Strong pelvic floor muscles

Submitted by louiseds on May 2, 2010 - 6:11am
Body: 

Hi Everyone

I've been thinking again about pelvic floor muscles and how important it is for them to be strong. Strong is good, right?

I am not so sure. I think active and responsive is good, but strong?

When a woman has POP her pelvic organs come back and downwards. There are basically two or three levels of pelvic floor muscles some just inside the vaginal opening, some further up. If your organs are low, and you do something that pushes them lower, and contract your pelvic floor, I think the inner PF muscles contract above the bladder and/or uterus, rectocele or bladder, and push them down further, which would aggravate tension on fascia that is already compromised, potentially compromising it further. This would be a bit like putting your hand around a half-inflated balloon and squeezing. See what happens to the bottom part of the balloon! Physiotherapists give us exercises to teach our pelvic floor muscles to engage automatically, whenever our transverse abdominus muscles engage.

I have been running around with DH for the last few still evenings, burning last year's bleached, uneaten grass in some of our paddocks, to stop it from blocking sunlight on newly emerging pasture plants (after it eventually rains - sigh). We operate with a firefighting unit, a rake each, and a box of matches. Sometimes we have to move quickly to put out flames that jump the firebreak we have dampened, or the wind picks up and spreads the fire faster than we thought. It is not always possible to move in a controlled manner, and the POPs can take a bit of a battering, which means that I have been feeling a little 'low' again. Sometimes, uncontrolled movement just happens, and that's when strong pelvic floor muscles can clamp together hard, potentially trapping a low cervix, or bladder, or rectocele below the PF.

If the PF muscles are not so strong they will not contract so hard and push the organs down further.

Does anyone have opinions on this?

Louise

ps, I am not particularly worried about this setback. They happen sometimes, but are always better after some TLC for a couple of days.

granolamom

May 2, 2010 - 1:59pm

I think you may be onto something louise
my grasp of the anatomy is not as thorough as yours, but what you say makes sense intuitively to me.
I think it also depends on how large the 'cele is and its position, as well as the direction of other forces (like breath and activity of other muscle groups, etc), but maybe this is one reason some of us seem to aggravate our prolaspes with traditional kegels?

and I'm loving the visual of you running around with a rake and some matches! never a dull moment for you!

Christine

May 2, 2010 - 5:33pm

That is certainly how I envision the pelvic floor and how it is talked about in gyn texts. How the professional reconciles kegels with the major pf function of helping things go out I cannot fathom.

Gosh, Louise, that sounds like dangerous work. Grass fires can be treacherous, but it sounds like you know what you're doing. Praying for rain.

C.

louiseds

May 2, 2010 - 8:21pm

Yes, it is the whole 'letting things out' function, combined with nutation of the pelvis to 'tighten the drum' that makes the pelvic door such a miracle, depending on whether it is in 'letting go' mode or 'keeping in' mode. They are as essential as each other.

If the pelvic floor muscles were not the web of thin, sinewy muscles that they are, what would they look like?

If a physiotherapist designed a new pelvic floor, what would s/he put in, and what would be changed?

I think the answer to both questions is , "Nothing"!

Granolamom, have you ever experienced pelvic organs descending when you Kegel with the organs too low? Perhaps that is why women are usually taught how to do them while lying on the back with the organs flopped back and out of the way?

Grass fires? Yes, it can be dangerous indeed if you do it with any significant wind, and at midday when there is no cool, damp, evening air coming in. We also have our portable firefighting unit (full water tank, pump and long fire hose) in the paddock with us. Because there are only two of us we damp down about a metre of grass all round the area we are burning, before we light up, and we only burn small areas at a time. We also have 2 metre wide, bare fire breaks around most of our paddocks, and there are bare patches of ground under trees and various other spots where the sheep camp. There are permanent firebans in place from November through to the middle of March every year, then you can get burning permits from mid-March through until mid-April, then it is pretty cool and safe after that.

Yes, burning is fun, but we don't like to burn more than necessary to allow germination. That is just wasting carbon that is better in the ground. The bare ground that results from a good burn is also an erosion risk. The ability of even a small fire to grow and destroy is also an awesome reminder about the fragility of life.

L

MaryEve

May 2, 2010 - 9:26pm

Can someone explain to me if there is a different way of doing kegels that would be beneficial? I am just wondering because I will be going to PT and hopefully, some of the exercises will be beneficial. Has PT helped anyone? Thanks.

louiseds

May 2, 2010 - 9:42pm

Hi MaryEve

Try plugging "kegels the right way" into the search box, and you will pull up Christine's post as the first hit. The Search box is invaluable for finding stuff that we have all written over the years.

