Let’s talk about pelvic floors, ladies and gentlemen. As you know by now, it is one of my most favourite subjects to chat about.
What is a well-functioning pelvic floor? Well, it is one that successfully undertakes its super important functions:
supports our internal organs, preventing prolapse;
prevents incontinence, whilst also letting fluids and waste products out when needed, without pain;
interacts with other core muscles, providing core strength - basically, supports our pelvic and lower back to provide them with stability;
plays its role in procreation, pleasurable sex and childbirth without excess tension.
In its role to support our internal organs, our pelvic floor always needs to show an appropriate amount of “resting tension” - it never fully relaxes for that reason - and this is normal.
What is more interesting is whether our pelvic floor deviates from that normal resting tension, and if so, is it too "tight", or too "lax or weak"?
We’ve been conditioned to think that any degree of incontinence is a sign that the pelvic floor is too weak. Actually, it is not that simple.
I have written before about this: frequently, our pelvic floor is too tight, unable to relax and stretch under increased load. This is something that is needed, for example, when we sneeeze or cough. If our pelvic floor is unable to stretch to meet that huge pressure from the sneeze, we will leak. That’s just the mechanics of it. And Kegels will make the problem worse, as it will add to tension.
But we can’t spot treat the pelvic floor in isolation. It works in coordination with the rest of our body.
Any degree of pelvic floor problems is also a sign of a CORE problem.
Our core is like a cylinder - the diaphragm at the top, pelvic floor at the bottom, adbominal muscles at the front and back muscles, yes, you guessed it, at the back. Then breathing pressurises it 20,000 to 25,000 times per day. This cylinder deals with this pressure from breathing and passes resulting beneficial tension to our pelvis IF IT IS WORKING WELL.
Or leaks, as incontinence; or mis-handles pressure, which comes up as hernias - if it is not functioning well.
Pelvic floor leaks are NOT normal. Don’t let mass media advertising for incontinence pads tell you otherwise.
And anyone can have a core problem! We tend to think that a visual image of a well functioning core is a well-developed 6-pack muscle. So, someone very athletic.
However, let’s examine pelvic floor incontinence in athletes. Do you think their cores are perfect? They are pretty good... But, actually, they can also have urinary incontinence, and quite a lot! Well-developed physique is no indication of the "absolutely perfect" health of their core. Between 5 and 80% of athletes have urinary incontinence! And not surprisingly, high-impact activities like Trampolining are the worst. So, such activities are TOO MUCH load for these people’s respective (and otherwise pretty good) core strength.
Add too much load, and we can all crumble with our continence. Only for some of us, it takes a laugh or a cough, if we are deconditioned.
Incontinence causes or contributes massively to mental health difficulties - depression, fear and anxiety. Keep our core functioning to the best of its ability, and we will support our emotional health, too.
And I will leave you with this final, rather sobering, thought. Incontinence - which you are now, hopefully, starting to see as an issue with the whole core - is one of the big reasons for older people being placed in care homes.
Pretty shocking? Yes. Hopefully, it can start motivating more of us to sort out those problems holistically, and not rely on pads to simply hide these concerns.
The things to take away from this are:
we need to train our whole core, not spot treat the pelvic floor;
don’t aspire to have a fab 6 pack, it does not tell us that much;
continence is so much more important than we think. Let’s not end up in a care home just for that reason!!!
To your health
Kaye
I practice in Wimborne, Dorset, UK, and online, seeing clients nationally and globally over Zoom. Contact me for a no-obligation chat:
+(44) 7768 135481