Pelvic Floor Function #3: Support

My in-laws have the most amazing hammock. It hangs between three trees and is built for 4 people (though admittedly we’ve had 6 adults and 2 children on it...). It’s made of a strong woven material, yet has enough give to make it incredibly comfortable. It’s quite supportive.

The deepest layer of your pelvic floor is designed in a strikingly similar fashion to that hammock. It slings between the sitbones, then connects to the tailbone in the back and the pubic bone up front. In a balanced pelvic floor there’s enough give to allow for some bounce during walking/running/jumping/etc, but it’s stiff enough to support all the organs.

Your bladder, rectum, and uterus (if you’ve got one) are all supported from the bottom by this hammock. There’s also support from ligaments that connect the uterus to the sacrum and the pelvis, and the uterus in turn helps support the bladder and bowel. They all hold one another up, with the pelvic floor acting as the most southern level of support.

After pregnancy, all the ligaments get stretched, and won’t return to exactly the same length they were before (they’re not quite as stretchy as muscle!). This may leave some feeling a sense of heaviness in the pelvis, or like things are falling out. This is typically because of prolapse— most commonly the bowel or bladder pressing into the vaginal wall. But DON’T WORRY: your bowel and bladder CAN’T FALL OUT. And it’s much rarer for the uterus to descend. (Another post will cover prolapse more in depth!)

The good news: by strengthening this deep hammock layer, you can reduce those feelings of heaviness (without surgery!) and keep things more in their place inside the pelvis. It’s like tightening the hammock back up after it got stretched out.

You can also give the hammock a break from gravity by going a little upside down. Try one of these postures for five minutes, a couple times every day (especially after exercise), and you should feel a little less heaviness. (If you don’t have a yoga block or bolster, just use pillows!)

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What do the other layers do? Check out the rest of this series on the Functions of the Pelvic Floor: Sexual, Sphincter, and stay tuned for next week’s post on Stability.

3 Weeks to Happy Hips

One of my favorite things about traveling is just walking.

According to my phone’s Health app we walked between 16,000 and 25,000 steps each day during our trip to France. We walked everywhere—to the boulangerie, the market, museums, sight-seeing, the train station. We had one day of bike riding, and took the metro quite a bit in Paris.

But all this walking was bookended by the other extreme: sitting. Door to door each trip took 24 hours. Between a 9-hour overseas flight, connecting flights, trains, taxi’s, and the metro, there was a lot of time on our tushes.

What do walking, biking, and sitting all have in common? They make my hips stiff. They all involve this isolated forward and backward movement (or just a flexed position of the hips, in sitting, of course). Sure, I tried to sit cross-legged as much as I could on the plane (until G got annoyed), but mostly it was just forward, then backward.

Our bodies aren’t meant to only move in one plane. They are meant to rotate and twist and turn and bend and have multiple ranges of movement. They want to move in variable ways.

The first thing I did when I got wherever we were going was just that: give my hips different ways to move. I’m not shy to do yoga or stretch in public. This pic is at the Dallas-Fort Worth Airport after the flight back from Paris (and felt oh so juicy—for my swollen feet too!).

How do you take care of your hips? Do you have a sitting job or long commute where they’re stuck in the same position all day? Do you do a lot of running or biking or walking where they’re always moving in the forward plane?

I’ve got a 3-week series coming up called Yoga + Anatomy: Hips Edition at Yoga Wild. With new inspiration from my trip (a mini-travel flow that doesn’t require putting your hands on the nasty airport carpet), I’ll teach about the bones, ligaments, muscles and joints that make up the hip joints. Then we’ll move them, using asana (postures) to open them up and stabilize them too.

The class is designed to give a novice yogi a solid foundation, and experienced instructors some new inspiration and deeper understanding of these important joints. We’ll talk about emotional patterns of holding tension in our pelvis too, which can lead to various discomforts.

By the end, you’ll feel more knowledgeable, open and grounded.

If you’re local to Tacoma, I’d love to have you join. You can register here. (But hurry—there are only 6 spots left!)