A physiotherapist helped me with waking up my PF muscles after a difficult second pregnancy, and I did initially learn pelvic floor exercises at antenatal classes the first time, but I have not visited a physio specifically for help with POP. Can't really see the point for me. This site and Christine's book have been my primary help for POP, teaching me more about how my pelvic region and whole body work, than anybody else.

Louise

bad_mirror

May 2, 2010 - 11:06pm

When I first discovered my cystocele, I went to a Mayan abdominal massage practitioner. There was an initial interview/assessment before the massage. When I told her I had recently retired from a long career as a professional ballet dancer she exclaimed, "Oh! Make sure you DON'T do any kegels! Your pelvic muscles are probably overly strong and tight." At the time, I was too overwhelmed to ask more about this but . . . Fuel for your fire, Louise?

louiseds

May 3, 2010 - 12:03am

Hi Badmirror

I have wondered the same thing myself. However, I now think that the pelvic floor muscles and the abdominal muscles are more alike than I previously thought. I think both sets of muscles are like trampolines, and both reflect, *and* absorb, intraabdominal forces, the abs at the front, the PF at the rear. They are both thin and sinewy.

Most serious dancers have stronger abdominal muscles than the rest of us, so I think they *need* strong PF muscles to match, or else there is unbalanced 'give' in the abdominal and pelvic regions (which are not separated by an active structure such as the diaphragm that separates the chest from the abdomen). A tight, flat drum on the front doesn't absorb much intraabdominal force, instead bouncing/reflecting forces back into the body. These reflected forces will eventually put a lot of pressure on the PF, so the PF has to be able to absorb the forces and bounce them back again, rather than distending and allowing the pelvic organs more movement and stressing their fascial supports. I think these forces are all ideally absorbed by the sacrum and transferred to the ground via the pelvic bones, the legs and the feet. Some may also be resolved upwards via the diaphragm into the chest and resolved by the muscles between the ribs (though I am really just thinking out loud on this last bit).

If the abdominals are less 'toned' I think the PF can be less 'toned'.

Posture is the other factor. With Zip &Tuck both PF and abdominals are not working at their functional length. They both need to be contracted to work. In WW posture they are both operating at their functional length, in slight tension, where they can both reflect and absorb.

I cannot understand why the physio would say a dancer should not do Kegels. Can you explain it?

Louise

heavenly

May 3, 2010 - 7:05am

Question....I know there is a lot of talk about diet for many reasons. My question is in the poo area. I know it is not good to lift, strain or the like but many times I have to give give a little push to start things moving, am I alone or is this ok. Just sit and have it all work without a little push is hard most of the time. Not much push, just a nudge, will this do more damage. Really concerned Sometimes I can hardly make it to the toilet but this is not the norm.

Thanks

Aussie Mum

May 3, 2010 - 7:25am

Hi Heavenly
I do too (have to give a little push) - especially in the evening. I was reading another thread here somewhere about this, and seems a few have probs with it getting harder as the day goes on. I have also found if I don't drink enough fluid that by the evening things are not looking so good, and like someone else said, I end up leaving it till the morning and wonder if this is such a good idea..... Sometimes I don't push, I just really,really relax and breathe and that works, or twisting my body from side to side, or leaning forward. There is a thread on this somewhere I was reading today I think (sorry can't recall if recent or old thread). Maybe someone else recalls the thread? I have also found (re diet) that if I overdo the fibre (had way too many prunes yesterday) it does not help my bowels, in fact makes me go too frequently and not necessarily more easily either, whereas 1-2 prunes a day prevents constipation - along with lots of water!!

heavenly

May 3, 2010 - 7:54am

Never so concentrated on my poo or posture in my life or thought I ever would be.LOL My POO is the topic of my husbands and my discussions now and think he is getting tired of it. Just rolls his eyes at me now. He does not get it I know!!

I never go to the bathroom at night, always a couple of times in the morning. We all have our schedules. Really don't have a problem going poo if I eat right and hold posture but usually give the nudge to sent it on its way.LOL Damn never thought this would happen to me, I am so active and I thought healthy. I am ordering Schueslers cell salts today to help strengthen and rebuild tissue. Also buying liquid minerals from the health food store. Make it or break it I say friend. We are in this together, thank you for responding to my request. Keep in touch!!
Maybe should have named the topic "THE PUSH."

kiki

May 3, 2010 - 1:51pm

what are Schueslers cell salts? sounds interesting!

aza

May 4, 2010 - 1:57pm

Hey Badmirror, what did you think of the mayan abdominal massage? I've heard great things about it being able to break adhesions around the belly and reproductive organs.
I think you're spot on with these ideas, Louise. Interestingly, in my experience with birth the worst POP I have seen was with a women with a very unyielding pelvic floor. I have always attributed her POP to a extremely long crowning stage but this piece of the puzzle makes even more sense.

