Leaking when you sneeze? Read this before you do more kegels.

“Oh, you’re leaking? Try to do more kegels. Your pelvic floor must be weak”

“Pain with sex? Maybe your pelvic floor needs some exercise, do some kegels!”

Have you heard these things before? Have you tried to do more kegels to resolve an issue, only to find out that it’s making said issue worse? (Steph raises her own hand) 

If you’re experiencing leaking, pain with sex, tailbone pain, or constipation, you may have a tight pelvic floor. If your inner thighs are always tight, if your glutes/hips always feel sore and tight, you may have a tight pelvic floor. 

The message that we hear all over social media is that 

“Tight is good!” 

“Want to activate your core? Suck that belly button in!”

“Leaking again, eh? You must be too weak down there. Add in a few more kegels.”

Here’s the thing though, we wouldn’t walk around with our shoulders ALWAYS up by our ears. We wouldn’t have our fists CONSTANTLY clenched. Try it and see what happens! How did it feel; sore right? Our core and pelvic floor works the same as other parts of our body. They are made of muscles, and muscles need to move in a full range of motion in order to be strong and functional.

Tight or weak, you may be surprised!

So, to bring us back to the title, is your pelvic floor weak or tight? It may be both! Tightness is often a sign of weakness, because that muscle isn’t able to move in a full range of motion. It may be stiffer to protect itself or the surrounding structures. 

Let me ask you another question, will adding more work make something less tired? Well, if I have 10000 things on my to-do list, and someone added 10 more, I’d be mad, I might quit, and I will most definitely be more tired and not want to do those extra chores.  The same goes for your pelvic floor, just like any other muscle of the body. 

So, how do you resolve leaks and pelvic pain? Well, first of all its always a good idea to see a pelvic floor physio. But beyond that, if you’ve already come to the conclusion that maybe your pelvic floor needs less kegels, let’s talk a little about some other things you can do!

What exactly are kegels, anyways?

A kegel is an exercise, and exercises are meant to strengthen things, when done properly. That means that to get optimal results, you should be doing moving a muscle in a full range of motion, which includes eccentric and concentric muscle movements. So you have to flex, AND relax. Perpetually holding a kegel leaves out the relaxing part. An exercise should also target whole areas, instead of isolating one section. Only stopping the flow of urine leaves out 2/3 of the pelvic floor, as your pelvic floor extends from sits bone to sits bone in the sides, and from tailbone to pubic bone in the front. 

Think of the ENTIRE span of the pelvic floor.

We’ve just talked about how your pelvic floor covers more than the area around the urethra, so it actually makes more of a diamond shape. It is possible for one area of your diamond to be tighter/weaker than other areas! If you are always constipated, perhaps your back pelvic floor is a little tighter. If you always have right hip pain, maybe your right side of the pelvic floor is a little tighter. Isn’t it crazy how everything is so connected?

What does your pelvic floor do in pregnancy?

Pregnancy causes postural changes, as your body stretches and makes room for baby. Your bladder gets squished on the bottom, your lungs and diaphragm get squished on the top, and most people are very eager for that delivery date so they can take a deep breathe again. 

Have you heard that core work is bad for pregnancy? You still use your core in everyday movements, and to twist as you throw snacks in the backseat of the vehicle (or happy meals, please tell me I’m not the only one who does that.) You should still know how to do all of those movements properly. Your pelvic floor takes a bit of a hit from the ever-growing uterus. 

Your core and pelvic floor are BFF’s, and very connected. And the diaphragm is connected to both of those. So, the posture and alignment changes, as well as the core changes, play a direct role in pelvic health. 

Knowing how to use your core and pelvic floor is very beneficial for pregnancy. Relearning how to breathe, remembering to relax your pelvic floor, and doing kegels when you need to can make a big difference between a comfortable pregnancy, or one that you wish would be over soon. You can reduce your Diastasis Recti, protect your back, and experience less pelvic pain and incontinence. 

What is the role of your pelvic floor in birth?

Your pelvic floor muscles don’t push the baby out, they get out of the way! The uterus is the one that pushes the baby out, thanks to the fundus, which hangs out at the very top. Reverse kegels, aka relaxation and balance, can reduce your chances of tearing significantly. 