If you’re not a local, I’m curious: does this sound interesting to you? And is it something you’d like to see as an online course? Drop me a line and let me know! I’m toying with the idea of online courses and would love to know what you want!

How to Contract your Pelvic Floor

Pelvic Floor Contractions are a SUPER important exercise to have in your repertoire. (If you always thought they were called something else that starts with a K, read this post for clarification).

Click HERE to get a free PDF Guide to a Proper Pelvic Floor Contraction, then keep reading!

How to contract your pelvic floor:

Start in sitting, or any comfortable position. Gravity makes a difference, so you may feel it more in an upright position, or you might feel better lying on your back.

Draw your attention to the perineum, which is the triangle between your pubic bone in front and your sitbones in back (think bike seat). Sitbones are the bony part of your backside (think sitting on hard bleachers). Imagine pulling your sitbones together, or your tailbone toward your pubic bone. Now pull up and in. Keep your glutes, thighs, and belly relaxed. Release.

If those cues don’t connect, try these:

Squeeze as if you’re stopping the flow of urine (but don’t do it on the toilet! It’ll confuse your bladder!). Release.

Squeeze as if you’re holding back gas. Release.

Pretend you’re sitting on a kidney bean, then try to pull it into your vagina. Release.

Pretend there’s an elevator in your vagina. Bring the elevator up a few floors slowly, then lower back down. Release.

You’ll notice I’m reminding you to release after each contraction. That’s because some of us are basically squeezing ALL THE TIME which leads to other issues to discuss another day. Always let it go!

Other things to avoid: bearing down, pushing out, holding your breath, squeezing REALLY hard. Try it gently—less effort is definitely more. They are relatively small muscles!

Even with the best cues, many women still do PFC’s incorrectly. If you really want to know if you’re doing them right, see a Women’s Health PT. We test them in the clinic by observation of the perineum, and most often an internal exam. No speculum, no stirrups, just a finger inside the vagina. We test your strength, endurance, and coordination. Then we help you train them to be strong and coordinated. They are a group of muscles just like any other muscle, and we can train them just like any other muscle too. They can be too weak or too tight, just like any other muscle as well.

Did you try it? Think you’ve got it? Tell me which cues work best for you!

On Kegels.

I’ve always disliked this term. I hadn’t ever fully fleshed out why until earlier this year, when I read a beautiful Instagram post by Latham Thomas of Mama Glow about the colonization of womens’ bodies by men. There are at least 5 glands and parts of the female pelvic anatomy alone named after male anatomists or physicians, and a long list of other anatomical parts throughout our body named for the men who “discovered” them. That list includes the elusive “G-spot”—named after Ernst Grafenberg (spoiler: it doesn’t actually exist!)

Arnold Kegel was a gynecologist in the 1940’s who was the first to publish anything about pelvic floor exercises, which he named after himself. That’s why they’re called kegels. That’s it.

I have learned over the years how much baggage the term carries. Just last week I had a patient say (and I’ve seen this a hundred times) with a little guilt in her eyes: “I’ve been really bad with doing my kegels.” Guilt! That’s often what I hear when women talk about “kegels”. They are this thing that women may or may not have been told to do by their doctor, or maybe just read about in Cosmo, but they don’t really do them, or they tried and “it didn’t work” so they quit. Often times women ask with skepticism what I can do for them, because they already tried kegels and “failed.” My response: Do you really know how to do the exercise?

There have been several studies done assessing if a woman is doing a pelvic floor contraction (PFC, I’m not saying the other name anymore) correctly. The consensus seems to be that around 40% of women who have been taught verbally (either by a doctor or written instruction) know how to contract the muscles correctly. The others are either not doing anything at all, squeezing other muscles instead (hey glutes and inner thighs!), or they are actually doing them backward—pushing out instead of pulling in.

So how do you contract the muscles correctly? Check out this post on PFC’s. I wanted to rant about the colonization of female bodies first, and that topic deserves a full post.

On to you: what’s your experience with the word “kegels”? What emotion does the word bring up for you? Please share below—I’m really curious!

