As a certified Pilates instructor with years of experience in physical therapy clinics and more than a decade of working with women on their core strength postpartum via my breathwork app Lindywell, it’s become abundantly clear to me that the pelvic floor is a crucial, yet often overlooked part of our body. It plays a critical role in our well being—particularly for women.
In addition to my professional experience, I am also a mom of four. Pregnancy and childbirth have a significant impact on the pelvic floor and yet the resources to help women in the postpartum season are slim to none. I’ve experienced two full-term pregnancies with singletons, one pregnancy loss and one full-term pregnancy with twins. Needless to say, my core and pelvic floor have been through a lot. Through it all, I’ve been tremendously grateful for my knowledge and understanding of the pelvic floor— how to care for it and how to repair it.
Thirty-two percent of women will experience pelvic floor issues at some point in their life, and I believe that number is likely higher as a result of working with so many women who are experiencing symptoms of pelvic floor dysfunction but aren’t even aware of it. I want every woman to have access to this information to improve their body’s function and feel their best.
What is the pelvic floor?
The pelvic floor is a group of muscles and connective tissue that form a hammock-like structure in the base of the pelvis. These muscles and connective tissues support our vital organs such as the bladder, uterus and rectum. The pelvic floor is an integral part of the “core” so if you want a strong core, a healthy pelvic floor is a crucial aspect to consider.
Many core workouts that you find in gyms and fitness centers focus primarily on the “abs” when focusing on core work. While the abdominal muscles are important too, what matters most is how your entire core functions together. Pilates is best known for building a strong, stable core and one of the reasons it delivers so well, is that it considers the pelvic floor as well.
Many Pilates exercises support healthy pelvic floor function by ensuring that the pelvic floor not only has the ability to contract and strengthen, but also has the ability to release and lengthen. Pilates also helps to improve posture and posture has a direct impact on the way our pelvic floor functions throughout the day, which is especially true during pregnancy as our posture shifts to accommodate the growing baby and the pelvic floor is directly impacted by the additional weight to support throughout the day.
Surprisingly, the way we breathe also has an impact on our pelvic floor. Pilates, while focusing on posture and core strength, also focuses on the way we breathe. By focusing on all three of these areas, Pilates is one of the best ways to care for your pelvic floor pre-pregnancy, during pregnancy, and in the postpartum period.
If you’re curious about how well your pelvic floor is functioning, it can be helpful to know some of the signs and symptoms of pelvic floor dysfunction.
Pelvic floor issues can manifest as:
- Incontinence: bladder leakage, painful urination, frequent urges, constipation, bowel strain, rectal pressure or discomfort.
- Sexual issues: painful intercourse, decrease in arousal or libido, infrequent orgasm.
- Chronic pain: back or pelvic muscle spasms, soreness or tightness in the lower back, hips, genitals, rectum, or pubic bone
While pelvic floor dysfunction is common, you don’t need to accept it as “normal.” Instead, you can strengthen and heal this area of your body with deep core and pelvic floor exercises. If you’re experiencing visible and/or chronic symptoms, seeking the support of a medical professional might be advised and check out NIH’s guide to pelvic floor disorders to learn more.
How is the pelvic floor impacted during pregnancy and birth?
Pregnancy and birth have a direct impact on the pelvic floor. Throughout pregnancy, the weight and pressure on the pelvic floor increases. In addition to supporting the bladder, uterus and rectum, it supports the growing baby, placenta and fluid. Therefore, a strong pelvic floor is essential to avoid pain and discomfort.
Additionally, during pregnancy the hormone relaxin is released and designed to loosen our connective tissues. While this hormonal softening of connective tissues is essential for a successful pregnancy and childbirth, it can also lead to increased mobility and potential joint instability, particularly in the pelvic region. This may cause discomfort or contribute to changes in posture and gait during pregnancy.
In addition to the extra strain on the pelvic floor from the growing baby, vaginal delivery can provide additional strain as well. The pelvic floor muscles are critical to the birthing process and helping to move the baby down the birth canal.
Healthy, strong, pelvic floor muscles (and the ability to connect the mind to these muscles) can help the birthing process in significant ways. The muscles may stretch or tear, impacting their strength and function. Understanding these changes is crucial in taking proactive steps to nurture and rehabilitate this vital area postpartum.
During a C-section, the pelvic floor muscles are indirectly affected due to the surgical procedure. While the pelvic floor itself is not directly involved in the incision or surgical process, there are several ways in which the pelvic floor can be affected such as indirect stretching of the muscles. The surgical incision made during a c-section is typically a horizontal cut made just above the pubic bone.
While this incision doesn’t directly involve the pelvic floor muscles, it is in close proximity to them. The procedure may indirectly lead to some stretching or temporary displacement of the pelvic floor muscles. There may also be an impact on the nerves in the lower abdominal area and as result, affect the function of the pelvic floor. It’s important to note that every individual’s experience with a c-section is unique, and the effects on the pelvic floor can vary.
