pelvic floor

The Elephant in the Room: Running & the Pelvic Floor

A few months ago, a new app, B-wom, which acts as a personal trainer for your pelvic floor, contacted me about being an Ambassador to their platform.  Definitely check it out--having more control and awareness of your pelvic floor is SO IMPORTANT in women's health.  I was invited to share my own experiences with them about fitness and my postpartum journey on their blog; you can read it here or below:

When I was discharged from the hospital after having my first child, I was given a “welcome home” packet with information about how to care for my newborn, breastfeeding advice, warning signs to look out for in the immediate days postpartum, and general advice about my new postpartum body.  In the fog of new motherhood and extreme sleep deprivation, I barely touched the pages of literature that were there to “aid” me. I spent the initial postpartum days hobbling around our NYC apartment trying to figure out how to swaddle my baby, change his diapers, and breastfeed, all while trying to wean myself off pain medication I was given to help me cope with my badly bruised tailbone, tearing, and my episiotomy.  

Unlike many other countries, in the US, a couple xerox copies of literature are generally all the help new mothers are given immediately after having a baby, if any.  A lot of times there isn’t even a couple printouts of information hastily thrown at the mother as she’s leaving the hospital to help guide her in the unchartered world of motherhood. Aside from 6-week postpartum checkup, you’re on your own.  Unless you’re willing to pay hundreds if not thousands of dollars for a doula who may (or may not) provide a postpartum follow up or have a lactation consultant visit your home, the proverbial village of raising a child and helping the mother recover doesn’t really exist. 

When I finally got around to reviewing the literature during a neverending pre-dawn cluster feed, there was one paragraph that mentioned women should start doing pelvic floor exercises “immediately postpartum.”  I honestly didn’t really know what that meant at the time, let alone the importance of this.  Frankly, thinking about “exercising” my pelvic floor made me nauseous, as EVERYTHING hurt so much in that region.  Anything that involved sitting, squatting, or going to the bathroom was excruciating.  Walking was incredibly difficult, as was going up and down stairs. Little did I know that a relatively “normal” vaginal birth would be just as difficult to recover from than a C-section.  As a person who was very used to an active lifestyle pre pregnancy and throughout the nearly 10 months of it, not being able to do the most basic movements without debilitating pain was a huge blow mentally, emotionally, and physically.


Elephant in the Room by Mark Bryan

Friends, family, and even strangers that I came to know through online blogs told me this was completely normal to feel this way. Everyone said to take it day by day, and they were right.  One week postpartum, I was able to walk multiple city blocks and navigate subway stairs, though very slowly and gingerly.  Two weeks, I was up to over a mile.  By 4 weeks, while I still was bleeding occasionally, I was able to walk 4 miles.  It was still painful from time to time, especially when I overly exerted myself.  I had to be very careful.  And yet by the 6-week mark, I was able to go on my first 3 mile run, which (fortunately) was nearly pain-free.  Yet things felt “different” in my pelvic region in the weeks (and months) that followed.  It felt “heavy” and often sore, and I sometimes leaked urine if I wasn’t careful.  When my doctor “cleared me” for exercise at 6 weeks, I mentioned this to her.  It seemed embarrassing to talk about it at first.  It was only during that checkup that she told me my pelvic floor was weak and that I should be doing pelvic floor exercises every day, and equally as important, she told me the reasons why. She even showed me how properly release and contract my muscles.  Little did I realize that while all OBGYN’s should be encouraging their patients to do this, it’s actually not very common practice.  How many other women out there don’t even realize this is so important to not only know about, let alone do?

Pelvic floor muscles are really a hammock of support for your bladder, uterus, vagina, and rectum.  So if your pelvic floor muscles are weak, these areas won’t function as well as they should.  The pelvic floor is also part of your general core. When you think “abs” and “core”–this also includes your pelvic floor muscles.  They support your lower back (lumbar spine area) and your hips.  So, when one has weak pelvic floor muscles, there can be cascading negative effects on all these areas.  Postpartum women are more apt to suffer from these effects, as especially if there is vaginal delivery, there can be some form of “trauma” to this region. Even if there is no tearing or episiotomy involved, the very act of pushing a baby out of the birth canal stretches the pelvic floor beyond its limits and therefore strains and weakens these muscles.  And yet, it’s not just this group of the population that may have issues–it can affect everyone (men and women, of all ages), not just post partum or post menopause women.  

