10 Things You NEED To Know About Your Pelvic Floor | The Best Pelvic Floor Exercises for Women

Hi. Welcome to our Q and A series. This month is all about pelvic floor health. You guys have submitted your top 10 cues about pelvic floor health, and I'm excited to bring in a pelvic floor expert. I'm partnering with Motion, And I have Dr. Jen here, who is a pelvic floor physical therapist, and actually the pelvic floor physical therapist that I saw after I had my second daughter, Bella. And Jen is going to share all of her pelvic floor knowledge with us today. So we are excited. We are going to jump right into your 10 cues. The first question is, who should see a pelvic floor physical therapist?

Awesome. So where I kind of like to start is just making sure that everybody has an understanding of what the pelvic floor is, because I feel like we read about it, our doctors talk about it, but they're not muscles that we can necessarily see. So your pelvic floor sits like a bowl at the bottom of your pelvis, and it helps to support your bladder, your uterus, and your rectum. So if you're noticing that you're having any symptoms for, like, revolving around those organs. So let's say you. You feel like you're running to the bathroom all the time. You can't quite make it to the bathroom, you're leaking with coughing, sneezing, laughing, maybe you're dealing with constipation, or you have pee with intercourse. Those are a lot of symptoms that I commonly see, and I feel that if you're having those symptoms, you should maybe reach out and ask for help.

That's awesome.

Great.

Okay, so how do I know if I have an issue?

Yeah. So any of those symptoms. I kind of think about red flags as well. So let's say you're leaking with coughing, sneezing, laughing, you're leaking on the way to the bathroom, you're having pelvic pain, you're noticing that intercourse is really painful. Those are kind of my. The things that I tend to look for the most. Another thing that I look for is any kind of issues with diastasis recti. So coding or doming with certain exercises. And you notice when you lift your baby, you're like, oh, man, something's happening there. It just feels weak. Awesome.

Great. All great indicators. Okay, what is pelvic floor physical therapy? And what does, like, an intro appointment look like?

Yeah. So pelvic floor physical therapy is the treatment of those pelvic floor muscles. And so what we usually do on your first session is we go through a pretty thorough Subjective history. So we'll talk about those three organs. So we'll ask you questions about your bladder and what going to the bathroom is like for you. If you're able to make it on time, we'll ask questions about your bowel function. If you're having any issues with constipation or diarrhea, bloating, abdominal pain, we'll ask about intercourse or even just general penetration. If you have issues with tampons or pelvic pain, we'll ask things like what do you do for work, what do you do for exercise, what are you eating, what are you drinking? Just so we can kind of really get an understanding of what your daily life is like. From there, I do a two part exam. Usually with the exam it's external and internal. With that being said, that internal exam is not absolutely be necessary for some people. It's something that they're just not quite ready for yet. So I always say if you have any issues or you're feeling uncomfortable, just let me know. I can sava anytime or defer the exam completely, but if I did do an internal and external exam, usually I just take a look at those muscles on the outside and assess the function of the muscles. And then I do a one finger internal vaginal exam where I'm wearing gloves, I use lubricant, I feel the muscles on the inside, I assess your strength and I look for and organ prolapse from there. Then I'll usually have you get dressed, we'll take a look at your muscles. If you're postpartum looking for diastasis recti, or if you've had a C section, might take a look at that C section scar. I might also have you go through some functional movements and take a look at your posture again just to kind of get that full picture. We'll come together, talk about what I'm finding and then make a game plan from there.

I feel like that's super helpful because I have no idea.

So I just shot.

All right.

Yeah, yeah. A lot of times, you know, people have had pelvic floor or they've had physical therapy for like their shoulder back or this is just a little different. So it's nice to know what you're walking into.

Get into it. Yes, but in the best way because it's all for the knowledge of figuring out next steps and making sure that you are healthy.

Exactly.

All right. How do I know if I have a tight or loose pelvic floor?

