We Pilates teachers love to talk about kegels. Like, all the time. Not just in class but at dinner parties, too (well, maybe that’s just me). It’s for good reason: engaging your kegels works your pelvic floor. The pelvic floor muscles are a group
of muscles that attach to the front, back and sides of the bottom of the pelvis. They are like a hammock or a sling, and they support the bladder, uterus, prostate and rectum. They also wrap around your urethra, rectum, and vagina.
A strong pelvic floor keeps you from leaking urine, holds your internal organs in place, supports your spine and pelvis and is needed for sexual function. Yes to strong pelvic floors, please! So many of us have been taught to dutifully “do our kegels,” especially after giving birth to make sure things stay where they belong and sex stays enjoyable. When you’re hypotonic (weak/loose) in that area, kegels done correctly are fantastic.
But what if your pelvic floor is too tense, or “hypertonic.” Basically that means it is constantly contracted (think of your shoulders hiked up to your ears when you’re stressed…now picture that happening down there). Doing kegels in that situation would be like trying to hike those shoulders up even higher; NOT a good solution to decreasing tension and improving muscle function.
SYMPTOMS OF A HYPERTONIC PELVIC FLOOR INCLUDE:
- Urinary frequency (more than every few hours), urgency, hesitancy (feeling you have to go, then nothing happens), stopping and starting of the urine stream, painful urination, or incomplete emptying
- Constipation, straining, pain during or after bowel movements
- Unexplained pain in your low back, pelvic region, hips, genital area, or rectum
- Pain during or after intercourse, inability to orgasm, throbbing, spasm, “pressure in the vagina”
The troubling thing is that many women suffer silently with undiagnosed hypertonic pelvic floors. SO many are doing exercise that is making them worse. Kegels are so often recommended to post-partum women, but how they are performed is almost never assessed in North America. Dr. Arnold Kegel started teaching pelvic floor contraction exercises in the 1940s by using internal palpation to cue the proper muscles. Somehow we’ve stepped away from that and kegels have become something women told to do without any real instruction other than “hold your pee.” The truth is, most of us only do kegels halfway (read: incorrectly). The “hold your pee mid flow” analogy we’ve been taught is crap. All you’re doing is lifting up, working in one direction. You need to practice “letting go” just as much as lifting. You need to
do it full range! Anyone who is hypertonic should be practicing “letting go” and omitting the lift entirely.
SO WHAT CAUSES A HYPERTONIC PELVIC FLOOR?
Tension patterns in the pelvic floor used to be unequivocally linked to sexual (or other types) of abuse. However researchers are finding that the vagina automatically fires (tenses up) in almost any type of stressful situation. The vagina does this to protect the incredibly precious goods inside and this is a direct reflection of the fight or flight response.
Constant physical stress (load bearing), repetitive pressures running, cycling, jumping can all cause an overworked hypertonic pelvic floor.
Many of us have replaced deep, abdominal activity with “sucking our stomach in,” and think we are constantly using our muscles. In reality, the sucking in motion is a pressure that pulls the abdomen’s contents up (not in). You get a temporary flat stomach that looks fantastic on the beach, but you also get a tucked pelvis, restricted diaphragm, no butt muscles used when walking, no real core engagement, and excessive friction in the lumbar spine, hips and knees…and a hypertonic pelvic floor.
TOO MUCH SITTING:
Sitting in chairs for the bulk of the day is one of the worst things for your posture and alignment. Sitting gives you a posterior (tucked under) tilt in your pelvis, restricts your diaphragmatic breath and increases pelvic floor tension.
So what’s a hypertonic gal to do?
CHANGE HOW YOU BREATHE:
I can almost always spot the hypertonic student in class based on how they breathe. They are the ones who can’t “let go” of their tummy when they inhale. They are so used to sucking in and holding tension in their abdomen that their shoulders and ribs do all the movement. Note: dancers, gymnasts and busy A-type runners are notorious for this! Learning to breathe like a baby in a crib – inhale let the belly rise, exhale let it fall – is the most important place to start releasing your pelvic floor. Bonus – you’ll also be calming down your nervous system if you breathe like this!
The opposite of chair sitting is squatting. This is a very important yet often neglected primal movement in our sedentary culture. Doing squats helps to stretch the pelvic floor and lengthen the weak, tight muscles. Try garland pose shown below.
FIX YOUR POSTURE:
Tummy sucking leads to a tucked under pelvis (flat bum) and popped out ribs (tight back muscles). Your ribs should be stacked vertically above your pelvis to ensure the pelvic floor and diaphragm move together with each breath. Choose alignment-based exercise like Pilates to reduce tension and connect to your true inner core! Try this streamable Restore Your Core video workout. thebellemethod.com/product/the-bump-method-4th-trimester/
SEE A PELVIC FLOOR PHYSIOTHERAPIST:
If you’ve done all the above and are still experiencing symptoms, see a specialized pelvic health physiotherapist for an internal assessment. It is important to learn how to relax the pelvic muscles. Because these muscles have been held in tension it can be difficult to know how to relax. That’s where physical therapy can help. It can also facilitate join mobility and release trigger points.
And finally, another reason to perfect your pelvic floor muscle function is because properly contracting and releasing that area connects to your deepest layer of abdominal muscles…which means truly flat strong lower abs! Can I get a “hell yeah!”
Knowledge is POWER, ladies!