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Have you ever finished an intense HIIT workout, complete with tons of squat jumps and jumping jacks, and then...felt a little pee come out? That can be super embarrassing, which is why many women don't really talk about their incontinence. But if you're finding yourself dripping a little unwanted pee (maybe even poop!) every now and then after exercise, then you could have a weakened pelvic floor, aka the area of muscles that surrounds your pelvic bone.
According to Dr. Jodie Horton, MD, FACOG and Chief Wellness Advisor for Love Wellness, approximately one-third of all women will experience a problem with their pelvic floor muscles during their lifetime.
"Many women don't think about their pelvic floor muscles until they fail us," she says. "As the pelvic floor muscles become weak, the bladder, uterus, and bowel can prolapse into the vagina or, in extreme cases, outside the vagina. This means that you leak urine, or it may make it more difficult to empty your bladder and pass stool." It can also mean women may have decreased sexual sensation and painful intercourse.
So if this sounds like something you (or someone you know) are going through, don't fret. Experts explain below exactly what your pelvic floor is, how to strengthen your pelvic floor, and the different pelvic floor exercises you can try.
What is the pelvic floor?
"The pelvic floor is made up of the pubococcygeus, puborectalis, and iliococcygeus. These muscles are grouped together and form a hammock that begins at the public bone, attaches to the sitting bones (ischial tuberosity) on either side, and ends at the tail bone," says Dr. Patricia Wallace, a gynecologist and urologist with Providence Mission Hospital in Southern California. "The pelvic floor muscles support the bladder, bowel and uterus. They also play an important role in continence and sexual function. It's also part of the core and stabilizes the upper and lower body."
Often when we hear "pelvic floor," we tend to think Kegels. You know, those exercises when you pretend to pee but instead hold your muscles for a few seconds? Kegels are often used to help strengthen the pelvic floor, which covers everything from controlling how you pee to childbirth to orgasms. Yes, orgasms. These teeny tiny muscles are easy to forget but are actually so important when it comes to how our body functions.
What causes a weak pelvic floor?
A range of factors can contribute to your pelvic floor becoming weakened, says Dr. Wallace, including obesity, menopause, pregnancy, and childbirth, especially if you vaginally delivered a very large baby. Luckily, there is good news. In almost all cases, it is possible to gain control over the pelvic floor muscles through pelvic muscle training.
Why do you need to strengthen your pelvic floor muscles?
According to Dr. Wallace, it's important to strengthen your pelvic floor muscles to improve your bladder and bowel control. "Plus, it can improve your experience during sex while also decreasing the chances of accidentally leaking from your bladder or bowel," she explains. "A strong pelvic core also helps to reduce back pain. And, it can also improve posture."
How to strengthen the pelvic floor:
Both Dr. Horton and Wallace recommend the aforementioned Kegels technique, which requires tightening your pelvic floor muscles (just think where you pee). A common practice is holding tight and counting three to five seconds before releasing the muscles for another three to five seconds. Then you want to repeat this about ten times.
"Kegels exercises teach you how to contract and relax the pelvic muscles," says Dr. Horton. "The pelvic workout can reduce the frequency and severity of pelvic organ prolapse, incontinence, and improve sexual function. Another benefit of Kegel exercises is that it is free, no equipment is needed, and is effective. Some women will even see improvement in one to six months."
Dr. Horton suggests working with physical therapists who specialize in pelvic floor disorders who would be able to work with you one-on-one to identify and strengthen the pelvic floor muscles through pelvic floor therapy. However, Pilates is also known to help strengthen the pelvic floor muscles.
Greta Wyeth, a nationally certified and STOTT certified Pilates instructor, says many of her clients come to her because they are experiencing pain, destabilization, or dysfunction in their lower back, pelvis, and pelvic floor.
"By strengthening the pelvic floor, we create tonic control for the core and stabilize the pelvis and spine," she tells HelloGiggles. "The pelvic floor is an essential stabilizer and one of its roles within the body is to support movement and stability of the core. The pelvic floor does this job in concert with other muscles like the adductors (or inner thighs) and it acts like a 'skeleton' in supporting movement. So when we move our bodies, we need a strong core that can stabilize our spine and pelvis."
Whether you are carrying a heavy backpack on a hike or you are bending over to unload the dishwasher, you need a supportive core and pelvic floor for good alignment and balance, and having a strong pelvic floor can help with that (plus your pee leaks)!
Pelvic floor exercises:
When it comes to the most effective exercises for the pelvic floor, Wyeth suggests doing pelvic tilts and the "pregnant cat."
"The engagement of the muscles within the pelvis is best accomplished using the co-contractors of the abdomen and inner thighs," she says. "The two exercises described below utilize the fact that your body habitually uses these co-contractors to support the engagement of the pelvic floor."
Lie on your back with your knees bent and your feet grounded on the floor. Make sure your back and shoulders have no tension and bring your arms down to your sides. Inhale to allow your pelvis to become neutral, while a small, natural curve in the lumbar spine lifts it away from the floor. Exhale using your oblique muscles to shorten the distance between the bottom of your ribs and the hip bones. Inhale to release.
Start on all fours, your knees under your hips and your palms under your shoulders. Make sure that your hips, spine, neck, and head are in neutral alignment (if possible, do this one in front of a mirror to check). Breathe in and as you exhale, draw your belly button to your spine but do not change the angle or position of your spine. Inhale to release, allowing your abdomen to expand and get big. Exhale to pull in on the abdominal wall from the pubic symphysis to the ribs and wrap around the entire midsection but not changing the angle of the spine.
Pelvic floor exercises to avoid:
Refrain from doing exercises that put pressure on the pelvic floor, says Wyeth, especially if you need to rehabilitate your pelvic floor muscles. She advises against exercises like crunches or sit-ups, especially if not done correctly. "If we simply use the superficial muscles of the core and scrunch up the abdominal cavity without bracing the core, the increased pressure can stress the pelvic floor similar to bearing down," she tells HelloGiggles. "This is lengthening and weakening for the pelvic floor." She also advises against standing and lifting a heavy weight, which "asks your core to contract (increasing inter-abdominal pressure) and asks your pelvic floor to lift against gravity."
When to see a doctor for pelvic floor pain:
Leaking a little bit of pee doesn't mean you should rush to see your family physician, however, Dr. Wallace says it's important for women to schedule an appointment with their doctor if they notice changes in bathroom use or have any other painful pelvic symptoms. "Older women are more susceptible to pelvic floor dysfunction, so getting an official diagnosis from a doctor, along with a treatment plan, are key to healing and feeling better."