Yeah. So this is a really good question and a question that I get a lot. It's hard to tell by yourself. I always recommend if you have questions, just reaching out and asking, or coming in for an exam. That being said, if you have a tight pelvic floor, some symptoms that I commonly see are pain with intercourse or feeling like you can't completely empty your bowels or bladder, and you might have some pain with penetration or wearing tampons. If you have a loose or weak pelvic floor, you might have issues with incontinence, coughing, sneezing, laughing, or you might feel like something is stuck or falling out. That being said, there's a couple of misconceptions. I see people all the time who have a really tight pelvic floor but are also leaking. And so that's why it's nice to come in if you're having issues, so you can understand exactly what's going on and what exercises are most appropriate for you. Sometimes the answer isn't always cables.

So does tight equal strong and loose equal weak or no?

Not necessarily. When we have really tight muscles, sometimes they're just held in this clenched position all the time and they actually get really fatigued. So when they actually have to do their job and help you hold your bladder when you're jumping, for example, they're so tired that they can't quite hold on any longer, and that's why we'll experience some leaking. So, no, to keep it short. Tight doesn't necessarily equal strong.

Okay, good.

Good.

All right, moving on. Is it too late to recover my pelvic floor if I'm one or more years postpartum?

So definitely not. I treat adults of all ages, so I see women when they're 60s postpartum. I see women when they're 20 years postpartum. Doesn't matter. It's never too late to start doing some exercises.

Good. All right. Incontinence. You briefly touched on it, but how do we make it stop? And what are the best exercises? I feel like as a group fitness instructor, people are constantly telling me, I'm jumping jack slightly pee my pants.

Yep. So it kind of depends on why that incontinence is occurring. And it kind of touched on that in that last question. But if we're having a really tight pelvic floor, sometimes we need to actually learn how to relax those muscles first so that when you do need to contract or shorten those muscles, they're able to do so through their full range of motion. If your muscles are kind of weak or lengthened, then we really need to start working on different relevance and strength so that you feel supported during all of your daily activities. In addition, a lot of times, too, we have trouble kind of just managing pressure between our diaphragm, our core muscles, and our pelvic floor. Sometimes I feel like we really hold our breath and we're kind of pushing downwards through those muscles, and that kind of causes the bottom of that pressure system to fall out and we start leaking there as well. So, again, it just kind of depends on why that incontinence is occurring. So making sure that you're able to totally relax your pelvic floor and contract your pelvic floor is really, really helpful.

I would say that was my favorite part about seeing you is I learned when we were going through exercises that when I thought I was activating my pelvic floor, I was actually activating my glutes and nerve. Other muscles that were bigger were taken over. As someone who's like an all or nothing, I was like, yes. And you were like, well, no, because when you do pelvic floor exercises, actually, like 15%, 30% is okay to get that activation right.

When you're practicing your Kegels, initially, it doesn't have to be this 100% effort because we're just laying on our back. You know, when you're doing squats or when you're jumping and you're running, that requires a little bit more help from those surrounding muscles. But initially, I want you to be able to just to try to isolate those muscles as much as you can.

Yes, the isolation, that was a big.

Learning point for me, so that was great.

Okay, how can I. Speaking of it, how can I strengthen my pelvic floor before having big. So if I've never had babies and I'm pregnant, what exercises can I do?

Yeah, so what I would say is trying to incorporate your pelvic floor into your daily activities or your current exercise routine. So my rule of thumb is exhalation on exertion. So during the hard part of an exercise or an activity, let's say you're lifting up a heavy bag or you're doing a squat, making sure that you're exhaling during that hard part. So as you're coming up from your squat, that's important. Breathing out and you're activating your core and your pelvic floor. So again, just kind of having those, thinking about that and carrying it over to your daily activities is a great way to kind of start building up some strength. And then also you can work on your Kegels. Let's say you're laying in bed, trying to fall asleep at night, practicing inhaling and relaxing your pelvic floor. Exhaling and contracting. The cue that I like to use is like you're picking up a blueberry with your vagina so that you're pulling up all three layers of your pelvic floor when you're doing that cable.