Aussie Mum

May 4, 2010 - 8:37pm

Hi Aza
I put a question out there re if others were really fit prior to their prolapse, only a few replies but most said they were not (not that this was a major survey or anything!).
How do you tell in the birth that it is the pelvic floor that is unyielding? Interesting thoughts...

bad_mirror

May 5, 2010 - 2:10am

Hi Aza. First off, I *heart* midwives! I had the worlds greatest home birth with one very wonderful midwife!! As for the Mayan massage -- well when it comes to POP, I don't think it helps but I also doesn't think it hurts. Does that make sense? I don't think it will cure POP, but it is a nice womanly thing to do for one's self that may promote circulation or somesuch. I had a great practitioner/ teacher which I think is important. But to be honest, I've not done it in about 9 months, and my POP continues to improve. I am in nursing school and barely have time to brush my teeth at night let alone spend an hour massaging my abdomen LOL. But I like it and hope to make it part of my routine again.

bad_mirror

May 5, 2010 - 2:32am

Sorry I must have missed your post on this, Aussie Mum. I can reply that yes, I was extremely "fit" prior to POP. I was a professional ballerina for over a decade and had acheived intermediate level of Bikram Yoga, which is rather rare -- I took two Bikram classes per day in addition to my work as a dancer. I biked, hiked, and participated in the Pilates classes provided by my ballet company as well. These things may have contributed to my pp cystocele, but I can't say for sure. I don't think that POP can be ever attributed to any one thing. It is due to complex of various factors IMHO.

aza

May 5, 2010 - 3:19am

Wow bad_mirror, amazing background you've got! And I totally agree that there are various factors out there (or in there;) that influence POP or any of the other maladies of symptoms the body might throw at us.

i thought about the theory in this thread while driving today, and I realised that with the few POP's I have seen, such as the one I mentioned below, I assumed that they occurred because the pelvic musculature and fascia was too compromised to hold things in place. I think a hyper-toned, non-elasticed musculature can definitely contribute to this. Think of the body builder physique with utter inflexibility and inability to even touch their toes. What good is lifting massive amounts of weight if you can't grasp your own feet? "What doesn't bend, breaks" (name that tune;) and the same can be said for our tissues. So I have always figured that prolapse in super-fit women happens because it didn't bend nor stretch and therefor broke, or lost the integrity of the tissues to contract and engage and play their part in the arrangements of the organs. Of course, with my broadened perspective now, thanks to WW, I see things a bit differently but still think this is an accurate perception.

Bad_mirror, I reckon most midwives *heart* birthing women like you! I am so happy to hear of such a positive birth experience. There are so many negatives out there. Stay home and be safe :)

Aussie mum, the work that I do with women (and the work you are about to discover , I think?!) includes not getting to the point where you worry during the birth that the pelvic floor is unyielding. Women can work with their tissues and ligaments and get to know their vaginas and entire pelvic cavity just as as well as every other part of the anatomy, which sort of makes sense at such a time as birth. You can learn how your body responds to intense pressure, such as a baby's head coming through your pelvis, and what you might be able to do help your muscles release tension and make the whole process a bit gentler. This is not perineal massage...that is just the tip of the iceberg... it is a totally different level of communication with your body.

And for what it is worth, I don't think this sort of thing is necessary to birth. Your body - give enough time and the right support - will birth. But getting to know your body on this level while pregnant cannot be anything other than helpful, at the very least, and more often than not it is phenomenal information to have about your core as woman (the true core, not the core muscles core ;)

And also, I have never, ever seen a perineum that is unyielding. Time, support and ways of working with the body might be needed but never once have I seen a perineum who would not budge. So why, exactly, are so many women being cut? I just don't get it.

louiseds

May 5, 2010 - 6:53am

Why do doctors always cut the perineum? Think about it. It is because they have never seen a perineum yield properly, because it is always cut before it yields. They create their own reality.

How rational is that thinking?

It is a bit like cutting out the abnormal growths or cells because they might turn cancerous. Might as well just skin all Australians because most of us will probably develop skin cancer at some time in the future. I better start learning what it is like living in a Glad Bag.

