Pelvic Floor

The Critical Importance of Pelvic Floor Exercises

Strong pelvic-floor muscles are an integral part of your body's internal core stabilizers. Maintaining and enhancing their strength will increase your likelihood of having a comparatively quick, complication-free delivery and recovery from childbirth.

Pregnancy Exercise: What Pelvic Floor Muscles Do

The pelvic floor consists of a thin sheet of muscles that cover the pelvic outlet. We call this group of muscles the pubococcygeals, (since they run from the pubic bone to the coccyx) or PCs for short.

These crucial muscles:

  • Support the body's internal organs.
  • Enable you to maintain urinary and bowel continence, and healthy elimination.
  • Provide support vital for reproductive and sexual functioning.
  • Bolster your organs during activities that stress them physically, such as laughing, sneezing and coughing.

Location of Pelvic Floor Muscles

In front, they attach to the pubic bone, and in back to the coccyx, or tailbone. On the sides, these muscles connect to the bottom bones of the pelvis, the ischium also called the "sit bones".

How Pregnancy and Childbirth Impact Your Pelvic Floor Muscles

Embedded in the pelvic floor muscles are two rings of muscle tissue—known as the anal sphincter and the vaginal sphincter. Between these two muscles sits the strong, dense connective tissue of the perineum. During some vaginal deliveries, the physician cuts the perineum in a procedure known as the episiotomy. A vaginal delivery or a C-section performed after a long pushing phase leaves pelvic floor muscles very weak—and sometimes traumatized.

Preparing Your PC Muscles for Birth

During pregnancy, the abdominal wall has 40 weeks to expand. pelvic floor muscles, however, endure extreme stretching, (and sometimes tearing) in just a matter of hours. And they do not automatically rebound after childbirth. To prepare for delivery and help you recover faster, you need to strengthen them through Kegel exercises, comprised of repeated contractions of your pelvic floor muscles.

Pregnancy Exercise: A Common Misconception about Kegels

All well-conditioned muscles have greater flexibility than do weak ones and pelvic floor muscles are no exception. The unfounded belief that well-toned pelvic floor muscles may become too inflexible to facilitate childbirth, or that strong muscles make tearing more likely may deter some women from doing Kegel exercises. In fact, the opposite is true. Muscle weakness and atrophy decreases flexibility and increases your risks for pelvic floor problems. The desire to avoid the discomforts from injuries to this sensitive area provides a potent incentive to participate in a program designed to strengthen and protect these key muscles.

Pregnancy Exercise: Consequences of Weak Pelvic Floor Muscles

After pregnancy, weakened pelvic-floor muscles often cause urinary stress incontinence—the accidental release of urine while laughing, sneezing or coughing. Weakened muscles can also contribute to uterine or bladder prolapse, a more serious condition where one or both organs drop down and sag into the vaginal wall. Unless you adequately strengthen your PC muscles after childbirth, these types of problems may worsen with subsequent vaginal deliveries, weight gain, and aging.

Ways to Protect Your PC Muscles

After childbirth, deep coughing for prolonged periods may cause uterine or bladder prolapse. prolapsed organs function poorly and may require surgical repair. Whenever you feel a bad coughing spell coming on, support your pelvic-floor muscles by sitting on a hard chair, on the floor, or on a large exercise ball.

Realizing the Benefits of Kegel Contractions

Using Kegel contractions after childbirth will increase blood flow to the pelvic floor and help speed healing. Contrary to what you might expect, exercising these muscles reduces pressure on episiotomy stitches and helps relieve perineum tenderness. These exercises will also help alleviate the discomfort of vulva edema, hemorrhoids, and anal fissures.

It's best to do Kegels while in a position that helps you accurately isolate your PC's from the inner thigh and buttocks muscles. Avoid learning Kegels while crossing your thighs, or while standing. These positions will make you more prone to engaging the large muscles of the hips and thighs. Kegels can be done sitting up on a hard chair, sitting on the floor, lying on your side, or on lying your back with your knees bent.

For this exercise to be most effective, you need to close both the anal and vaginal sphincters, and lift the entire area up into your abdominal cavity just a little bit.

How to Perform Kegel Exercises:

  1. First squeeze the anal sphincter as tightly as possible, and then squeeze the vaginal sphincter as tightly as possible.
  2. Then try to increase the intensity of your effort.
  3. Hold the contraction as tightly as you can for five or six seconds.
  4. Completely relax your effort, allowing your muscles to soften. Rest for a few moments.
  5. Repeat the sequence 10 times to complete one set.
  6. Perform 5–6 sets throughout the day.

Kegel Exercises: Mental Imagery Enhances Effectiveness

Research shows that use of mental imagery greatly enhances neuromuscular learning and efficiency. Mental imagery is particularly helpful after childbirth to help you "re-connect" with your pelvic floor muscles.

Illustration of pelvic floor muscles

Suggestions for using mental imagery to isolate Pelvic Floor muscles:

  • Watch, in your mind's eye, the two rings of muscle squeezing tight, tighter, and tightest.
  • Imagine that your pelvic floor muscles are laced together like sneakers. As you contract your PC's, visualize pulling the laces up the inside of your torso and the laces pulling the pelvic floor taut.
  • Imagine that you could pull your pubic bone and your tailbone closer together. Watch, in your mind's eye, the two bones moving closer together.
  • Use internal dialog; say to yourself the words that you would use if you needed to use the bathroom and none were available.
  • Imagine an elevator rising up higher and higher as you intensify your effort.

A single Kegel should take only 10 seconds or so. These muscles fatigue easily, so you need to perform many sets of repetitions throughout the day. A good time to do Kegels is while nursing your baby, or while waiting at a red light. After childbirth, pelvic floor contractions are particularly helpful to do after every bowel movement.

Kegel Exercises: Another Common Misconception

Don't worry if you feel your deep abdominal muscles contracting simultaneously with your pelvic floor muscles. Feeling your belly button move, waist narrow, or abdominal muscles tense during contractions does not indicate that you are doing Kegels wrong. In fact, the deep abdominals, (transverse abdominis), pelvic floor muscles, and deep spinal muscles, (the multifitus) are designed to work together to provide internal support and stability for your torso. Pilates and other core-conditioning systems often instruct clients to contract the pelvic floor simultaneously with the deep abdominals, because it is a powerful core stabilization technique.

If you still have trouble finding your pelvic-floor muscles, you can learn the proper physical action by trying to stop the flow of urine as you use the bathroom. Do not, however, practice Kegels while urinating. This can interfere with complete emptying of the bladder, which increases the risk of urinary-tract infections.

How to Tell If Your Reconditioning Is Working

Directly after a vaginal delivery, most women find it almost impossible to contract their pelvic floor muscles—I know that I did. For many, it feels as if there is "no there there," because the muscles are traumatized. But don't let the absence of a "squeezing sensation" convince you that you're doing them "wrong," or you "can't" do them. The key is to be patient, and to do them regularly, with clear mental focus. As your muscles recover, they will begin to contract more efficiently, and then you will begin to feel the sensation of tightening and softening as you work the area.

After childbirth, you will be finished with the reconditioning phase for your pelvic floor muscles when you can fully clamp off a strong stream of urine. However, to keep the area strong and functioning well for a lifetime, Kegel exercises should remain a regular part of every woman's fitness routine.

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