For decades doctors, physiotherapists, trainers, therapists, you name it, have been hammering away at women-and men too-that if they want to strengthen their pelvic floors or resolve a pelvic floor issue, they must do kegels. A Google search of the pelvic floor will give over 1 million hits. The majority of these hits will all tend to focus on a weak pelvic floor and its associated symptoms. However, the pelvic floor is just another muscle and like any muscle it can be hypertonic/facilitated (overworking) or hypotonic/inhibited (underworking). Coupled with this it is the ‘base of the core’. As a result, if one component of the core is underactive or lazy, the pelvic floor will often be called upon to compensate for this and hence overwork. Have you ever noticed that you tighten around your butt with you go to lift something heavy or when you are stressed? Chances are your pelvic floor is overactive and tight. If a muscle is already overactive , why continue to overwork it by doing kegels?
Have you a pelvic floor issue?
Ask someone what a pelvic floor problem presents as and the usual reply you will get is leaking, usually associated with childbirth. However, there are many other symptoms. These are:
o Urgency to go to the bathroom while exercising or lifting
o Clenching of the butt or pelvic floor when stressed, lifting something or standing around
o Pain low down around the sacrum and coccyx
o Waking up at night to go to the bathroom
o Painful intercourse
o Poor core control
Anatomy + Function
The pelvic floor is a large sling of muscle composed of various smaller slings and separates the abdominal and pelvic cavity. These muscles form the sphincters that control bladder and bowel function. The sling also holds up and supports all the abdominal contents and organs. The pelvic floor also provides resistance to increase intra-abdominal pressure during strenuous activities. It has an intimate relationship with the diaphragm in this manner. Consequently, a dysfunction in the diaphragm will often affect the pelvic floor and vice versa.
The pelvic floor forms the floor of the core and is part of the Deep Front Line. As a result, any dysfunction in another part of the core will often cause the pelvic floor to be called upon to compensate, resulting in overactivity of the pelvic floor. Likewise, weakness or underworking of the pelvic floor will result in another core stabiliser having to pick up the slack. The pelvic floor itself can also be split in two, one portion that acts anteriorly on the bladder and one posteriorly on the bowel. I commonly see one portion overworking for the other that is underworking.
Like other areas such as the jaw and diaphragm, the pelvic floor can be recruited to assist in core stability when performing something like a max lift or those last few meters of a sprint. This is normal and effective. If this pattern of recruitment extends however into simple daily activities we can cause a problem and some of the symptoms noted above can become more evident.
As we can see, this structure can be somewhat complex in nature. Due to this, one cannot box a pelvic floor issue into simply weakness with kegels as the fix. The plank does not fix all core issues and the kegel does not fix all pelvic floor issues. Assessment is necessary and treatment needs a more holistic approach encompassing breathing, core stability, hip and pelvic mobility and awareness.