*Nothing in this post should be construed as medical advice or used in place of seeing your medical provider. Every person has a different story and reason for his/her symptoms. This post is only meant to bring awareness to a situation, not diagnose. Do not perform any exercise or lifestyle change without consulting with your doctor first.
Have you heard about the pelvic floor? If you've birthed a child then you are probably well familiar with your pelvic floor and how it functions (or doesn't!). It's the group of muscles at the bottom of your torso that pretty much hold everything together. Moms are not the only ones out there with a weak pelvic floor! It is estimated that 24-50% of the population has a dysfunctional pelvic floor (1) and yes--men can have it too! How do you tell if your pelvic floor is weak? Read on...
First, Let's talk about the anatomy of the pelvic floor. It's basically the structure that holds our internal organs up. It is a group of muscles that makes up the bottom part of our abdominal core, and helps to hold our reproductive organs in their proper place. It's very, very essential in stabilizing our spine for proper force transmission during movement.
The muscles of the pelvic floor lay in a criss-crossed pattern. These muscles do not work in the same way that your arm or leg muscles work. Deep spinal or deep abdominal muscles (like the pelvic floor) do not work to do movement. They work to stabilize. A very simple way to explain this is they need endurance to hold vs strength to lift. Once we lose that endurance (or the brain turns the muscle off) We use our larger muscles (think thighs and back) to do every single movement in the body. Whew! No wonder 80% of the population has back pain! (2)
So what happens if your pelvic floor is weak or not activating?
1. You will not be able to stabilize your lumbar spine or activate your core muscles properly.
That means more stress will go into your low back and can lead to pain, disc degeneration and arthritis over time, and not just to the back. Feet hips and knees also take on more stress when the pelvic floor is turned off.
2. It will decrease your physical performance.
Your maximum strength and power will have a lower limit than if you stabilized your spine properly, which can greatly effect athletes of all kinds.
3. You will support your bladder, kidneys and reproductive organs differently, and have slightly less control over urination. Anyone who leaks a little when laughing, coughing or jumping understands this (and can probably fix the problem!).
4. It will make you look like you have a pudgy lower belly.
Your pelvis will naturally fall forward, leading to a look that your lower abdomen is larger than it actually is.
Please note that when I say the pelvic floor is "weak" I am including the inability to activate the muscle. There is a distinct difference between a "weak" muscle and a non-activating muscle. A weak muscle means that the fibers of the muscle are not able to overlap as far as they could (contraction), and cannot consistently contract over and over for a long period of time (low strength and endurance). A muscle that is not activating correctly means the brain is not coordinating the muscle correctly. The fibers of the muscle are perfectly normal for strength and (probably) endurance, but the brain isn't turning the muscle on at the right time. This is called altered neurofeedback, and there are many reasons why this can happen. The general public tends to just relate to any disturbed function as "weak", so that is why I am using it this way for this post.
How can you tell if your pelvic floor is weak? You can talk with your doctor, particularly an Ob-Gyn. Many health and fitness professionals like a physical therapist, sports chiropractor or specialized personal trainer can also do movement assessments to see if you have a weak pelvic floor (They won't be going in there to check it though like your MD or specialized PT might do). Luckily for you, there are 3 pretty simple ways to tell if your pelvic floor is not working correctly:
1. Can You Stop Urinating Mid-Stream?
This is pretty straight forward. Next time you pee, try to stop mid-stream. If you can't, then you most likely have a weaker pelvic floor.* In order to stop peeing midstream, you have to squeeze your pelvic floor muscles. This is called a Kegel contraction. Kegels are not just for women. Men should be doing them too! If you can't stop midstream, then one possibility for that is the muscles are not strong enough or do not have endurance to hold the contraction.
2. Can You Perform a Pelvic Tilt?
This one is a little harder. A pelvic tilt involves rocking your pelvis up toward your head while keeping the rest of your body relaxed. In order to do a pelvic tilt correctly you need to close the "clyinder" that makes up the abdominal core. What's the bottom of the cylinder?--The Pelvic Floor! Sooo....if the pelvic floor is weak the cylinder won't close so the pelvis will not tilt properly.
Here's how to do a pelvic tilt at home:
Step 1. Lay on your back with your knees bent so feet are flat on floor. Your arms can rest by your side or on your belly.
Step 2. Keeping your upper body relaxed, slowly rock the pelvis toward the floor using your lower abdominal muscles and pelvic floor. (Hint, hold a kegel while picturing drawing the muscles toward your head.) You should not feel this exercise in your back, and you should not feel your larger back muscles contracting.
How'd you do? If you are unable to tilt the pelvis (i.e. flatten the back) then there's a good chance that you could use some work on your pelvic floor. Luckily for you this is also one of the corrective exercises for the problem! So keep working at them (but not too many sets/reps!).
3. Can You Get Up From the Floor Without Using Your Hands?
This one seems really simple, but might surprise you! There are two ways to test this: 1. Sit down on the floor and try to get up without using your hands. or 2. Try to get out of a soft chair without using your hands. If you are older, or have any injury/condition that affects the lower legs, then make sure you try #2 instead of #1.
This one also relates to locking the "clyinder" of the core together. We have to have the core muscles engaged and the spine in proper position to be able to get momentum to rise. If you can't engage the pelvic floor, it will be harder to rise from the floor without using your hands and you will typically feel it in your back.
This is one I never really thought about until the first time I sat down with my son after he was born. I tried to get up to help someone and I couldn't do it! I was still very new at holding a newborn and there was no way I was letting go to use my hand to get up. It was very frustrating. It took me a long time before I could get up off the floor without pushing with my hands.
Fixing The Problem.
How did you do? If you had no problem completing those 3 tasks, then most likely your pelvic floor is functioning well. If you had trouble with those exercises, or if you are concerned about your pelvic floor function in general, I recommend talking with your medical doctor to see if there is a problem and get referred for a proper rehabilitation program.
While you are doing that, the best way to start the process at home is to begin with kegels. To do a kegel, make sure your pelvis is in a neutral position. This means it's not too far forward, or backwards. Then gently squeeze the pelvic floor muscles together like you would to stop urinating. Hold for 3-5 seconds then gently release. Try doing this 8-10 times throughout the day. Eventually it will be second nature to engage the pelvic floor.
Stay tuned to next week when I'll discuss 3 exercises to rehab the pelvic floor.
Resources:
1. NIH. Roughly One Quarter of US Women Affected by Pelvic Floor Disorders. https://www.nih.gov/news-events/news-releases/roughly-one-quarter-us-women-affected-pelvic-floor-disorders
2. Bussey et al. (2019) Is Pelvic Floor Dysfunction Associated with Transient Development of Low Back Pain During Prolonged Standing? A Protocol. Clinical Medical Insights-Women's Health. Vol 12:1-7