Updated: Jul 5, 2020
If you are managing a pelvic health "thing": pelvic organ prolapse, high-tone or hypertonic pelvic floor muscles, incontinence- you probably know, it's a journey. You master the basics: breathing, alignment, managing pressure during movement. Then, there is the rest of it: fine tuning, managing swings in sensations and symptoms and learning to adapt your hard-won strategies to new activities.
I have been managing symptoms of prolapse and hypertonic pelvic floor muscles for years. I consider these conditions to be manageable, but chronic, features of my body. But just because I am perpetually managing a thing, doesn't mean I'm not living my life. Picking up my kid. Running. Swinging kettlebells. Jumping for joy!
Just as is the case with any chronic condition, most pelvic floor dysfunctions are never “cured”. They are managed. And sure as the sun will rise, you will have regressions in symptoms.
So what do you do then? Can you still exercise if your pelvic floor is acting up? Of course! In fact, I'll argue that your workouts provide a valuable laboratory in which to experiment with and develop strategies for managing your symptoms in ways that will improve your comfort during your routine daily activities. Of course, if you are experiencing extreme discomfort, leaking large volumes of urine or if can't manage symptoms with these suggestions, I urge you to reach out for medical/professional guidance (read to the end for more on this).
Here are strategies that I use and that you can explore when new symptoms appear or old symptoms flare.
Note: When I say “symptoms”, I’m talking about pain or pressure in the pelvic floor or vagina, sensations of bulging or of something falling out of the vagina or unintentional leaking of anything (think, sneeze-peeing or leaking urine during jumping or running). These symptoms can be caused by a few different conditions (like pelvic organ prolapse or hypertonic pelvic floor muscles, for example), but a lot of the basic troubleshooting can look similar: implementing breathing strategies, identifying and staying under one's symptom threshold and giving oneself permission and opportunity to explore various movement patterns. I'll go through more specific troubleshooting for individual conditions in future posts.
1. Make sure you are breathing. This isn’t a trite suggestion. If you aren’t breathing, you aren’t managing your intra-abdominal pressure well. Intra-abdominal pressure is pressure that builds up in your abdomen to stabilize your torso during any kind of movement or activity. GOOD management of intra-abdominal pressure is KEY to minimizing and eliminating symptoms of pelvic floor dysfunction. If you need a crash course in HOW to breathe well to manage your intra-abdominal pressure and control pelvic health symptoms, download a copy of The No B.S. Guide to Breathing (for a Strong Pregnancy and Postpartum).
2. Vary your breathing strategies. So you downloaded my guide, or you learned how to breathe elsewhere. Amazing! You now have a super versatile tool at your disposal. Wherever you learned it, you likely learned a basic “exhale on exertion” strategy. This is where I start a lot of folks off. But it doesn’t work for everyone all the time. You can manipulate your breathing by changing when you contract your pelvic floor relative to when you exhale. Visit this blog post to check out variations of breathing strategies that you might find helpful.
3. Play with your alignment. During pregnancy and postpartum, I encourage people to start in a ribcage-over-hips stacked alignment. It works for a lot of people. It doesn't work for everyone. Is that surprising to you?? It turns out there is no one “optimal” alignment for every body. There’s a saying, “the best posture is your next one”. Which is to say, ribcage over hips probably works for a lot of people because they aren’t in it all day. It’s good to mix things up and it’s good to find a position that is not the one you spend all day hanging out in. It’s also worth noting that the goal of “ribcage over hips” is to get your pelvis and ribcage into “neutral” alignment. That is, in the middle of their range of motion. But neutral is a range. There’s a lot of wiggle room, even in a stacked alignment.
4. When do you feel the symptoms occur? Work under your symptom threshold. For example, you go for a run and you start leaking after 2 miles. Try reducing your distance to less than 2 miles or adding in walk intervals so that you can finish your 2 mile run without leaking. Run 1.75 miles. And gradually progress your distance. Or, run the same difference but add in walk intervals (e.g. 1 minute run, 1 minute walk). See what you can tolerate.
5. Modify your sets, reps and intensity. If you are experiencing leaking or discomfort in your strength training routine, modify the weight you are pushing, the number of reps your are completing or the number of sets in your workout. Similar to #4, you’ve got to find your threshold and get underneath it. Then progressively build back up.
6. Decrease your range of motion. If you are leaking or feeling pelvic pressure when you lift, pay attention to WHERE and WHEN you feel that symptom during the lift and adjust your range of motion. For example, you can try a shallower squat or deadlifting off a block.
7. Change the tempo of the movement. If a particular exercise causes symptoms, try changing the speed at which you do it. Slow yourself down so that you can be more intentional with your biomechanics and breathing.
8. Work in gravity neutral or negative positions. If you are experiencing symptomatic prolapse, gravity neutral or negative positions are your friends both in your strength training and as rest sets. Some ideas of gravity neutral or negative exercises include glute bridge variations, hip thrust variations, bird dogs, donkey kicks, supine chest presses and dead bugs.
9. Increase the rest between sets or between workouts. Give your pelvic floor more time to recover.
10. Regress or substitute when appropriate. A lot of times, symptoms of pelvic floor dysfunction can be managed by modifying variables listed in previous tips. The hard rub is sometimes they can’t. If you just can’t make an exercise work for you, try a regression of the same move. Or sub an exercise that achieves the same goal. I assure you, there are still plenty of options available to you, even if a few are off limits temporarily.
Give these strategies a try. Have you come up with something else that helps you out? I would LOVE for you to shoot me a message and tell me about it.
If you are having difficulty troubleshooting on your own, I offer online consultations (visit my page here)! I also recommend if you are having bothersome symptoms that you can’t easily manage with simple troubleshooting that you book an appointment with a pelvic health physical therapist. Pelvic health physical therapists can work with people in person or through virtual consults. Contact me if you would like assistance finding one.
Good luck friend!
Want to know more? Take a deep dive into HOW to dial in your breathing strategy to manage your pelvic health and feel stronger in your workouts. Download a copy of The No B.S. Guide to Breathing for a STRONG Pregnancy and Postpartum.
My mission is to make sure that having a baby is not a reason why you can’t do all the things.
Contact me if you have questions about exercise or pelvic health pertaining to pregnancy or postpartum, if you’re local (Seattle's Eastside: Redmond, Bellevue, Kirkland and surrounding areas) and interested in working with me on a custom personal training plan, or if you’d like help finding a qualified pregnancy or postpartum personal trainer near you.