Pelvic floor.... How do you do yours?

[Miss E]

So, this time around it seems my pelvic floor muscles are a lot weaker than last time. I've already had a couple of little leaks when I've sneezed or coughed! I didn't realise it could happen so early on in pregnancy, especially when I didn't even have the hint of a problem last time, ended up with an emergency CS and then have spent the last couple of years without any problems... I'm terrified of where I'll be in another 20 weeks. So of course I am madly doing my exercises at the moment.

But, I'm wondering how you do yours. I've always done 10 long squeezes (holding for as long as I can, ideally 10 seconds) followed by 10 quick squeezes. This is what I was taught at the pregnancy physio class I went to early on when I was preg with DS.

Also, is it strange for me to be having prob's this early, especially when I've never even had a hint of a problem before?

TIA

[Butterfly Dawn]

I had probles all through my last preg with this. I had to wear pads and change them twice a day as sometime I didnt even know I had leaked. If I even suspected I needed to pee I would go. I found I had to do PFE all the time, long holds and short holds, if I missed a day it was disastress- however, on the other side of it- I dont have much of a problem at all now ans Im surprized, but happy.

[k4t]

Bumping this thread up. (and hijacking it a little bit.)

I've been trying all different types - short holds, long holds (that I really struggle with,) and 'elevator' holds where you try to adjust the squeeze through three levels of intensity (my yoga instructor recommended these.)

I'm really struggling to hold for 10sec. Anyone else have similar problems? How long did it take to improve?

I'm also struggling to remember to do mine regularly - does anyone have a good routine or time of day that works?

[LionsandBears]

K4t - just keep practising. You'll get there.

Good prompts to remember are, when brushing your teeth, sitting at the lights while driving, during ad breaks. Come up with something that's easy for you to remember and go from there.

[Julie Doula]

Grab a copy of Your Pelvic Flaw by Mary O'Dwyer. Very well researched and it shows you how to do pelvic floors properly, and how to exercise in ways that do not increase abdominal pressure and put pressure on the pelvic floor.

Also a visit to a pelvic floor physiotherapist may be helpful.

I've always done 10 long squeezes (holding for as long as I can, ideally 10 seconds) followed by 10 quick squeezes

from what I can remember, more recent research out-dates this. I'll see if i can find out specifics - sorry I forget!

[2CheekyMonkeys]

i can hold mine for a good while but after a few reps i feel like i need to do a wee, which is irritating and so i dont bother much. anyone else experience this?

[Jellybean29]

I thought squats were the new way to do pelvic floor? Off to find the article....


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[Julie Doula]

yes, this article has a strong case for squats rather than pelvic floor squeezes:

Why you should stop doing Kegels… « Journey To Crunchville

The kegel is just such a huge part of our inherited culture information, no one bothered to fully examine it. Your Pelvic Floor is underneath the weight of your organs, and the strength your PF needs is equal to this weight (you don’t need SUPER STRONG PF muscles, just enough to keep everything closed). When you run, the extra G forces (2-3) actually increase the “weight” while running, but the PF should be adapting, just like all your muscles. One of the biggest misnomers is that tight muscles are “strong” and loose muscles are “weak.” In actuality, the strongest muscle is one that is the perfect length – you need Pelvic Floor Goldilocks – it’s juuuuuust right. The Kegel keeps making the PF tighter and tighter (and weaker and weaker). The short term benefits are masking the long term detriments. Ditch the kegels and add two to three squat sessions throughout the day (anywhere). The glutes strengthen and as a result, they pull the sacrum back, stretching the PF from a hammock to a trampoline. Viola! You can still practice opening and closing your PF in real-time situations, but you don’t have to approach it like a weight-lifting session or anything. It doesn’t need to be on the To Do list

Working on relaxing the PF and keeping it closed “just enough,” stretching the backs of the legs to free up the pelvis, doing regular, daily squats to strengthen the glutes, and ditching the heels (except in special occasions) are things you can do all the time for all-the-time improvement.

[Jellybean29]

Thanks Julie !


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[k4t]

Thanks for the advice Julie. I picked up a copy of Mary O'Dwyer's newer book Hold it Mama which has been really useful.

[~TT40~]

I use to think i did mine often and they were great.. But from only 10weeks i started leaking when ever i threw up, and this is my 1st pg!! and like you thought god already?!! Would be different if i was 30 weeks i wouldnt be so scared!

going to give squats a go with my usual pfe =)

Sent via my vortex manipulator!

[Julie Doula]

Thanks for the advice Julie. I picked up a copy of Mary O'Dwyer's newer book Hold it Mama which has been really useful.