In my own experience, because I talked about my issues with my doctor early on, did more research on my own in the months that followed, and began to integrate pelvic floor exercises in my routine, I was able to resume my active lifestyle pretty quickly after giving birth.  Since I didn’t have any severe issues like organ prolapse and I closely monitored my progress, I even was able to run a marathon less than five months postpartum with little pelvic floor issues during training.  I was lucky.  While I am a more informed individual about the pelvic floor and more attune to its interconnectedness with my own body, I still have flair-ups from time to time, even two years after giving birth.  I still dread coughing or sneezing especially when I am running as I know I may pee just a bit.  I still get embarrassed when I talk about these “incidents” sometimes.  Even writing about my experiences gives me pause.  But being open about this is extremely important to discuss with others.  I’ve now learned so many of my friends and family suffer from a weak pelvic floor, and yet didn’t know what to do, and most just sort of accept it as “that’s life.”  I find women tend to be more apt to think we can handle this on our own, it will go away with time, or “that’s the way things are,” and not to seek help if there is an issue, no matter how minor.  We joke about peeing when we sneeze, but we may not do something about it.

However, there are some solutions.  First and foremost, it’s educating women to be more open about discussing their issues–no matter how minor–with their doctors, and their community.  And taking action to prevent things from getting worse is also key, as inaction can actually make it worse.  Having a weak pelvic floor may even prevent some women from doing things they love to do, or used to do.  Regaining strength and control to these muscles will help, and yet it takes time and regular practice as often as one brushes their teeth.  Talking the right steps to mitigate this can also be at your fingertips -whether it’s finding a physical therapist who specializes in the pelvic floor or even easier- the B-wom app, which acts as your own personal pelvic floor fitness coach.  Seeking help now will give you more confidence in yourself and allow you to move forward and take control of your life.  

The Best Hidden Exercise You Should Do Every Day

This post was originally published in Red Tricycle, where I am also a contributor.  You can also read the whole article here:

Recently, a friend of mine mentioned that she didn’t like running that much.  It wasn’t because she wasn’t in shape, or she wasn’t fast, or she didn’t have the time…it was because she felt like she had to pee every time she took a step and that was holding her back from doing what she once loved to do years ago.

Ladies, if you had to pick ONE exercise to do every single day, it should be training and toning your pelvic floor. 

I used to think that the pelvic floor, or “doing your Kegels” had more to do with enhancing your sexual pleasure than really anything else.  We’ve all seen Sex and the City and heard the talk (mainly from Samantha) about the importance of doing Kegels and why.  It’s true that having a strong pelvic floor can definitely help in this department but that’s only one reason.  The other (in my view, even more important) reasons why having a strong pelvic floor is so important isn’t really discussed as much, or at least as openly, as it should.  Yet it affects everyone (men and women, of all ages), not just post partum or post menopause women.  Especially if you are active, here are some reasons why strengthening your pelvic floor NOW is so helpful:

●The pelvic floor is part of your general core. When you think “abs” and “core”–this also includes your pelvic floor muscles.  In fact, your Deep Core Stability Muscles include the pelvic floor.  Having strong pelvic floor muscles help support your overall core stability and strength.  When you have a strong core, it helps with your overall stability, posture, and form, all of which make you a better runner and athlete.  If you want to be a faster and stronger runner, you should be doing your pelvic floor exercises.

●The pelvic floor supports your lower back (lumbar spine area) and your hips.  If your pelvic floor is weak, it further increases your risk of injury to this area (or other areas that are supported by the pelvis, lower back, and general core…like glutes, hamstrings, groin).  Doing pelvic floor strengthening can also help with any pain management you may have in your have lower back pain or pain in your hips.

