Flexible Strength: your pelvic floor in pregnancy and beyond

Flexible Strength: your pelvic floor in pregnancy and beyond

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The pelvic floor: you’ve heard about it, you’re told to “exercise” it, you know it’s there…but it’s a little bit intangible and ethereal. What does it do? How should it feel? How do I know if I’m doing it right? Pelvic floor awareness is the most important thing to discover and fine-tune here. Yes we need to strengthen, but we also need to have the ability to release and be flexible. And, above all, you need to BREATHE, fully and deeply. Pelvic floor exercises without attention to the breath are basically null and void.

We need to be aware and be able to control the pelvic floor muscles, rather than simply make them “strong”. Imagine an accordion: if it was squeezed up tight permanently it wouldn’t be able to open, close, undulate and make use of all the air within it to make beautiful music. The tallest buildings on earth look fixed and stable, but have flexibility built in to their structure, so that they can bend and weave with the elements rather than breaking. This flexible strength is what we need to aim for with our pelvic floor.

Pelvic Floor Awareness

Sit upright on a chair. Your feet are hip-width apart, with your weight evenly released into your feet and sit bones.

  1. Breathe in as you lengthen your spine and soften your shoulders.
  2. Breathe out and softly lift your back passage, as if you’re trying to stop breaking wind. Continue this lifting energy and bring it to the front, towards your pubic bone as if you’re trying to stop the flow of pee. Draw these muscles up and in, lifting from the back forward and up. We want to try and locate the full breadth of the muscles from the back to the front, imagine like flower petals folding up and into a bud, evenly from all sides. You may feel your lower belly lifting up as well.
  3. Maintaining this engagement, breathe. Ensure that you can still breathe fully and wide into the sides of the ribcage, while continuing to lift into your centre. There should be no bracing.

Watchpoints

  • Check your shoulders are relaxed, and scan your body for any tension as you breathe: jaw, neck, buttocks – soft and relaxed.
  • If you lose your connection, that’s totally normal so don’t feel frustrated, simply take a breath and start again. With practice, it will become easier and more natural.
  • The key is a soft engagement rather than a stiff fixed one. Make sure that you can still breathe, and your torso isn’t rigid.
  • Please don’t practise this while sitting on the loo and stop midflow while actually having a pee. You might introduce the chance of a UTI that way.

Help! I can’t feel it!

If you really can’t find your pelvic floor at all: try sucking your thumb. Or, place both hands palms down on a table while you’re sitting down. Press down on the table, you should feel a natural lift of the pelvic floor muscles. Persevere with these pelvic floor awareness exercises, and you should begin to find the mental connection which will allow you to feel them – it’s a subtle sensation, not “obvious” like tensing your bicep muscles, so it may simply be that you need to find that mindful connection to your body, and relax into it a bit. Also try getting stuck in with your hands to actually find where the muscle attaches: feel your sit bones with your fingers, trace your fingers around your pelvis and imagine the pelvic floor as a hammock spanning the whole pelvic cavity. Having a tactile approach while you experiment with finding your centre may help you to connect to the engagement.

If you still struggle after giving it a real go (it will take a bit of regular practice) – and particularly if this is not your first baby and you’ve found pelvic floor sensation tricky since your previous birth – it’s worth going to a women’s health physio to see if a hands-on practitioner can give you some pointers.

Pelvic elevator

Sitting on a chair, feet hip-width apart, flat on the floor. Release your weight evenly on both sitting bones.

Depending on what stage of pregnancy you are at ­– you can perform this exercise throughout – you could also do this while lying down on the floor, but it is sometimes easier to locate the pelvic floor initially if you are upright, as you feel the sensations more strongly when working on lifting directly upwards, against gravity.

Imagine that your pelvic floor is a lift in a building. We have ground floor (your pelvic floor at rest), level 1, 2 and 3. There is also a basement floor below ground floor.

  1. Breathe in, wide into your sides and lower ribs.
  2. Breathe out, and connect to your centre, back to front – visualize closing the lift doors. It may help to imagine the sit bones drawing towards each other (without clenching your buttocks).
  3. Breathe in, relax but maintain that soft engagement.
  4. Breathe out as you imagine the lift travelling to the first floor, lifting your engagement higher.
  5. Breathe in to pause at the first floor (keeping the lift doors closed).
  6. Breathe out, and take the lift to the second floor.
  7. Breathe in, pause, staying at the second floor.
  8. Breathe out and take the lift up to the top floor, full lift up through your centre as far as you can take it without bracing or tensing.
  9. Breathe in and soften your shoulders and jaw as you hold the connection.
  10. Breathe out as you lower down through to the next floor slowly, pausing to breathe in, then lower to the next floor.
  11. When you reach the ground floor, breathe in and soften your muscles as you lower to the basement floor. Imagine opening the doors of the lift and release your pelvic floor muscles completely (possibly best go to the loo before you try this one, just in case!).
  12. Slide the doors closed once more as you breathe out, and repeat the whole exercise up to 3 times.

The beauty of this exercise is that you can do it anywhere, any time. It is also very calming, so if you’re feeling stressed at work it’s a good way of tuning into your breath and “taking a moment” without anyone realizing that that’s what you’re doing.

Pelvic floor, 1, 2, 3 squeeze

This exercises gives you something to squeeze, which offers a bit of feedback for the pelvic floor engagement. A great way of enhancing your pelvic floor engagement if you’re struggling to locate the muscles. You can use either a pillow, or a Pilates small ball. It is a great way of finding the isolation of the pelvic floor muscles as opposed to gripping the inner thighs or buttocks.