That's a good lead, thanks k4t. Does she also recommend squatting, do you know?

[Pholi]

Speaking as a women's health physio, there is a lot of reseearch which disputes the claims re squats. You can have long, strong muscles (think ballet dancer - just because they're flexible doesn't mean they're weak), long weak muscles, tight strong muscles (muscle bound bodybuilder) and tight, weak muscles (eg, spasticity following brain injury). There is not enough mobility between the sacrum and the os nominates (the other 2 bones of the pelvic ring) to significantly alter the length of the pelvic floor muscles. The anatomy of the pelvic floor is not the simple forward/back line people imagine, either, it is actually quite broad and has fibres that lie diagonally and almost transvere across the body as well. IF it worked that lengthening the pelvic floor by contracting the gluts caused continence, then how could you pee while standing up (as standing uses gluts)? And when you tried to allow your pelvic floor to stretch for birthing, your sacrum would have to move forward to allow the pelvic floor to stretch widthways, and that sacral positionitself would reduce the space available in the pelvis!

In fact, the pelvic floor is dynamic - it changes according to the demands placed on it, and like all muscles it can contract to shorten and stretch to lengthen. Having a strong pelvic floor almost never limits it's ability to stretch, and this is borne out by the many women with strong pelvic floors who birth their babies vaginally. It can tear and heal, and like all injured muscles, often need exercise to regain it's previous strength, length and functional abilities.

Many, many high trained clinicians and researchers all ovder the world have 'bothered to examine it' and the current findings are not hard to find if anyone is interested in looking into things further (use google scholar.) My understanding is that 'Hold it mama' is written by a well-trained Aussie womens health physio, is based on recent research findings from all over the world, and is excellent.

'10 long and 10 quick squeezes', the 'elevator' method favoured in yoga, and various other protocols have all been advocated, and there is not one single set of parameters that is suitable for everyone, as it depends on what your abilities are to start with, and what your problems/goals are. Just like muscle training in the gym, everyone's on a different program. The woman who leaks when she squats and lifts will have different needs to the woman who leaks when she sneezes or laughs, or the one who leaks on long hikes, which is completely different to the one who floods when she gets the key in the door, or who dribbles constantly through the day without knowing it!

If your type of leakage is on cough, laugh, sneeze, with a small volume and you are aware of the leak as it happens, then 10 'long and strong as you can' and 10 quick, 3-4 x/day, is a good general starting place. Count how many seconds you can hold a stong contraction to start with, and then see how many reps in a row you can do of those number of second hold, and aim at one second more and one rep more, until you get to 10x10secs. It might be, for example, that you can do a 7 second hold, but only repeat it 4 times before your 5th hold fades out at 6 seconds. So your 'program' to start would be 5 reps (ie, the 4 you can do plus the 1 you can't) of a 7 second hold. Then do as many quick ones as you can, up to 10, and the number to do is one more than you can do effectively to start with. As you get better, you should see the number of seconds or the reps or both, increasing by one or more, every couple of weeks.

[k4t]

Thanks for the detailed advice Pholi. There's no mention of squats as a substitute for PFE in Hold it Mama although she does recommend practicing in many different positions as you improve. There's also quite good explanations of how to make sure you're doing it right. I think this is what worried me most as most advice I've read just talks about doing the pee stopping exercise as if that's all you need to do to be sure you're using the right muscles.

I'm not sure if I'm unnaturally obsessed with this topic at the moment - I've only every had very occasional minor sneeze/laugh incontinence. I think I'm most hoping that PFE will help improve my chances of an intact perineum. I figure the more aware I am of those muscles now the more chance I have of being able to keep them relaxed during second stage.

[Julie Doula]

hi again k4t, if an intact perineum is your goal, this collection of articles and studies may be useful to you. I believe the model of care you choose, and whether your environment enhances or inhibits your natural birth hormones and your freedom of movement, is significant in achieving an intact perineum.

[Pholi]

k4t, awareness of them definitely helps you to relax during labour, and there's reasonable evidence that a strong PF and good awareness antenatally helps to maintain continence postnatally as well. Prevention is better than cure, and all that. Another good way (TMI warning) to practise relaxing the PF is when you poo - try to let it 'fall out of a big hole, rather than squeezing it out of a small hole.

Oh, and you can try doing a set every time you finish in the loo - it can be a good reminder, it's several times a day, and it's a nice private place where you can usually get peace and quiet to concentrate. You CAN do them anytime, anywhere, but the hard bit is remembering. Maybe put a sticker on the inside door handle of the loo at home to remind you, or a cartoon or 'positive birth mantra' on the inside of the toilet door?