A deep dive into the correlation between Pilates and your pelvic floor. Could you be doing more harm than good? Find out in this discussion with Senior Pelvic Floor Physiotherapist extraordinaire, Director and Owner of Melbourne Pregnancy & Pelvic Floor Physiotherapy (MPPP), Pilates instructor, and in my opinion, all-round superwoman, Rebecca Liberatore.
The pelvic floor refers to the group of muscles, ligaments, and connective tissues at the base of your pelvis that support your bladder, bowel, and uterus (in women). They form a type of hammock that holds everything up, or as Rebecca simply puts it, “the pelvic floor is quite literally the floor to your pelvis”.
During Pilates exercises, these muscles can be strengthened as you work on your core and even your glutes. This is because the pelvic floor muscles attach to your pubic bone at the front of your body, and your tailbone at the back.
A strong pelvic floor allows you to healthily and appropriately control your bladder and bowel function. This prevents problems such as prolapse (when your bladder, uterus, and bowel are unsupported and essentially drop down), and incontinence (when you’re unable to control the release of urine or faeces). So on the contrary, you can see that a weak pelvic floor can lead to issues.
The interesting thing about this topic though, is that most people don’t realise that it’s very possible to also have an overactive, much too tight pelvic floor, and that too is a problem. Take it from me. I will openly share that I have had issues with this, and hence how I met Rebecca at MPPP who was a fantastic support.
A very tight pelvic floor can lead to discomfort and pain when probed, and often the muscles are unable to appropriately release when you need them to, but instead stay firmly wound up like a very tight fist, and can even involuntarily spasm – not fun.
As a Pilates instructor, I found myself in a position where I was overly tightening my pelvic floor muscles, so much so that they became extremely wound up. I was not aware of the fact that I had to learn how to release these muscles for them to relax in appropriate scenarios. And so, I had to work with a pelvic floor therapist (Rebecca) to learn how to do this.
At the intersection of definitely not wanting a weak pelvic floor, but also waiting to avoid creating a hyperactive, super tight pelvic floor, it’s imperative to understand the way to achieve a healthy middle ground where your pelvic floor muscles behave appropriately, as they should.
So what do we need to know? Which specific movements do we need to pay attention to and alter for our specific needs (and it is important to highlight that we all have different needs) to maintain that happy, healthy medium?
“I think the most important thing to be aware of is that the pelvic floor is meant to switch on when we need it to. However, for the majority of the time, it should stay relaxed,” Rebecca shares.
“The aim of a Pilates class should not be to have your pelvic floor engaged the whole time. This can lead to an overactive/tight pelvic floor and affect what it is meant to do naturally. You can actively turn it on for certain exercises when instructed to do so, but after that exercise, you must let go of the muscle and allow it to return to its relaxed position,” she says.
Tight, weak, or just right?
But what if you don’t know whether you need to strengthen, or stretch and release your pelvic floor muscles? How do you know whether or not this is something you need to focus on?
“This is a tricky one because often a weak pelvic floor and an overactive pelvic floor can present in the same way,” Rebecca says.
“The most common signs that there is something not quite right with your pelvic floor are:
Urinary leakage – either with coughing, sneezing, lifting, jumping etc. or on the way to the toilet
Frequent urination
Pain with bladder filling and emptying
Constipation
Faecal leakage
Loss of wind control
Heaviness or dragging in the vagina
A lump or a bulge that you notice coming from the vagina
Pain with or inability to have penetrative intercourse
Pelvic pain – often associated with Endometriosis.”
If you have noticed any of the above symptoms, it is highly recommended that you book in with a pelvic floor therapist to get assessed.
Rebecca recommends that “if you develop symptoms or have had a recent trauma to the area, like pregnancy and/or childbirth, then it is best to get it checked first,” before commencing physical exercise when you may be unaware of how to turn the pelvic floor muscles on or off.
What to do about a weak pelvic floor
“If you have had your pelvic floor muscles assessed and they are weak, it’s time to get to work! These muscles are like any other muscle in the body, and if they are weak, we need to strengthen them.
“So you might choose a few exercises in your Pilates class and try to engage and hold your pelvic floor on for some or all of the exercises (depending on how strong you are). Remember laying down is easier than standing up!” Rebecca informs us.
During pelvic floor physiotherapy, Rebecca gives us some insight into what the pelvic floor exercises would entail.
“For a weak pelvic floor, we look at getting people to progressively increase how long they can hold their muscles, and in more challenging gravity-dependent positions,” she says.
What to do about a tight pelvic floor
When I asked Rebecca whether or not Pilates is still beneficial for those with a tight pelvic floor, she advised that “as long as you have an awareness of what your muscles are doing, then it definitely can be”.
“I would ensure you check in and make sure your pelvic floor is relaxed in between exercises (sometimes it is sneaky and tries to turn on).
“Pilates is fantastic at improving overall body awareness and allowing you to tune in with your muscles and know what is going on. There are some fantastic pelvic stretches that your Pilates instructor can take you through to help you relax and loosen the pelvic area,” Rebecca adds.
Pelvic floor physiotherapy focuses on “returning the pelvic floor to relaxed, and sometimes repeated contractions, and seeing how well people can start to coordinate their muscles to turn on and off,” Rebecca says. “We also love to give pelvic stretches like child’s pose and happy baby,” she adds.
Body scans
What I found to be a very helpful tool that Rebecca taught me during therapy and that I adopted into my every day, was body scans. This exercise refers to quite literally pausing whenever you remember to, mentally scanning your body from head to toe and paying attention to where you may be tensing or clenching unnecessarily, then concentrating on letting go. It helps to develop good body awareness and also brings your attention to your subconscious physical reactions in certain contexts.
Oddly, I found that when I’m performing tasks on auto-pilot, or learned skills, usually when standing, like brushing my teeth, washing the dishes, or in the shower, I am usually unconsciously tensing my pelvic floor. Once I realised, I was able to pay attention to the area and consciously let go and release the muscles. The more you do this exercise, the more you remember which contexts you’re most probably unconsciously tensing, and you can be more mindful in those particular contexts moving forward.
Similarly, if you have a weak pelvic floor, you can use this exercise as a time to remind yourself to do your relevant pelvic floor strengthening exercises. But it will also help you to release tension in other areas of your body that you may not be aware of.
“Body scanning is really important to increase your awareness of what is actually going on with your body. We are so busy throughout the day we often have no idea what is going on internally. Body scanning is a great way to check in and see what your muscles are doing and remind them to return to the optimum position,” adds Rebecca.
“Traditionally, Pilates focuses on awareness and correct activation of muscles. It can help to bring your attention to these super important muscles while exercising,” she says, and it is so true.
Understanding how you can affect your pelvic floor muscles during Pilates exercises will benefit you immensely, as will understanding the value of being mindful of your body when you move. It is essential to achieving the goal of a healthier and happier you and getting the most out of your Pilates practice.
I hope this article has brought awareness to the importance of your pelvic floor muscles and has also empowered you to do something about any issues you may be facing in this area. Whatever it is, you’re not alone, and there is a whole lot you can do about it to move forward.
Visit Melbourne Pregnancy & Pelvic Floor Physiotherapy (MPPP) to get an assessment if you think you need it or feel free to email me if you have any questions or feedback at hello@pilateswithelle.com.au.
Elle
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