvic floor throughout the day. The beauty of exercising your base is that no one even knows you are doing it! You can be standing in line at the grocery store or sitting in your car, waiting for the light to turn green, and BAM! You are working your base out! Even better, think about integrating your pelvic floor and diaphragm into your gym routine, especially lifting weights or doing other core work.
I dare you to start thinking about exercising all aspects of your core, especially your pelvic floor. Remember, it’s all about the base!
Victoria Yeisley, DPT, has been specializing in pelvic floor physical therapy since 2008. She completed her Doctor of Physical Therapy at Boston University and currently works with Northwestern Medical Group in Chicago, IL, where she is integrated as a part of the OB-GYN team. Victoria’s passion lies in empowering her patients to not only be educated about their pelvic floor, but to gain control over their symptoms. She feels extremely lucky to be able to practice her passion every day and hopes to be able to continue to promote pelvic floor muscle awareness for all!