To squeeze or not to squeeze that is the question… What should I be doing before pregnancy to prepare, and after pregnancy, to help recovery?
The standard answer or first response that most people assume is to squeeze, AKA the Kegel. The Kegel was an exercise named after a Dr Kegel (an American gynaecologist) and involves actively squeezing and tightening the muscles of the pelvic floor.
The issue with such an exercise is that it doesn’t change the firing pattern of the muscles – they only tighten muscle fibres that are free to engage rather than altering HOW they engage. The result of this is that many people develop more imbalance in the pelvic floor where the parts which can ‘fire’ work harder and harder but the parts which can’t engage still don’t.
Tami Lynn Kent in her fantastic book ‘Wild Feminine’ says “Most women do not truly have weak pelvic muscles, but rather muscles that are not able to fully engage because of core tension, past traumas, and other pelvic imbalances.”
What can go wrong with the pelvic floor?
I see a lot of trauma in the pelvic floor as a root cause of imbalance. This can be both physical in nature (from, for instance, postpartum trauma or accidents) and emotional.
Postpartum trauma can come from physical things such as – episiotomy, severe tearing, excessively long labours, excessive pushing during labour, poor stitching, repeat infections/poor healing of the vaginal wall. But it can also be related to the way a woman was handled in labour, whether she felt overwhelmed or pressured into making certain decisions or felt a lack of ownership over her own body.
There is an integral relationship between the balance in the pelvic bowl and hips and the pelvic floor – imbalance in one can leadto imbalance in the other and vice versa. The pelvic floor has attachments into the deep fascia within the hip, coxxyx, sacrum and pubic bones, so dysfunction in the pelvic floor can also come from chronic dysfunction in the pelvic bowl (sacrum, coxxyx, ilia and hips).
Dysfunction of the pelvic floor can lead to urinary stress incontinence, prolapse, fecal urgency or incontinence in varying degrees.
How to test if your pelvic floor is in balance?
The best way to check it is to test a woman doing a Kegel – with a finger in the vagina squeeze the pelvic floor so that the muscles come together – they should feel like they come together equally all around and lift. “Muscle fibers holding tension and pain (and diminished energy) will have much less movement, or squeezing action, during a Kegel” (Wild Feminine p.35).
Next, feel into the walls all around to see if there are any tender spots (or trigger points) in the muscle. Trigger points in a muscle indicate dysfunction of that region. So, we know now that to improve the function of these muscles there is more to it than just squeezing… But, how best to treat this?
Here’s a summary of my top tips for getting your pelvic floor back to optimal health:?
1 A muscle needs to be able to fully relax to function optimally. Learn to relax your pelvic floor. Meditation techniques work well for this. Focus your attention on your pelvic area – lay your hands over your pelvis and feel your breath move into the pelvis. Relax, feeling with each in-breath your pelvic floor completely relaxing and with your out-breath feel your pelvic floor gently contracting. Continue this until you really start to feel a connection between your breath and your pelvic floor. The root chakra is located in this region and it’s good to visualise a connection between your root and the earth, releasing tension down to the earth and receiving nourishment back from it. Try to sense any emotions held in this area or even if you feel a disconnection with this area. Just starting to sense your pelvic floor and making a connection starts the process to help things flow and come into balance
2 The pelvic floor muscles work best when working in harmony with each other. Test your pelvic floor to see if the muscles are working together. Feel how your pelvic floor contracts and check if it contracts equally in all 4 quadrants (top/bottom/left/right). Test to see if there are any tender spots in the muscles or areas where there is.
3 See a pelvic floor specialist to help rebalance this area. I can say both personally and professionally how having work done on this area leads to real improvements in function.
Having had an episiotomy 11 years ago, my pelvic floor was holding tension. I have had Osteopathic women’s health work and also Holistic Pelvic Care™️work on my pelvic floor and not only has it improved my ability to contract my pelvic floor in a balanced way, I’ve also seen that niggles I used to get running disappear after having this work done.
I have trained both osteopathically and as a holistic pelvic care™️specialist and use these 2 together to get real changes. I regularly help women overcome and let go of the imprint of traumatic events and work to improve the balance and function of the pelvic floor muscles. I work with women with incontinence issues, prolapse, dyspareunia (pain during sex) and chronic pelvic problems – or simply help women to feel more connected.
If you find you have a hip or sacroiliac issue which only started after childbirth and is not resolving it may be related to imbalance deep within the pelvis and usually I get good results very quickly in such cases.
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Don’t treat the pelvic floor in isolation. Remember it is part of a whole body! How it functions is influenced by your whole body health. Think about getting your pelvic floor to work together with your core muscles and diaphragm. Think about creating a lift of your pelvic floor – a drawing in of your lower abdominal muscles (transverse abdomini) as you breath out and think about letting your pelvic floor fully relax as you breath in.
your pelvic floor – a drawing in of your lower abdominal muscles (transverse abdomini) as you breath out and think about letting your pelvic floor fully relax as you breath in.
Think about good alignment in your posture so that you are not creating excess downward forces onto your pelvic floor, making it work harder than it has to.
Your levels of stress will also have an effect on its function. If you have symptoms of pelvic floor dysfunction that become worse during periods of high stress, try to work on reducing your stress levels.
5 Avoid excess downward pressure. Avoid any straining when opening your bowels as this can produce excess force onto the pelvic organs, pelvic floor and the surrounding myofascia.
Don’t do any high impact activities postpartum whilst breastfeeding as you are at greater risk of overstretching support ligaments in this region – this leaves you at a higher risk of developing a prolapse.
6 Try Hypopressive exercise. This is a really good system of breathing and postural exercises which help train the unconscious control of the pelvic floor and improves posture. I both practice and teach this system, which involves using a negative breath to trigger a reflex which contracts and lifts the pelvic floor and other core muscles. It works really well to improve your posture and is a fantastic postpartum exercise for activating your core and pelvic floor without having to consciously control and contract your pelvic floor.
Training is with a qualified hypopressive trainer – you can find a register of trainers and more information on www.ukhypopressives.com
If you have any further questions, then feel free to drop me an email. Or if you are interested in booking a consultation then I’d love to see you. Remember it’s much better to be preventative, so if you have had any sort of birth trauma it’s good to be checked out.
x Rebecca