Yes, Someone told me that, and I was like, oh, that's genius. Like a visual visual or like a Kleenex. Someone once told me, like a Kleenex and get all four corners to come in. If you're looking at a Kleenex, all four corners, like, come in. Yep, Yep. It's four corners. I like it. Okay, now, how can I strengthen my pelvic floor after having babies?

Yep. And so this is where I come in and say, I really recommend seeing your pelvic floor physical therapist after you have your baby. That way we can really check and see what's going on in terms of strength. If you have any perineal tearing, if you've had any issues with hemorrhoids or a C section scar, it just allows us to be really thorough and talk together about what you can work on. But if you don't have access to a pelvic floor physical therapist, I would say work on just relaxing those muscles first. Having a baby is really hard, regardless of having to work vagina or C section. So kind of taking some time to breathe and check in with those muscles, Visualizing them just kind of letting go and melting underneath you and then slowly incorporating the keels over time.

Yes. And I would add on. So when I came in for. Initially, I came in for Dr. Pelvic Floor, but hemorrhoids were like a whole separate issue. And so you gave me this one tip about hemorrhoids that was amazing. When going to the bathroom, the whole can talk through that.

Yeah. So when people are trying to have a bowel movement, they really, really push down through their pelvic floor muscles. And sometimes if you have hemorrhoids or prolapse, it just puts a lot of pressure on that area. And so what I like to teach people how to do is kind of lean forward, allow their bellies to relax, and actually push out through their hands and outwards through their sides. So that way they're still kind of able to put that pressure somewhere, but it's a little bit more equally distributed versus placing it straight down onto a pelvic floor. Yes.

If you've had severe hemorrhoids, it's very Helpful. Okay. These are all awesome.

Okay.

Number one, best exercise for postpartum recovery.

Yeah. So pelvic floor relaxation, I think, is number one. Really learning how to just relax your pelvic floor. We carry so much tension throughout the day in our neck, our jaw, and in our pelvic floor. So you're having the ability to kind of just check in and make sure you're not clenching those muscles and being able to relax so that when they do need to do their job, they're able to move through that full range of motion and generate a lot of strength and support for you. Not what I would have thought. Yeah, that's like, opposite of what I would have thought. Yeah. Yep. Yep.

Okay. Speaking of which, I just. One exercise that we did that I really liked, too, was the volume up and volume down, which helps with the relaxation on the way down. So it was like as you're working through a Kegel or a full range of motion, it's like working from that 30% to 50% to 75, and then going down that same slow reverse action.

Yes. Yep. That's a really helpful exercise, too. So I call it the volume exercise. So you kind of start with your Kegel. You're just contracting to 30%, then you're working it to 50 to 75, and then back down to 50 and 30. So you're really kind of working on the control of those muscles. Yes.

Going back down is hard.

Really hard.

Especially if you're postpartum, you're weak. You'd be like, I've gone up, and now just let it all go super high. Exercises to avoid if you have tr.

Yes. So diastasis recti, as you guys might know, is when the two walls or the tissue between your lung and alba kind of gets stretched as your baby grows. And so it kind of creates this gapping of those muscles or you notice coning or doming. So what I typically tell people is that if you lift your head and you kind of notice that you're seeing some tensing of those muscles, that coning or doming, it's probably an exercise that you're not quite ready for just yet. It doesn't mean that you can't ever do it ever again, but maybe you need to play around with your breathing mechanics or activating that transverse abdominis muscle, and then try to exercise again, see if it gets better. If it doesn't, then it might mean that you need to modify that exercise or choose something else until you. Until you develop a little bit more strength in those Muscles. Awesome.

And the best exercises to heal.

Doctor. Yeah. So I'll actually demonstrate this now if you want to hop down onto the mat on my back. Yes. So the most kind of fundamental exercise I like to teach is just how to find your transverse abdominis and activate it. So what I'll have you do. Perfect. I'm just going to have you find your hip bones on either side.