●A strong pelvic floor will help with incontinence issues.  Just because you feel like you may need to urgently pee when you are exercising at a higher intensity doesn’t mean you’re exempt from training your pelvic floor.  Or that one time you sneezed and you felt like you needed to pee (or maybe you even leaked a bit of urine)…or even worse–you sneezed during exercise, that’s probably when you really noticed an issue.  Developing a stronger pelvic floor can help with any incontinence issues, no matter how minor they may seem. 

●A weak pelvic floor can make constipation worse.  The pelvic floor muscles are really a hammock of support for your bladder, uterus, vagina, and rectum.  So if your pelvic floor muscles are weak, these areas won’t function as well as they should.  When you train your pelvic floor, you are more able to have a healthy elimination.

●A strong pelvic floor helps with childbirth and postpartum recovery.  If you are thinking about having a child, whether you are a first time mom or not, having better control of your pelvic floor will help with delivery (it helps move the baby down the birth canal, and during the “pushing” phase of birth).  And doing pelvic floor exercises immediately after giving birth can be a great way to help regain strength in this area (again, it’s part of your core), and also promotes healing from any tearing sustained during childbirth.  Your pelvic floor muscles get stretched out in just a matter of hours during childbirth vs. the 40 weeks that it takes your abdominal muscles to stretch out, so it’s extremely important to begin a regular strengthening routine for your pelvic floor.  Once you are “cleared” for other exercise, having a well-established deep core routine and stronger pelvic floor muscles will be so beneficial to a mother’s mental and physical wellbeing.  While there is a lot of discussion in our culture about “getting our bodies back” and “getting rid of our mommy’s pooch,” working towards a strong pelvic floor should be the primary go-to exercise in the postpartum exercise routine.

●Your pelvic floor muscles will get weaker with age and non-activity.  Just like any other muscle, if you don’t focus on strengthening or using it properly on a regular basis, it becomes weaker over time.  And hormones won’t help, which is why postmenopausal women suffer more from pelvic floor dysfunction. 

So, how do you begin?  There are lots of variations, but the most basic one is that of a Kegel.  You can do this sitting or standing, anywhere and everywhere.  Begin by tightening your pelvic floor muscles, starting from the back to the front (anal sphincter to vaginal sphincter), and hold for a few seconds.  Then release, allowing your muscles to soften and then gradually relax for a few seconds.  Remember to breath throughout this process (have your breath start with your diaphragm, then chest), as you would when you are doing any other strength training exercise. You can repeat this sequence 10 times, and do 3 reps. You can gradually work up to tightening your hold for more seconds at a time, increasing the intensity of your effort, and the frequency of these exercise.  Like any strengthening routine, it takes time to see results.  But doing them on a regular basis, especially combined with diaphragmatic breathing, will eventually give you a stronger inner core.

For those that think they have more of a severe issue, the good news is there is additional help out there.  You can talk to your OB GYN (who should be checking your pelvic floor strength as often as they see you, but many of them do not), or you can also go to a Physical Therapist who specializes in the pelvic floor.  If you also practice yoga or Pilates, you can also talk to your instructor about additional exercises to do to help with pelvic floor awareness and strengthening.

In my own practice, I have found that incorporating them into my daily activities like putting my makeup on, eating breakfast, riding the subway, or washing dishes help me to be as regular about doing them as I am about brushing my teeth.  Aside from the stated benefits above, training my pelvic floor has helped me become more aware of my entire body, especially my core, and not just the “outer unit” muscles. As an athlete, it’s extremely important to be attune to not only the muscles that you think you may use in a specific exercise, but to be aware that your body is a system of interconnectivity.  If one area is (or becomes) weak, it’s going to eventually affect another area that is more dominant. The pelvic floor is unfortunately a very common weak area for most everyone, and yet if affects us in so many ways when we’re exercising or going about our daily lives.  The benefits of doing these exercises on a regular basis last a lifetime, so start today.