L (shrugs)

Christine

May 5, 2010 - 3:21pm

Thank you for starting it, Louise, and the comments are brilliant. I want to join in, but it will be a day or two. Lots going on here. C

Aussie Mum

May 5, 2010 - 6:36pm

I just had a birth debrief counselling session where we went over everything. Very helpful - I was mentioning to the counsellor about how I actually refused to be cut, I suppose as I felt overwhelmed that my worst nightmare of up in stirrups was happening. I ended up having forceps and a 2nd degree tear, but also the resulting issue of some tissue bridging which has caused some ongoing discomfort made me wonder if maybe I should have had the cut after all. In the session yesterday it was reassuring to hear that a cut is always 2nd degree anyway and I do recall the ob. saying that I was lucky as the tear was about the same as the cut would have been!!! What a crazy woman, not having a cut with a forceps delivery!!!
Episiotomy is the norm these days, you are right Louise, how would they know if they just cut as routine! Aza I have heard that in the past some hospitals were letting women tear as a tear will go along a path of tissue which will heal easier, is this true?
Oh also Aza, re-visiting this birth made me think further about if I could have a natural birth again, I am still too scared, I am having the session you referred to next week - so will see how I feel after this!

aza

May 6, 2010 - 6:54am

Yeah Lu, I totally agree. I was a bit sleep deprived when writing that post and what I meant to say was not why, but how - how on earth can so many people slice into women's bodies like they are simply cutting a fingernail? And yes, they create their own reality of what they see, but they also create the reality of unsafe practices for women and unborn babies that makes cutting *almost* make sense. If you have medicated a woman and fetus, altered the course of labour with drugs with serious side effects (tetanic contractions and severe fetal distress, to name only a few) and then add in the horrific practice of forceps or vacuum extraction....well, cutting a perineum to save a babies life that one has endangered or attempting to guide the length and depth of a tear that is probably going to happen because a baby is yanked out with a machine or instrument of some sort...well, it starts to make a tiny bit of sense, in some parallel universe sort of way.

Lovely Aussie Mum, good on you for refusing to be cut. Maybe something to think about rather than being cut or not is how to put yourself in a situation where this is not even a question. It starts before you decide about the inevitable damage to your bits, it starts with birth interference or not. The cascade of interventions is a fast and strong one for sure, and cutting a woman's genitals often happen along that cascade. It rarely happens in unhindered out of hospital birth, darlin. Look deeper into the statement of 'episiotomy is the norm these days' because while this is true for obstetrics and surgical birth, it most definitely is not true of non-medicalised out of hospital birth. Episiotomy will never, ever be the norm in my world or the world of many other people who work with birth. Big hugs to you as you work through this! I know it is so difficult.

louiseds

May 6, 2010 - 8:57am

I remember being told that if I didn't want an episiotomy I might tear. That an episiotomy is easier to suture than a tear, and that an episiotomy is a controlled cut (!). There is a small window of opportunity for episiotomy, and they are not going to wait a couple of minutes while I decide whether or not to have one. I had a fully managed labour too, stirrups, epidural and the works. I could not have pushed DS1 out to save myself. Fully managed was what they did because I had pre-eclampsia. I don't want to think there was any other option. I don't know any woman who has taken the risk of active birth and no epidural with pre-eclampsia and come out of it with mum and baby OK. I was lying back with my pelvis closed, and my coccyx squashed towards my pubis. No way could a baby squeeze through that small space. He had to be extracted, and the epi was needed to get the forceps in, as much as get the baby out. It sickens me even now.

Yeah, well if I didn't have the Chinese meal which puffed me up like a balloon, maybe I wouldn't have got pre-eclampsia. These are questions that simply cannot be answered.

ps, I went on to have two completely normal, well nearly normal, active labours and births, in hospitals, with everyone surviving just fine. I wouldn't have changed them for the world. Amazing.

L

aza

May 7, 2010 - 12:01am

It all boils down to prevention before the only options appear to be intervention. Who knows if your first birth could have been different, pre-eclampsia can be very serious if it leads to toxemia (just like a stretching perineum can be very serious if it leads to tearing) but where is the information and tools to take care of blood pressure issues and congested perineums before they become problematic? Which, in both cases, rarely need to.
I know that people have good hospital births, thankfully, but to me it is a a bit of russian roulette and bit like going to a gyn with a high rate of hysterectomies and hoping to get away without surgery. And if you are lucky enough to not be told you need the knife, then where are the other options and tools and skills for treating the problem in the first place?

granolamom

May 9, 2010 - 3:48pm

louise -
when I initially found my pop I of course started kegeling like mad and I'm pretty sure it aggravated and/or brought about my rectocele. I could feel the pull on the posterior wall of my vagina. even now, when I do kegels the way I was shown (lying down) I feel lots of bulginess kind of like a tampon for a while afterwards.
then again, I may not be a 'typical case' if there is one, due to some extensive tearing I dont' think my pelvic floor muscles are really attached where they are supposed to be anymore. not sure if that's even anatomically possible, but that's my sense.

and re mayan massage, my mw showed me how to do that and it feels really good. don't know if its actually beneficial but it makes my uterus feel tight for lack of a clearer description. I don't do it anymore because of the IUD though.