First trimester/early pregnancy (until 16 weeks): begin lying down in the Relaxation Position, a ball or pillow between your thighs/knees. Feet are hip-width apart.

Later pregnancy (after 16 weeks): sit upright, feet flat on the floor, either on a chair or on a Swiss ball, and place a ball or pillow between your knees.

 

  1. Breathe in, to lengthen the spine and prepare.
  2. Breathe out and connect to your centre (see Pelvic Floor Control).
  3. Breathe in, maintain that connection.
  4. Breathe out and count to 3, gently squeeze the ball/pillow, while holding the pelvic floor engagement.
  5. Breathe in and let go of the pelvic floor engagement, but keep squeezing the ball/pillow.
  6. Breathe out, count to 3 and release the squeeze on the pillow.
  7. Breathe in, scan your body for tension, relax the features of your face and your jaw.
  8. Breathe out, connect to your centre, and breathe in to maintain.
  9. As you breathe out, count to 3, squeeze your pillow to activate the inner thighs. This time also squeeze your buttock muscles, and feel like your whole pelvic area is “switched on”.
  10. Breathe in, try to release the buttock and inner thigh engagement, but maintain your pelvic floor lift. Notice the difference in the internal and the “external” engagement here.
  11. Breathe out and fully release all your muscles.
  12. Repeat the whole process up to 4 times.

Watchpoints

  • Notice whether you’re frowning or clenching your jaw while performing this exercise. Try to soften and release. If it helps, exhale as if you’re slowly blowing a candle out, and that should allow you to relax your jaw fully.
  • You can change the breathing pattern if you like (swapping the in breath timings with the out breath): but make sure you always breathe.

Emergency stop

The pelvic floor has to be strong for endurance, the long metaphorical marathon. But it also has to have the power for sprinting. This exercise develops the “fast twitch” muscle fibres, which are responsible for those shorter bursts of movement and energy. For example, chicken wings contain lots of fast-twitch fibres, enabling the chicken to take flight in an emergency – fast twitch fibres are quick to respond, but also fatigue after a short burst of energy.

We need to train the pelvic floor both for stamina and speed: it needs the fast-twitch capability for rapid response when you cough, laugh, sneeze or jump around, as well as when your baby is making its descent out into the world. During late pregnancy and in the postnatal period, stress incontinence is a common issue. If your rapid response team doesn’t get mobilised soon enough, simple acts such as sneezing or coughing can cause a bit of a nightmarep. So consider this your rapid response team training: this exercise is a good one to have in your back pocket to train your pelvic floor to be robust for those “emergencies” which require pelvic floor power without a moment to lose!

You can perform this in any position, so practise in whatever position you feel comfortable, and ideally try it out in a number of different positions. Practising in lots of different positions will help you to find the muscle memory for it to be effective in your daily life.

  1. Breathing deeply and normally, on an outbreath quickly lift your pelvic floor up and in tightly, to full engagement.
  2. Hold for about 5 seconds, taking deep long breaths.
  3. Release on an in breath.

Repeat around 6 times.

Pelvic floor, deep belly breathing

Suitable for: all stages of pregnancy

In our society we’re conditioned to hold our bellies in – you know you do it, when you’re having a photo taken, or when you’re reminded of your posture we just suck our tummies in tight. Often all this does is lead to a lot of tension around the abdominals and pelvic floor and temporarily push your internal organs up and in, rather than creating any useful strength or muscle balance. Being pregnant can be a tricky emotional time letting go of your semblance of control of your tummy and its (sometimes alarmingly overnight) growth in size. This exercise allows you to connect to your belly through your breath, and fully relax all of the muscles around your abdomen and your pelvic floor. It’s a wonderful way of calming body and mind, so it’s perfect for all stages of pregnancy (for late pregnancy, sitting up bolstered by pillows may be a better position).

It’s a great way of preparing for your labour, you can tap into this calm meditative state, and use the breathing technique during your contractions.

 

Early pregnancy and postnatal: start lying on your back, head on a small cushion, knees bent, arms relaxed with hands on the belly.

Later pregnancy (or early, if prefer): sit against a wall, surrounded by cushions. Soles of the feet together, knees apart. NB if you’re suffering from PGP  you may be more comfortable with your legs in parallel and outstretched, with a cushion underneath your knees.

 

  1. Lying with your eyes closed, release the weight of your body into the floor underneath you. Feel the weight of your head, ribcage, pelvis.
  2. Bring your awareness to your breath. Initially, just notice it, without changing it. Notice the in breath, the out breath, the space in between. Notice whether there is a rhythm, a consistent length of in breath versus out breath.
  3. Begin to bring a pattern to your breath. Breathe in through the nose for a count of 7, and out through the mouth for a count of 11. Let the breath sigh out through the lips as if you’re fogging a window in front of you.
  4. Bring your awareness to your belly, and your hands resting there, picture your baby in your belly. If your bump is bigger, notice if your baby is awake, moving, what sensations you can feel internally and externally through the hands.
  5. Breathe in and notice how your hands rise and the belly inflates with the breath.
  6. As you breathe out, notice the fall in your abdomen as the breath recedes.
  7. See whether you can channel your breath deep down towards the belly and pelvis, imagine it like a soft wave travelling down the body and washing away any tension.
  8. On the outbreath, feel the belly soften and imagine the pelvis wide and open, and completely relaxed.
  9. Practise releasing the jaw by changing the sounds of your outbreath. Experiment with a “ssshhhhhhh” sound, or a long audible sigh. If you feel a bit silly doing this, try to just relax into it a bit and remember you’re on your own, no one is watching or judging.

 

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