“What’s an example of a good pelvic floor strength program?”
This question about pelvic floor strength programs came to me from a mom a couple of weeks ago after my blog post about how to kegel correctly. She asked for an exercise program specifically targeting the pelvic floor.
This is a tough one because pelvic floor muscle strengthening is not indicated for all women. And, as we discussed last week in the reverse kegels post, practicing pelvic floor strengthening exercises when not indicated could exacerbate any pelvic floor issues you already have.
Don’t get me wrong – some women really do need to work on pelvic floor strength. So, if your pelvic floor physical therapist prescribed them, then please keep going! There are even special weights you can use to help with strengthening so you aren’t just kegeling until the cows come home. Did you know those existed? Interesting, huh?
Because I don’t know your specific needs, I can’t tell you if you need to buy kegel weights or need to work on relaxation. So, instead of telling you to start incorporating a “Pelvic Floor Day” into your strength training program or how many sets and reps to do on any given day, I think I can give you some much more helpful information.
Understand Your Pelvic Floor
I want you to understand your pelvic floor muscles a little more so you can take more control over your pelvic health.
First, let’s dive into the two different types of muscles in your pelvic floor. There are the muscles that respond quickly but then fatigue quickly – these are your sprinting muscles. Then, there are the muscles that respond a little slower but keep working for a long time – these are your marathon muscles.
A sprinter and a marathon runner are going to have very different training programs. However, your pelvic floor isn’t all sprint nor all marathon. When you cough, laugh, or sneeze, you want the sprinters to be strong. But when you are standing or walking all day, you want the marathon runners to be strong. A healthy pelvic floor has a good balance of both.
The sprinter muscles use “quick flicks” and are often really helpful with stress (laughing, coughing, sneezing) and urge (gotta go right now) incontinence (leaking urine). A “quick flick” is when you contract your pelvic floor muscles for a count of 1, 2, then release for a count of 1, 2. Remember, the release is just as important as the contraction!
Next time you feel a sneeze coming on, try the “knack” where you contract your pelvic floor muscles in anticipation of the sneeze. The knack isn’t a max force contraction, just about 50% to give the muscles a head start.
The Marathon Runner
The marathon muscles are helping you throughout your day. They are gently engaged (without you realizing it) all day as you stand, walk, and do the activities of life. These muscles are like your postural muscles that keep you upright without you thinking about it. You might feel heaviness in your pelvic floor after prolonged standing or at the end of the day if these muscles are fatiguing. Sitting down often relieves this pressure and gives these marathon muscles a rest break.
These muscles respond well to gentle contractions held for about 10 seconds. If you try a gentle contraction and count to 10, make sure you continue breathing the whole time. You may notice your muscles starting to quiver and shake, maybe you can feel your inner thighs trying to help out – take a break. Holding for 10 seconds sounds easy enough, but you may need to start slowly and work up to it.
Sprinter? Marathoner? What Am I?
So, should you practice the quick flicks or the prolonged gentle holds? I don’t know. That all depends on what’s going on in your pelvic floor.
You’d think we would have some hard and fast rules, like “all women need to work on strength after birth” … but we just don’t. If you are in a lot of pain after birth, your pelvic floor may reflexively spasm making relaxing the pelvic floor a lot more important. I think many women do not realize just how nuanced and complicated the pelvic floor can be. It doesn’t always have to be complicated, but sometimes it is! And it’d be negligent to ignore that.
Despite my inability to give you personalized medical advice via a blog post (and trust me, I wish I could!), I do think if you understand the muscles, their function and purpose, you can make some educated decisions for yourself.
Function and Purpose
This next part is key when considering pelvic floor muscle optimization. The pelvic floor is supposed to work *against* gravity. Most of the day you are upright in standing – this is when the muscles are challenged the most to do their job.
Laying on your back is often how the pelvic floor is assessed and how you are taught to do your kegels. But, that’s not very functional… How often are you laying down throughout the day? I don’t know many women who lounge all day, eating bon bons, and watching Netflix. I wish.
So, the best way to improve your pelvic floor strength? It’s not going to be with quick flicks and gentle 10 second holds. Maybe that’s where you start, but it shouldn’t be everything.
Pelvic Floor Gains
Your biggest pelvic floor gains are going to be with bodyweight or weighted functional movements. I’m talking squats, lunges, lifting weight over your head, upper body work – if you’re standing, your pelvic floor is getting a work out too. Even in sitting and laying down, your pelvic floor can still be challenged. But, the standing exercises are going to be key.
But, again, I can’t tell you to do 10 squats, 20 lunges, and 15 overhead presses as if that will be the silver bullet for you. Are you sensing a theme here?
Your muscle strategy – that is which muscles are working during a squat or lunge – matters. Your symptoms during these activities – leaking urine, pain, prolapse – they matter. Without knowing those things about you, I can’t give you a specialized program. And there is no one size fits all program; I hope I’ve convinced you of that by now.
However, there is still a lot you can learn to help yourself!
Your Pelvic Floor Strength Program
In general, the ideal strategy during strength training is to exhale during the hardest part of the activity. For example, inhale going into a squat and exhale standing back up, inhale into a push up and exhale as you press your body up, etc. Remember from this previous post about healing your Diastasis Recti, when you inhale your pelvic floor expands, when you exhale your pelvic floor gently contracts. This is a great place to start.
Let me say that again – this is a great place to *start*.
However, working on different breathing techniques while you exercise is going to be how you progress. Exhale on your way into a squat and inhale up, exhale into a push up and inhale up. Better yet, use your breath in the way that makes you feel most powerful while you exercise. That may change with time and with different exercises. That’s okay. It’s part of the puzzle of what makes you unique and different. And it’s another major reason why I can’t tell you exactly what to do without knowing a little more about you.
The best pelvic floor strength program? I can’t give you that. But, I can give you the knowledge to figure out your best routine. And, the knowledge to figure out when you need the help of a professional (check out Pelvic Guru to find someone near you)! Because leaking urine, pelvic pain, and prolapse does not have to be your normal forever.