The Five Pillars of Pelvic Floor Fitness

Taking care of your pelvic floor health can feel like a huge mountain to climb.

There's the exercises that are hard to remember to do and even harder to figure out if you're doing them right.

There's the conflicting advice, the difficulty in finding the right medical professional to help you, the setbacks and the negative thoughts - why me? will I ever get better? is this my life now? and the trying; the endless trying.

At Sheela, we know that incontinence, prolapse and pain are not normal parts of ageing and there are loads of things that can help resolve your issues. 

When you start researching pelvic floor issues for yourself, it can be totally overwhelming and it can seem like it's impossible to find the information that you're looking for that will help you.

We've been busy learning about all the different ways you can support your pelvic floor health and we've come up with 5 different ways your daily actions can either support or stress your pelvic floor.

These are: how you go to the toilet, how you think, how you eat and drink, how you exercise and how you rest.

Most people do these 5 things every day and by making small adjustments in these 5 areas, we can make a big impact on our pelvic floor health.

The Five Pillars of Pelvic Floor Fitness

1. How You Go to the Toilet

Did you know there's a right and a wrong way to go to the toilet?

When we're little, we learn how to wipe our bums and how to wash our hands but rarely are we taught how to wee and poo. 

Sitting on the toilet for long periods, bearing down, pushing and holding our breath all work against us when we're trying to improve pelvic floor health.

When we sit on the toilet, we need to have our knees 1-2cm higher than our hips.

This allows the pelvic floor muscles to relax and allow the wee and poo to leave the body without stressing the pelvic floor muscles. Then all we have to do is lean forwards, put our elbows on our knees, relax our tummy muscles and breathe deeply. The gentle motion of our muscles as we breathe should be enough to get things moving.

No more pushing, straining or spending a long time on the toilet.

If there's nothing happening; take a break, have a little walk, drink a glass of water and try again later. 

The easiest way to achieve the correct posture on the toilet is to use a toilet step to rest your feet on but you can use anything - a pile of books, some toilet rolls, a bin - it really doesn't matter. 

Weeing and pooing like this takes a lot of strain off the pelvic floor muscles and even reduces the risk of developing haemorrhoids and let's be honest, who doesn't want that?

If you want to know more about pooing properly, read this. 

2. How You Think

The brain and the pelvic floor are connected by thousands of nerve endings all over the pelvic floor which connect to the brain via the pudendal nerve and the spinal cord. These nerves provide a highway for messages to travel between the brain and the pelvic floor.

Our pelvic floor muscles are under conscious and subconscious control which means that they will work without us thinking about it and we can use our brain to influence how these muscles contract and relax.

We have a pelvic stress reflex response which means that if we are under any physical or mental stress (it doesn't have to be pelvic floor related) then our pelvic floor muscles will tense in response and tense pelvic floor muscles can't always perform squeezes quickly or strongly enough to prevent leaks. 

So what does all this mean for you?

Improving your mind/ body connection by meditating, visualising or exercising will all help you improve your ability to consciously relax and contract your pelvic floor muscles when you need to - reducing the stress they're under, allowing you to strengthen them if you want, and enabling you to squeeze and release at will.

Try this visualisation exercise to get you started or read more about the Pelvic Stress Reflex Response here. 

3. How You Eat and Drink

There are a lots of ways what and how you eat and drink can affect your pelvic floor function but there are two main questions to think about when you're looking at your own habits. 

Is what I'm eating and drinking helping support good muscle tone? 

Is what I'm eating and drinking helping making poos that are easy to pass?

Follow these tips to ensure that how and what you eat and drink helps your pelvic floor muscles have everything they need to repair, grow, function well and remove any stress constipation might cause. 

• Sip 2-3 litres of water each day but don't over do it. Use your wee as a guide - it should be pale yellow with a faint smell.
• Include a portion of lean protein for muscle tone in every meal. Lean protein sources include chicken, fish, pulses, beans, tofu, eggs, natural yogurt and nuts (unsalted/ uncooked) and a portion is about the size of the palm of your hand. 
• Ditch the white carbohydrates and switch to brown carbohydrates to up your fibre intake (brown rice, brown bread, brown pasta, etc.)
• Incorporate sources of soluable fibre into your diet (kiwi fruit, pears, prunes, oats, figs, apricots, flax seed, chia seed, beans, barley, etc.)
• Avoid liquids and foods that irritate the bladder (chilli, citrus, fizzy drinks, alcohol, caffeine, etc.)

