So excited I peed a little: a post on the pelvic floor

When the Pittsburgh Pirates finally broke through their 21 year losing streak and made the playoffs, I used this expression. 

"I'm so excited I peed a little."

When I deadlifted a personal best 275lbs last December, I was only half-kidding....

 
 

In 2013 there was a video made during the Crossfit Games asking women whether or not they pee themselves during workouts. In fact, at the beginning of the video, which you can watch here, many women confess that they pee during a double under, which is a form of jumping rope. 

 Dustienne Miller.

Dustienne Miller.

Pelvic floor dysfunction is far from funny, despite the jokes we make, usually to make ourselves feel better. It affects women of all ages, some of whom have had children and some who haven't. Jumping jacks have some women running to the bathroom and others who are just like...um...no. None of those for me thanks. I have to pee just watching you do those. 

In an effort to better understand what's really going on and what women can do about it, today's guest post comes from Dustienne Miller, a board certified women's health clinical specialist and yoga teacher based in Boston. Her physical therapy practice, Flourish Physical Therapy, emphasizes the importance and of pelvic and orthopedic wellness. 

KL: Thank you so much for shedding more light on this topic Dustienne. Let's start with the basics: what is pelvic floor dysfunction?

Dustienne: Hi Kim! This is a great question and thank you for bringing attention to this topic. A lot of women I work with believe that leaking during workouts is normal, especially after having a baby. While this is a common experience, it is not normal. It is a sign that the core is compromised.

Our bodies are wildly complex with hormones, menstrual periods, pregnancies, and deliveries. Tack on to that a prior hip or back injury and the body has to work even harder to stabilize the pelvis.

No woman should feel ashamed for leaking during workouts. If she is comfortable wearing a pantyliner, that’s fine, but there is another option: to rehabilitate and feel more in control.

KL: What causes it?

Dustienne: We look at the core as a canister where all walls must activate for optimal stability. The human “canister” is made up of the:

  • abdominal wall
  • diaphragm (even up to the vocal cords)

  • multifidi (deep segmental back stabilizers)

  • pelvic floor 

Leakage occurs when the physical demand of the exercise or activity is more than the system can handle. Some common symptoms of compromised stability are:

  • If you lose support in the abdominal wall, you might have a diastasis recti.

  • If you lose support in the back, a disc herniation may occur.

  • If you lose support in the pelvic floor, you might experience urinary leakage or pelvic organ prolapse. 
     

A simple way to practice supporting the pelvic organs is lifting the pelvic floor muscles up and in while sneezing, coughing, and lifting. This movement is referred to as a kegal exercise. Pelvic floor muscle contractions are enhanced when coordinating with the breath as explained in this video about pelvic floor movement with the breathWhen performing a squat, inhale on the descent. As you push through your feet, legs, and glutes to come back upright, exhale and pull your lower abdomen and pelvic floor muscles in towards the spine. This same principle can be applied to lifting grocery bags and children.

Kim: Are there specific exercises you can do to help prevent the leakage? We tend to use PRI drills at Spurling, such as the one below. We try not to do them with the full foam roller like I did in this video though, because that just looks awkward: 

 
This is a very brief explanation of a version of the 90/90 hip lift; concentrate on full inhales and full exhales doing five breaths.
 

Dustienne: Doing breath work in different positions, like the 90/90 Hip Lifts, are great. Once you understand the concept of coordinating your breath using your pelvic floor, you can integrate it into your workouts and you'll strengthen your pelvic floor as you strengthen your other muscles. 

Any exercise that strengthens the hip external rotators also strengthens your pelvic floor via the obturator internus muscle. The clamshell exercise is one example. 

 
  Lay on your right side with your knees bent. Engage your lower abdomen. Keep your trunk and pelvis still as you lift your left knee up towards the ceiling. Repeat 30 times and switch sides. For more load, loop a resistance band around the thighs.

Lay on your right side with your knees bent. Engage your lower abdomen. Keep your trunk and pelvis still as you lift your left knee up towards the ceiling. Repeat 30 times and switch sides. For more load, loop a resistance band around the thighs.

 
 
 

Dustienne: Your core is key; fellow physical therapist Julie Wiebe has an informative post about strengthening your core. It's written for runners, but you don't need to be a runner to see it's benefits. 

(Note from KL: These posts I did on core exercises here and here might also come in handy.)

Lastly, yoga has proven to significantly reduce urinary incontinence. One study showed over a 50% reduction in leakage. Anyone looking for a yoga based pelvic floor strengthening program can check out my DVD on optimizing bladder control and strengthening your pelvic floor.  

KL: Is there anything in particular women can do during exercises such as jumping jacks or jump rope to help prevent this?

I look at core activation with lower load tasks to predict where someone is losing stability. 

For example, if someone demonstrates poor hip stability in one legged stance, they will have less stability as the load increases with jumping. 

Rather than trying to fix the problem during a high level activity, look at breaking the task down. Retrain motor programs so that the body automatically fires the deepest muscles of the core. You can start with single leg weight shifts and test your balance. If you demonstrate poor hip stability with your trunk leaning off to one side, there could be even less control as you increase the demand of jumping and running. 

KL: Where can women go to find more information?

Physical therapists with special training in pelvic health can offer individualized evaluation and care. We evaluate your spine, pelvic girdle, hips, pelvic floor…the whole system to make sure you are firing muscles optimally.

       You can find someone in your location here:

 

About our guest: Dustienne Miller is a board certified women’s health clinical specialist and yoga teacher based in Boston. Her physical therapy practice, Flourish Physical Therapy, emphasizes the importance of pelvic and orthopedic wellness. She is passionate about using yoga as a holistic treatment modality. Check out her blog at www.yourpaceyoga.com.