Not too many of us want to talk about this, although we might with our closest training partners, especially if say, one of them makes us laugh in Boot Camp while doing burpees or during a run. “Stop it!” You might cry, “I just peed in my pants!” There’s that dribble from urge incontinence (there, I said it) from a cough or sneeze that comes out of nowhere and then the continuum of unpleasantness goes on from there. I know women who’ve had to slip a pad into their shorts in the transition area of a duathlon before running. I know runners who no longer run because the leaking is so bad. I find that unacceptable. And if you’re having problems–anywhere on that continuum–so should you.
I’ve written a lot about pelvic floor health in the last year and have learned a great deal. First and foremost: It’s not really your bladder’s fault, it’s a weak pelvic floor. And while pregnancy and birth can certainly compromise that tiny area of muscles between our pubic bone and tail bone that essentially hold up all of our organs (is that all?), that weakness can (and most often does) effect everyone eventually, even women who have never given birth; even men, because yes they too have a pelvic floor.
Here’s a run down of the most eye-opening pelvic floor facts I’ve learned from two people who have studied the pelvic floor extensively. This is the information that can mean the difference between wet and dry running shorts, and for some working out again with confidence.
1. The Pelvic Floor needs to be stretched and strong. When I interviewed biomechanical scientist Katy Bowman last year she blew me away with the very obvious:
One of the biggest misnomers is that tight muscles are “strong” and loose muscles are “weak.” In actuality, the strongest muscle is one that is the perfect length – you need Pelvic Floor Goldilocks – it’s juuuuuust right. The Kegel keeps making the PF tighter and tighter (and weaker and weaker). The short term benefits are masking the long term detriments. Ditch the kegels and add two to three squat sessions throughout the day (anywhere). The glutes strengthen and as a result, they pull the sacrum back, stretching the PF from a hammock to a trampoline. Viola!
And because that seemed so incongruous to so many people I interviewed Katy again to get a “say what?” on that:
The muscle tissue in your PF is the same as the muscle tissue in your biceps. When you’re done realllly working your biceps, you’d like your arm to go back to its original length, right? What if, when you were done doing your curls, your elbows stayed as bent as they were when your muscles were the TIGHTEST? If you equate strong with tight, then you’d have “strong,” contracted arms with bent elbows all the time. Tight muscles. Unusable arms. That’s not what TONE is. Tone is having the MOST strength and the MOST length.
2. A flat butt indicates a person has a weak pelvic floor (and likely pees when sneezing). This is why squats are the new kegel. Again, I bring you Ms. Bowman:
The muscles that balance out the anterior pull on the sacrum are the glutes. A lack of glutes (having no butt) is what makes this group so much more susceptible to PFD. Zero lumbar curvature (missing the little curve at the small of the back) is the most telling sign that the PF is beginning to weaken. Deep, regular squats (pictured in hunter-gathering mama) create the posterior pull on the sacrum. Peeing like this in the shower is a great daily practice, as is relaxing the PF muscles to make sure that you’re not squeezing the bathroom muscle closers too tight.
3. That hip, knee, foot, or back problem might really be a pelvic floor problem. The biomechanics lessons from Katy provide endless insight to the the many connections involved with our health. In the case of the pelvic floor, lots of important body parts connect to it: abs, glutes, hip flexors. If these supporting muscles aren’t strong enough our pelvic floor suffers; likewise, calling on these muscles to do the work of weaker muscles will trigger new problems. Katy posted four fast fixes for pelvic floor disorder on her blog. One of them: Not using the treadmill. I am so down with that!
4. In a well-aligned muscle-balanced body, kegels would not be necessary. Yup, if all of our muscles maintained their ideal strength and length so that our alignment kept our body in good working form, then there would be no need to “spot train” problem areas. And if you do need to “spot train,” understand that more than your pelvic floor is compromised (see #3 above). In another post by Katy (more prolific about the pelvic floor than I) she says:
PFD is a sign that your entire body is collapsing, from the inside-down. While the sneeze-pee and organ prolapse may seem like a huge deal it is nothing compared to the neurological damage to the spine, nerves, and tissues that those nerves supply (especially the nerves running to the lower legs.) The kegel is a drop in the bucket to what someone with PFD needs to do to heal all their structures. PFD is a whole-body situation and for optimal, whole-body outcome, the body has to be treated holistically. Otherwise it’s like putting a new roof on a termite-ridden frame.
5. A kegel is a two-part process, not just a contraction. Since most of us aren’t perfectly balanced and aligned, we still need to know how to do a kegel but only if they’re done correctly. Doing them incorrectly is only going to exacerbate pelvic floor disorder. And no matter what, you still need to be able to engage your pelvic floor. Guess what? A Kegel is more than a contraction. The next step is to relax the pelvic floor so as to lengthen it (see #1 above). The Kegel Queen emphasizes the relaxation step in her program and why she insists you can’t do kegels anywhere, like while we’re driving, as we’re often told.
6. If you can totally relax your pelvic floor you can completely relax your body. The ability to completely relax your pelvic floor allows you to completely relax your body. Can you do this pelvic floor party trick?
7. Doing two kegels is good, but doing 200 is NOT better. Both Katy Bowman and the Kegel Queen agree that too many equates to a too-tight pelvic floor. Katy points out that a too-tight pelvic floor can pull the sacrum out of alignment (hello back pain!) and the Kegel Queen explained it to me in a recent interview in terms I can understand as a fit mom:
Kegels work by increasing your control of the pelvic floor muscles, and by building mass and tone in the pelvic floor. How would you build mass and tone in any other muscle in your body? As anyone who does weight training knows, you’d do a small number of strong, sustained reps. Not 200 “quick flicks,” or 200 anything! Your pelvic floor is no different.
8. Even if your pelvic floor is in good shape, even if you’ve had corrective surgery, you still need to maintain pelvic floor strength.This is forever people. It’s like strength training any muscle. Once you feel like you’re in a good place you can’t just stop. This applies to all fitness, so of course it applies to pelvic floor fitness. Even my pelvic floor expert, Katy Bowman, discovered she needed to get back in touch with her pelvic floor after the birth of her baby (she’s human!)
I know that’s a lot of links. All that in one post is, “Everything Kara Learned About the Pelvic Floor That She Wants Every Woman to Know.” So please share it with your sweaty sisters at your next workout. No one needs to worry about what will happen while running or laughing. And if you’re working out with your sweaty sisters you need to do both at the same time.
I have the "Down There for Women" DVD to give away if you want more pelvic floor tips. Just leave a comment here AND click over and "like" the Hot (Sweaty) Mamas Facebook page. I'll pick a winner July 11!