There's lots more nuance to how what you eat (read this) and drink (read this) affects your pelvic floor function, but these guidelines are a good place to start. 

The bonus is a diet rich in lean protein, fibre rich foods and good hydration is also a great way to support your general health - especially as you age. 

4. How You Exercise

There is a widespread belief that pelvic floor exercise means kegels and we are here to tell you that it doesn't!

Kegels (or pelvic floor squeezes) are just one way to exercise your pelvic floor muscles.

A kegel is an isolated squeeze of the pelvic floor muscles (and no other muscles). There are two kinds - fast and slow. Slow squeeze and holds improve strength and quick flicks improve responsiveness. 

There are a number of reasons why kegels aren't all they're cracked up to be:

• it can be hard to know if you're doing it right
• they're not suitable for everyone 
• if you have a tense pelvic floor, they could be making things worse
• a kegel routine is hard to maintain
• there are lots of exercises that actually recruit more pelvic floor muscle function than kegels (lunges, cat/cow, squats, bridge, etc.)

So if kegels aren't it, what exactly is pelvic floor exercise?

You'll be delighted to know, there's a very simple answer to this one - all exercise can be pelvic floor exercise.

If we get really clear on where our pelvic floor muscles are, how they work, and what that feels like in our own unique bodies, all exercise can be pelvic floor exercise. 

Generally speaking, we squeeze the pelvic floor muscles and exhale with effort and release and inhale as we relax. We can add this pelvic floor awareness to almost any exercise. 

Yoga and pilates are particularly good exercise for people who are working on their pelvic floor as they prioritise posture, core strength and breathing co-ordination - all of which are essential for good pelvic floor health. 

Walking, swimming, and cycling and even lifting weights (mindfully!) are also excellent pelvic floor exercises. 

Impact exercise i.e. anything that involves both feet off the floor at the same time - running, jumping, jumping jacks or burpees can put extra pressure on the pelvic floor so be mindful of these. Consciously squeeze the muscles when you land and stop when the muscles tire (i.e. you leak) and try a different form of exercise. You will be able to build more strength slowly over time. 

5. How You Rest

Finally, we come to my favourite pillar: rest.

Muscles can only heal and grow stronger when we rest. This is because every time we strain a muscle, like when we exercise to the point of fatigue, there are tiny tears in our muscle fibres. When we rest the muscle, our bodies lay down more new fibres in the area which make the muscle stronger than it was before. It's why exercise works - we stress the muscles creating micro tears and the body lays down new stronger muscle to repair it. But it only happens when we rest.

The pelvic floor muscles can only rest when we're lying down. This is because when we're standing or sitting, even if we're consciously releasing our pelvic floor muscles, they're still working hard to support the weight of our organs above them. 

So, if you're trying to improve your pelvic floor strength, all the exercise in the world won't help you if you don't get horizontal for 10 minutes a couple of times a day.

This might look like watching TV lying on the couch instead of sitting, reading a book lying on your bed, answering emails lying on the floor on your tummy or better still doing a short meditation to connect to your pelvic floor. The important thing is to lie down! 

If you'd like to know more about how rest can help your muscle function, read this. 

If you're facing a pelvic floor issue like incontinence, prolapse or pain, pelvic floor health care can seem really intimidating.

We think the five pillars of pelvic floor fitness are a great place to start.

Making small adjustments in these five areas will give you a really good foundation for a healthy pelvic floor.

Following the suggestions above with give you great insight into how your pelvic floor is working for you, build your mind/ body connection, remove common pelvic floor stressors from your daily routines and help you release tension and build strength in the pelvic floor muscles themselves. 

For more accessible, practical content like this, follow us on Instagram (@sheela.ie) and YouTube (@sheelawomen). 

Lastly, if there is a woman out there you think might need to hear any of this, please share.

Pelvic floor issues are incredibly common but not normal and that means there are ways to prevent, manage and treat pelvic floor issues at any age.