This is a post about pelvic floor dysfunction. But we’re a tech family, so indulge me in a little analogy:
I run my computer hard. I keep 20 applications running, 100 tabs open in my browser, at least 2 desktops active, I open and close the lid of my laptop with abandon. Oh, and I really love clicking “Remind me tomorrow” when I get a notification that an update is needed.
At some point, I errors start popping up. I’m out of memory. Photoshop unexpectedly quits. I can’t see the cursor in Word. If it’s really dire, there’s this one pixel that’s always blank.
Every time I go to my tech-genius husband to complain about my poor little laptop, he always asks the very same question, with a slight roll of the eyes. When’s the last time you rebooted?
Every time. Problem solved. You’d think I’d learn.
My sophisticated, capable piece of technology is well designed. But it has its limits. And sometimes, to keep functioning well, it needs a reboot.
The innermost core of our body works much the same way. It’s this incredibly sophisticated, well-coordinated machine that usually works really well to manage the pressure in our abdomen, stabilize our spine, support our pelvic organs, manage continence (prevent unwanted leaking of pee, poo or gas). But sometimes, it gets overloaded. Through pregnancy. Perhaps through sport. Perhaps it’s just been a while since it had a reboot and it gets a bug in its coordination. It needs a reboot.
When our core is in need of a reboot, we experience pelvic floor dysfunction. When our pelvic floor isn’t functioning well, we experience things like leaking, abdominal separation, prolapse of our pelvic organs or even just an imbalance in muscle tone (as in the case of too-tight pelvic floor muscles or abdominal gripping). We act like these things are the end of the world, but they’re actually predictable consequences of running the system hard and are often pretty easily managed with a little reboot.
Often, a reboot for the pelvic floor and core looks like breath-reeducation, exploring our body alignment and coordinating our breath to movement and exertion. But before you can address the problem, you need to know what it looks like.
Here, I am going highlight the more common pelvic floor (and core!) conditions experienced by pregnant and postpartum people. But also note, these conditions are also experienced by people who have never been pregnant (and by people with and without a vagina). Armed with knowledge, you have the power to advocate for the treatment and management of your own pelvic health. If you are experiencing one of these conditions, my goal is to offer hope and provide concrete action items you can implement to begin your healing. Follow the links in each section to find resources and tips that will help you manage the symptoms of each of these common and normal conditions. At the end of this post, I’ll include action items that apply to all of these conditions.
Pelvic Organ Prolapse
Pelvic Organ Prolapse (or, as it’s better known by it’s cute acronym, POP) occurs when the support offered by the pelvic floor (represented by the hammock in this image) is compromised and one or more of the pelvic organs (bladder, uterus or rectum) bulge into the vaginal wall and cause it to droop.
The degree of pelvic organ descent is described by its “grade” and it’s helpful to note that the severity of symptoms does not correlate to the grade or to the worsening of the grade. Instead, symptoms tend to correlate with things like stress, sleep, time of day, time of the month and management (or not) of intra-abdominal pressure.
Estimates of the prevalence of POP vary widely- so anywhere between 50% to nearly 100% of people who have given birth will experience some degree of POP [reference]. It’s very common.
In most cases, POP isn’t “curable” but the symptoms are manageable and sometimes the grade can be corrected a bit. It just takes a bit of effort to find the appropriate help, experiment with strategies and learn what works best for you.
If you suspect you have POP, you’re best bet is to get evaluated by a pelvic floor physical therapist. In the mean time, there is a lot you can do to manage the symptoms you are experiencing. Start with the general strategies at the end of this post (breath re-education, alignment variability and coordination of breath and movement), and also check out:
Hypertonic Pelvic Floor
POP’s less famous, but no less troublesome, cousin is hypertonic (or overactive) pelvic floor muscles.
It’s a separate condition, and can occur independently of or in combination with POP. It occur when muscles are too tight and can not adequately lengthen or relax.
If the pelvic floor muscles can not appropriately relax, they can’t appropriately respond to changes in demand imposed on them. Symptoms of a hypertonic pelvic floor might include (but are not limited to) increased urinary frequency or urgency, slow stream of urine, painful bowel movements, constipation, pain with sex or tampon use, a sensation of pressure or inability to perform/feel a kegel. Note, some of these symptoms overlap with those of POP, which makes diagnosis by a professional (→ pelvic floor physical therapist) extremely valuable.