Perfect.

And then you're just going to move about 1, 1 inch in. And then can you just do like a little fake cough for me? So you kind of feel those muscles popping into your fingers. So in order to activate those muscles, we're going to pretend that there's a string attached to your two hip bones. And as you exhale, you're going to imagine that string pulling your hip bones together. So you're essentially using that transverse abdominis to kind of pull in this way. So while you inhale first, you're going to completely let your belly expand and relax. Exhale. You're pulling those two hip bones together and you should feel those muscles kind of tighten up underneath your fingers.

Yes, that's super helpful. I've used that in classes now that I teach because a lot of times you just say like, make sure your back is driving into the mat or tuck your back. But pulling your hip bones is such a better cue than your low back into the mat, right?

Yep. It's just great because that allows you to access these muscles with a neutral spine as well. And it's something that you can carry over into everything that you do. And then from here we can make it more fun and exciting once you really get that, that activation down, you can move your arms, you can move your legs, we can get you jumping, squatting, things of that nature. But this is kind of step number one.

And now something that I think is interesting because. Dr. We just think of the abdominal separation, but it also has to do with the underlying transverse abdominals and the tension you can create. Right, exactly.

Yet. So it's not always about like how, how big your gap is. I always say it's about how much tension you're able to generate across that honey and elbow so that your abdominals are working together and you feel supported. So while you might have a three finger diastasis, if that tension is nice and firm, I'm less concerned versus someone who's maybe one finger, but my, but my finger kind of sinks in as I'm pressing through that lineal.

But yes, I think that's really important because I don't Think a lot of people know that.

Yeah. Yeah. Everybody gets really, really focused about the gap, but really we just want those muscles working together as much as possible. Yeah.

Good. Okay, I think we have one final question for you, and it is, what is the number one thing you would tell women about their pelvic floor? So if you could say, like, I wish every woman knew this, what would it be?

Yeah, really good question. So what I. What I like to tell people is just don't be afraid. Afraid to ask for help. You can have an issue with your pelvic floor if you are pregnant, if you are postpartum, or even if you've never had a baby before. So if you're noticing that something is off, go ahead and reach out, ask for help. Even if it's just a quick email or just coming in for one evaluation, just learning more about yourself is truly helpful. And then.

Maybe this will drag it.

So why do.

Why is public floor health, like, not something like, we all take health class in high school.

Right.

Why is it something do you think that's like. I feel like it's a topic that I'm not. I'm still, I'm. I know my body pretty well. I teach group fitness. I didn't go to school for kinesiology, but I've taken, you know, all the personal training and all the group fitness certifications, all the women's health certifications. And I feel like it's still something I am still questioning and learning about. And as someone who's knowledgeable about my body, why is it just such an un. Undereducated topic?

Yeah, I think it's just been taboo for so long, and I think a misconception is that everybody feels like, oh, I've had a baby, so it's just normal that I'm leaking or, you know, maybe I just won't ever be able to run again. That definitely doesn't have to be the case. Anybody can come in, get an assessment and start some exercises. And a lot of times we're able to make progress and you're able to kind of reach those goals.

Is there anything else you would like to add?

I think that's it. Yeah, I think we covered a lot here. Thank you so much for this opportunity. Yeah, I appreciate it.

Thank you so much. And you guys, if you live local in the Minneapolis area, I highly suggest checking out motion, specifically Dr. Jen. She's been amazing. I saw her and obviously you've heard me talk. I learned a lot and it was really educational for me. And I only took what, like three, four appointments and I feel like I was like ready to go. So I highly suggest checking out Motion. We'll link them below here and we'll link Dr. Jen's profile as well and we'll provide more details typed out in the blog post associated with this video. So thanks so much Dr. Jen. I feel like we all got a little pelvic floor education, so hopefully you found this helpful and you can find more of our Q and a series@nourishmovelove.com.