Moon Journal

Let’s talk about the moon.

I’ve always been fascinated by the night sky, whether it’s a full moon or stargazing. Growing up in Montana, I adored nights under the stars. It truly is Big Sky country. I remember my parents stopping the car on the highway and turning off the headlights so we could see the immensity of the sky full of stars. It’s pure magic.

I was introduced to The Moon is My Calendar last year by my Naturopath, and it has changed my life. Each month has a circular calendar that you draw symbols in for each day about energy levels, exercise, meditation, mood, etc. Then there’s a small space for each day to just jot down whatever notes I want to.

If you’re like me and have been tracking your cycle for eons, it’s similar, but is intentionally about so much more than just when you bleed.

I took it on as a science experiment. I’ll do this every day, then after a few months I’ll look back and calculate when I felt what, etc. It didn’t work like that, though. 

I found that by taking a moment at the end of each day to just reflect on my day, the knowledge integrated into my being. I started to notice patterns naturally. I really do have more creative energy when I’m ovulating (and I’m oh so aware of when I am). I gave myself permission to say no to pretty much everything the first couple days of my cycle so I can just be by myself, probably on the couch (in sweats), honoring what my body is asking for.

Even in business—I have wanted to start my own practice for years, but it wasn’t until this spring that the Universe conspired to bring it to be. I am working hard, but in all honesty, it’s all flowing because I’m paddling downstream. I learned that from the Moon, from my cycles, and from listening.

If this intrigues you, I invite you to do the same. Maybe you jot down notes on a sticky pad or in your journal. Maybe you just spend some moments at the end of each day reflecting. Maybe you already have a Moon Journal. If you are interested in The Moon is My Calendar journal, you can order your own calendar journal here. (It’s an affiliate link, so I get paid a small portion of your purchase, fyi).

I’ve heard from many friends that they are intimidated and want to do it right, but the beauty is that there is no right way to do it. It’s a practice just like yoga and journaling and art. You just do it and see what comes out.

I’d love to know what you have learned from the moon and your cycles— Share in the comments!

Pelvic Floor + Core at A2 Physical Therapy

Do you pee a little during your workouts? Are you terrified of jumping jacks or jump rope or box jumps or just jumping? Do you avoid running because you might leak?

Maybe it’s not a leaking issue—maybe it’s feeling heavy “down there” after a workout, or a walk, or just being on your feet all day. Maybe you’re not quite sure what’s going on but it’s not how it used to be.

Maybe your core just isn’t the same after having a baby.

Maybe high school sex ed just didn’t cut it and you want to know more about your body.

If you relate to anything I just said, join us for this workshop, because we’re gonna cover all that, and more.

We’ll talk about:

• The pelvic floor: what it is and what it does

• The core—in detail!

• What to do about leaking

• What normal bladder and bowel habits look like

• How to use your pelvic floor during exercise & daily life

• How to lessen pain with sex

• And more!

We’ll incorporate pelvic floor and core exercises throughout the workshop to give you some real-time feedback so your body learns how to incorporate the pelvic floor with movement throughout the day. There will be time for Q&A too!

This is a workshop for you no matter what your exercise and fitness background. It will also be full of incredible information for personal trainers, yoga or pilates teachers, and orthopedic physical therapists who want a little deeper focus on local core activation for your clients.

Ready to join? Sign up at http://bit.ly/A2PelvicFloor

Details:

Open to all self-identifying women.

$15 to join, all proceeds donated to YWCA.

6-8 pm on Thursday, Sept 19

A2 Physical Therapy

3819 6th Ave in Tacoma 

Questions? Hit me up!

I'm Moving to Hilltop!

I’m moving! As of September 1, my treatment space will be located inside Fern + Foster Family Wellness at 1402 S 11th St in Hilltop.

It has always been my dream to work within a multi-disciplinary practice to meet the needs of patients in multiple areas, so this move is VERY exciting for me. Other services provided in the space include massage and acupuncture from Hello Pelvis, lactation services, and midwifery. There will also be classes and workshops across a wide range of topics, including a postpartum movement class taught by yours truly! You can check their calendar of events here.