Pelvic floor muscles can become overly tight for a number of reasons, including guarding (contracting to protect an area after injury… like, tearing during childbirth), compensation (for weak or uncoordinated muscles elsewhere), chronically sucking in one’s tummy or emotional stress (just like you hold tension in your shoulders!).
A personalized treatment program designed by a pelvic floor physical therapist is the gold standard approach to tackling too-tight pelvic floor muscles (are you starting to see a theme here??). Here are a few self-help tips to explore in the mean time:
Urinary incontinence (leaking) is the unintentional loss of any amount of urine. It’s a super common symptom experienced by a lot of people (especially those who have given birth).
It turns out that leaking can be caused by an underactive OR an overactive pelvic floor, POP and even other non-pelvic floor related things (like your brain!) and so it’s extremely valuable to get evaluated by a pelvic floor physical therapist. They can determine which end of the pelvic floor tension spectrum you live on and give you a custom treatment plan that will address your issues.
If you’re dealing with pesky leaks in the mean time, try a few of these reliable strategies for managing leaks when coughing, sneezing or laughing:
Diastasis Recti (Abdominal Separation)
Abdominal separation (diastasis recti) is the most VISIBLE of the common pregnancy and postpartum core conditions and so it often gets the most attention.
In order to make space for baby, your body is designed to stretch. The line of connective tissue that runs down the midline of your abs stretches and thins giving the appearance that the 6-pack muscles are moving away from one another. Imagine what it looks like to stretch a pair of pantyhose. It’s very common, very normal and happens to nearly every pregnant person [reference].
If you have a wider diastasis that does not generate tension, your core might not feel very strong. If your core isn’t able to generate tension it won’t be able to do a good job creating the central stability you need to complete everyday tasks or exercise (making all those things much more difficult). If this is the case, you will use other parts of your body to compensate and this might lead to secondary aches and pains elsewhere in your body.
Most of the time, the abdominal separation resolves by 6-8 weeks postpartum. When considering whether or not the diastasis has “healed” or not, we look at whether or not a person can generate tension through the connective tissue. The ability to generate tension is much more important than the absolute size of the gap between the muscles. The gap will not return to zero, but it probably didn’t start at zero either. At 8 weeks if you still have a gap significantly greater than 2 finger widths apart or one that is very squishy, make an appointment with a pelvic floor PT and see if you can find a postnatal fitness specialist to work with in the mean time.
For more information on diastasis recti, check out:
Action Items: The Reboot
No matter which flavor of pelvic floor consideration you are confronting, the first line approach to managing it is likely to be remarkably similar.
1. Practice breathing. Breathing diaphragmatically puts your pelvic floor through its full range of motion ((← essential to balancing a hypertonic pelvic floor). It works to lengthen and strengthen those muscles as well as encourage better coordination with the whole inner core unit and response to changes in demand (← necessary to control leaking, coning or doming of the abdominal midline, and descent of pelvic organs).
2. Bring awareness to your alignment. Do you spend a lot of time in a butt-tucked-under position? With ribs super flared or shoulders super hunched? There’s no perfect posture, but there are postures that might make it easier for your pelvic floor work well. Try spending more time untucking your butt, relaxing your rib cage down, or getting your rib cage stacked over your pelvis.
3. Experiment with coordinating your breath with your movements in order to maximize the support offered by your core and pelvic floor. A good starting point is to exhale during the hard parts of a movement or exercise. If that doesn’t work for you, I can offer you a variety of alternatives to try. Practicing your breathing strategies during exercise will train your pelvic floor to work automatically and reflexively during your activities of daily living.
If you’re looking for guidance in navigating your pelvic health symptoms or returning to sport after a pelvic floor diagnosis, I offer 1:1 coaching and consultations. Please send me a message to set up a free Meet and Greet to discuss your goals and how I can help you achieve them!
Learn how to dial in your breathing strategy to harness control of your pelvic floor and manage your pelvic floor symptoms. Download a free 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. I work with people locally (Seattle’s Eastside: Redmond, Bellevue, Kirkland and surrounding areas) and online to develop personalized pregnancy and postpartum personal training plans. I also offer labor support (birth doula services) within the greater Seattle-Metro Area.