How to strengthen and heal your pelvic floor
Strengthening and healing your pelvic floor can help you to feel your best and continue function without pain or discomfort. Here are 5 ways to strengthen and health your pelvic floor during pregnancy and postpartum:
1. Be mindful of your posture
The more your slouch and put pressure on your abdominal wall, the more pressure the pelvic floor endures. Be mindful of your posture throughout pregnancy and the postpartum period to support healthy alignment and healthy pelvic floor function.
2. Add Pilates to your regular routine
Pilates will help to strengthen your pelvic floor while also helping the overall function (remember, the ability to release and lengthen the pelvic floor muscles is important too). Pilates also helps to improve posture and breathing patterns, which both have a direct impact on your pelvic floor.
3. Do squats (no added weight needed!)
Squats are a great way to support, strengthen and heal your pelvic floor. As you squat, imagine your sit bones widening and your pelvic floor lengthening. As you return to standing, imagine the basket-weave muscles contracting and lifting out of the base of your pelvis.
4. Give your body adequate time to recover after birth
All too often women jump back into exercise without taking time to adequately heal and rebuild core strength. The first step in returning to exercise should be gentle core and pelvic floor exercises that do not put additional strain on the pelvic floor or the linea alba (connective tissue that runs along the front of the belly). Gentle postpartum exercises that can be found in the Lindywell app or on the Lindywell YouTube channel are a great place to start.
5. Avoid force or rushing when using the bathroom
After pregnancy and birth, the pelvic floor is recovering from extra strain and pressure. When possible avoid additional strain when using the bathroom to prevent intensifying the fatigue. Take your time, drink plenty of water and eat plenty of fiber to promote healthy bowel movements. If you have additional concerns in this area be sure to reach out to your medical provider.
5 Exercises that can be used to strengthen the pelvic floor
Improving the health of your pelvic floor muscles doesn’t have to be daunting or overwhelming. Simple exercises can make a big impact. Here are five Pilates exercises to incorporate into your regular routine to ensure that your pelvic floor stays strong, healthy and functional during pregnancy, postpartum and beyond. (Psst: All exercises can be viewed in this video.)
Pelvic Floor Lift
In a seated position, inhale to prepare. As you exhale, contract and lift the pelvic floor muscles out of the base of the pelvis. As you do this, think about pulling a tissue out of its box—that is the same motion you want to imitate with your pelvic floor. As you inhale, relax and release. Repeat 5-10x.
Pelvic Curl
Lie on your back with your knees bent and your feet flat on the floor. (Note: If you are currently pregnant, be sure to listen to your body and adjust to do what feels safe to you). Inhale to prepare. As you exhale, peel your spine up off the mat rolling up into a bridge position. Keep both feet firmly planted on the mat with your arms long down by your side. Inhale at the top of your bridge and exhale as you slowly roll your spine back down to starting position. Focus on engaging your pelvic floor as you roll up and roll down, releasing and relaxing between repetitions. Repeat 5-10x.
Bent Knee Fall Out
Lie on your back with your knees bent in tabletop position (a 90 degree angle). Note: if you are currently pregnant, consider keeping both feet on the mat and propping yourself up on your back with a pillow to avoid laying flat on your back). Engage your core and hinge one bent leg out to the side like you’re opening a book. Your core and hips stay stable, like the spine of a book, as your leg (the page) opens. The goal of this move is to create stability in the pelvic floor. Repeat for 5-10 reps on each side.
Seated Spinal Twist
Sit on your mat with your legs straight out in front of you (slightly bent if needed to maintain a tall spine). Interlace your hands behind your head and inhale as you rotate your spine and shoulders to the right. Exhale as you return to center and repeat on the other side. As you gently rotate in the spine, focus on keeping the pelvic floor muscles as stable and stationary as possible. This movement should be coming from your core, using those muscles to rotate, hold, and return to center, rather than using your arms or hips.
Standing Chair Squat
Stand on your mat with your feet hip distance apart. Squat back imagining that you are about to sit back in a chair, and then return to standing position. As you do this movement, remember that your knees will bend, but they should not protrude in front of you. Send your hips and tailbone back to the imaginary chair behind you. As you squat, allow the sit bones to widen and the pelvic floor to lengthen and release. As you return to standing, activate the pelvic floor and imagine lifting the pelvic floor out of the base of the pelvis.
Caring for your pelvic floor is an integral part of overall well-being, especially for women who have been through pregnancy and childbirth. By understanding its importance, the changes it undergoes, and implementing targeted exercises, you can nurture and strengthen this vital muscle group. Remember, consistency and patience are key. Start today, and reap the long-term benefits of a strong and healthy pelvic floor.