AND there is a small yoga studio, so no more trying to do yoga and exercises squeezed between a massage table and a chair!

If you’re a current patient, mark your calendar and look closely at your appointment reminders to make sure you head to the right place come September! I can’t wait for you to see it!

Urgency Part 3: Mind Over Bladder

Bladder training: it’s like potty training...yourself. Because really: who teaches us what’s normal once we’re adults? No one. Unless it’s a problem. Then it’s often me (or another Pelvic PT). Just call me your Bladder Coach.

(If you haven’t read Urgency Part 1 & Part 2, head back to them first. It’s imperative to understand what urinary urgency is and why your bladder is giving you funky signals before any of this bladder training makes sense. After you read those, then carry on!)

Here’s how to train your bladder so it listens to YOU, instead of YOU being bossed around. I call these steps “Mind Over Bladder”:

1. When you get an urge, DON’T RUN TO THE BATHROOM. Stop where you are. Sit down if you can. Just don’t head to the loo.

2. Start squeezing your pelvic floor (yes, cross your legs too if you want!). Squeezing your PF actually tells your bladder to chill out and calm down. 

3. Distract yourself. Count backward from 100 by 7’s or recite the Star-Spangled Banner in your head. Try not to think of how bad you have to pee.

4. Stay calm & breathe. An urge is literally a contraction—it will end eventually, no matter how strong it seems to get. Ride it out.

5. Once it’s gone (or *mostly* gone) calmly head toward the toilet. If it starts up again, start back at step #1.

The goal is CONTROL. Your bladder is highly trainable, and it’s used to getting what it wants (to be emptied) after it sends you the urge signal. You need to train it out by separating the urge from the reward. As you practice this consistently, you’ll start to notice more of that normal feeling of FULLNESS instead of the urge, and it will get easier to control.

I know it might sound crazy, but this stuff WORKS. There are countless women who are just handed a pill when they complain of urgency, but best practices recommend bladder training BEFORE medication for urgency. If this is you, try these steps! I’ve helped women wean off of bladder meds they’ve been on for years.

Tried it on your own and didn’t succeed? Reach out for help from a Bladder Coach (aka Pelvic PT). We’re here for you.

Want a FREE Coaching session (aka phone consult?) Click HERE to schedule!

Urgency Part 2: Your Bladder is a Big Fat Liar

In Urgency Part 1 we talked about what Urgency is, and what might contribute to it. Again, an urge is a sudden strong sensation to empty your bladder that is hard to postpone.

What’s so abnormal about this sensation, you might ask? Let me break it down.

Our bladder’s job is to fill, hold, then empty. That’s it. All day long, it moves through that cycle. The walls of the bladder are a muscle. That muscle relaxes to fill and hold, then contracts to empty. It’s a smooth muscle though, meaning you can’t control it—it’s like the muscle of your heart (thank goodness we don’t have to think about contracting that one, right?!).

A normal “full bladder” sensation is a STRETCH, meaning the walls of the bladder stretched or lengthened enough to tell you it’s about full. You can easily ignore this, though, and move on with your day. You’ve had this feeling, right? Right. 

An urge, however, is a CONTRACTION, or shortening, of the bladder walls. Which means it is literally trying to empty, right then and there. No wonder it sends you running to the toilet! What’s the worst thing you can do if your bladder is literally trying to empty? Step your legs apart, right? Walk. Run. Yep, that’s definitely not going to do the job.

This is basically an incorrect signal, and often a false alarm. The strength of an urge is NOT correlated with how full your bladder is. Your bladder is a big fat liar. And the more you follow its command (ie. head to the loo), the more it thinks it’s normal. The bladder is, for better or worse, highly trainable. It squeezes, you run, and it gets reinforced that this is ok. Super annoying.

If it’s trainable, can you train it back, you ask? Absolutely.

How?