Making sure both sides of your pelvis are balanced also plays a huge role, as the hips insert into the pelvic floor. Making sure both hips have equal range of motion can have a positive impact on your pelvic floor, and help your baby get into an optimal position for birth. In most cases, your pelvis has enough room for the baby to navigate. 

Pain and leaking after baby isn’t a rite of motherhood.

What does this mean for postpartum?

I hate to break it to you, but postpartum lasts forever. You can be 2 months or 20 years postpartum. Your body has done an incredible thing by growing and birthing your baby (babies) and doesn’t just bounce back right away after birth. So, if you’re leaking now when you didn’t before, don’t assume you just need to add more kegels! Try these things first, and once again, it’s always a good idea to see a pelvic floor physio. **Note: it’s ok to do kegels, but we all need different amounts. I just want to encourage you to think outside of that kegel-box.

Stack it up.

Let’s talk alignment, but this will probably be different than what you’re thinking.

Keeping ribs over hips, butt untucked, slight lean forward, stacks the diaphragm over the pelvis, which helps it to communicate properly with the core and pelvic floor. These guys manage the inter-abdominal pressure, and having things lined up helps to ensure that all team members can show up and do their jobs.

Rib boobies are what I call a perma-jutted ribcage. If you notice a divot under your ribs, maybe your bra band size never went down after baby, maybe your mid back always hurts… maybe your ribs are thrust forward! Try to get them down in line with your hips, and try to breathe into your belly, back and sides, not your shoulders and chest. 

Is your butt a lot flatter after baby? Do you find that you’re sinking forward into your hips? Do you tend to squeeze your butt together when you’re standing or carrying, or maybe to try to ramp up effort when you’re doing something physically heavy?

You may be a butt-gripper! This is a common posture that many of us fall into. Not using your glutes effectively can increase lower back pain, leaking, as well as glute pain. Your glutes are movers, and by tucking and squeezing them they aren’t able to move in a full range of motion and do that moving. Your back and pelvic floor take the brunt, because someone has to move that stuff. 

Diaphragmatic breathing: this may feel a little backwards.

Do this with me: breathe in and REALX your belly, sides, back, pelvic floor. Try to keep those shoulders and chest still.

Now, breathe out and let your parts go back to resting tone. Does that feel weird? Does it feel backwards? That is coordinating your pelvic floor, core, and diaphragm.

It all moves out with the breath, and back with the breath. That is the first part of relaxing your pelvic floor, by breathing into it. This is also why it’s important not to suck in your belly: your ribs pop up, which makes it harder for your diaphragm to do its thing, and you can’t expect your pelvic floor to relax if your belly isn’t relaxed.  

You can also add in some external stretches (glute or inner thighs) or your pelvic floor physio may do some internal releases. 

Once you know how to relax your pelvic floor, you’re reasonably sure your butt isn’t always clenched, those rib boobies are back in line, you’ve trained your brain to do this backwards thing called diagrammatic breathing, you will hopefully start to feel less symptoms! 

Don’t stop there; learn how to incorporate kegels in everyday activities and any workouts you’re doing. Build total body strength and balance, as the stronger you are, the easier tasks will be, which means less bearing down to get that stability.  

Match the effort with the exertion.

If you’re doing everyday activities or walking/running, and you’re not sucking in your belly, and you are doing D breathing, your pelvic floor will do this lovely, natural rise and fall by itself.

Picking something reasonably heavy? Might want to add a medium sized kegel. Holding up a kitchen cupboard while your husband finds the right drill bit (true story) you might want a big kegel. 

Honour your beautiful body.

Some people have a tighter pelvic floor, which may need more relaxation. Some people may have a weaker pelvic floor, and need more activation.

It’s always a good idea to get accessed, and remember to monitor your symptoms! If you’ve been doing more kegels/core work and you’re noticing an increase in symptoms, make sure you’re balancing that with rest and relaxation. 

Common isn’t normal.

Let’s say that all your friends leak a little. Let’s say that you see lots of depends commercials on T.V. And we’ve all heard the jokes about crossing our legs when we sneeze so we don’t pee ourselves.

It may be common, but it isn’t normal, and there’s so much you can do about it!

Want more info? 

www.stephouwman.com

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