The short answer is: stop obeying it! Try to ride out the urge with legs crossed and by squeezing your pelvic floor. If you can wait till the urge subsides, then head to the toilet: you’ve won. Keep doing that and it should start to get easier to control, and sometimes go away completely. 

The long answer: Head to Urgency Part 3 for the full scoop on Bladder Training.

Urgency Part 1: When You Gotta Go

When you gotta go, do you GOTTA GO? Do you feel like your bladder is going to explode every time you put your key in the front door? Does running water send you running to the bathroom?

Urinary Urgency is defined as a “sudden, compelling urge to urinate.” Sure it happens after you hold it for a while, like on a plane or at a movie, which is totally normal. But if it happens ALL THE TIME, and starts to limit your life? That’s a problem. It’s one of those things that a lot of people don’t realize is a problem until they hear that it’s not actually normal.

What causes urgency? There are a few different contributors. The most common is bladder irritants, which are foods and drinks that the bladder just doesn’t like. The big ones are coffee, tea, alcohol, carbonation and artificial sweeteners. (Most of us can relate to hitting the road with a cup of coffee only to stop at the first rest area we come across, amiright?) Others are acidic foods like tomatoes, spicy food, and citrus.

Another big cause of urgency is not drinking enough water. Say what? A lot of people with bladder issues cut down their fluids to AVOID having to pee, but this actually contributes to the problem. If your body doesn’t have enough fluid, the bladder is really unhappy. Why would it want to hold on to super concentrated urine? One easy way to tell if you’re hydrated is to check your output: if it’s smelly, dark urine, you’re probably dehydrated. You want it to be “clear and copious,” as my high school track coach always said (oh the things we remember).

My advice: work toward drinking half your body weight in fluid ounces, mostly water. Don’t like water? Add cucumber or a slice of lemon.

There is usually lot more going on with Urgency, but I don’t have room for it here. I typically spend two whole sessions on educating my patients about how the bladder works and how to retrain it!

If you raised your hand with those first questions, start with looking at what you put into your body (and therefore your bladder). I’ll share more in Part 2, so keep an eye out!

What makes you gotta go? Share in the comments!

Pelvic Organ Prolapse (Part 1)

Let’s talk about pelvic organ prolapse. You might call it a heavy feeling, or a bulge, or say it feels like there’s a “golf ball in your vagina.” You might feel something when you wipe, or you might think stuff is going to fall out. I’ve had more than one woman tell me her vagina is falling out. Oofda.

 Well what’s going on? First of all, don’t worry: your organs ARE NOT falling out. I always say I can fix a prolapse 50% in one visit by just telling my patients that fact. Did I change where their organs are sitting in their body? Nope. But I affected their perception, gave some peace of mind.

Prolapse occurs when one or more of the pelvic organs (bladder, rectum, or uterus) drop lower in the pelvic cavity due to a decrease in support. All of these organs are “suspended” inside the pelvic cavity by ligaments around the uterus. From below, they are supported by the pelvic floor, like a hammock. During pregnancy, these ligaments obviously stretch A LOT. In the most perfect vaginal delivery, the pelvic floor also stretches A LOT. Even with a cesarean birth, the ligaments still stretch, so it doesn’t necessarily prevent prolapse.

As I said before, it often feels like a heaviness or bulge in the vagina. Many women feel this immediately postpartum, then it gets better over the first several weeks. Some women notice it all the time, while others don’t notice it at all. Some feel it more after a workout or a long walk. Sometimes it goes away completely when they lie down. Sometimes it interferes with sex, causes urinary leakage, or causes constipation.

The good thing about prolapse? It’s not going to harm you. As professionals in this area, we care more about how much it BOTHERS you than how severe the prolapse looks objectively. Which is why I can fix one 50% in one visit ;). It’s all about perception. No good doctor should recommend surgery if you aren’t complaining about how it feels.

How is it treated? Start with physical therapy. We can’t necessarily tighten ligaments from above, but we can sure work on strengthening the pelvic floor to improve support, provide manual techniques to optimize organ position, and teach you strategies to minimize discomfort. And we can keep reminding you that nothing’s going to fall out. ;)