This is a summary of a blog by Wendy Powell posted several years ago. It’s still relevant today.
It is estimated that 50% of women of childbearing age will experience some level of Pelvic Organ Prolapse (POP). It is not simply caused by childbirth or having a weak pelvic floor. It’s something still not discussed enough.
What is it? Excessive pressure inside your abdomen and pelvis can build up to the extent that it eventually pushes everything away, outwards and downwards (a prolapse is literally a “falling down”). Many internal organs can be affected: the bladder, large bowel, intestines, vagina or uterus. Prolapse, Hernia and Diastasis Recti (when the muscles of the rectus abdominus, the 6 pack, part) are all conditions which can result from this internal pressure. There are some factors which can make the pressure inside your abdomen high: past pregnancies and obesity can be contributing factors, as can any straining, such as heavy lifting, or violent or prolonged coughing.
How does this relate to exercise in general and to Pilates? Some exercise classes still teach traditional pelvic floor exercises – i.e. bend your knees, tuck your backside under, clench your gluteal (buttock) muscles and squeeze. This may tighten up your pelvic floor muscles in the short term (not strengthen them, just tighten them) but does little to fix your long term ability to keep your internal organs where they are supposed to be. A shortened muscle will tighten up over time, but it is not necessarily strong. A muscle needs to be at full length to work effectively and be strong.
Pilates’ teaching to “engage your pelvic muscles to 30% of their full capacity” will help, but there are still some Pilates moves which are not suitable for someone who has had a POP.
What can I do to correct this pressure in my abdomen and pelvis? 1. Sit on an exercise ball or sit upright (on your sit bones – not slumped back on your tailbone) on a chair. Purse your lips and exhale as you draw your belly button back towards your spine then lift your pelvic floor – right in the middle but don’t ‘tuck your tailbone’ (sacrum) under. Relax as you inhale and repeat. Your shoulders, chest or pelvis do not move, don’t squeeze or clench your buttocks or your inner thighs.
2. Your pelvic floor is connected to the whole system of core muscles. It’s also connected to the muscles on both the insides and outsides of your thighs. Sitting on the exercise ball and doing the contraction above whilst squeezing a cushion between your legs is extra effective. Now try tying a resistance band around your knees and pulling apart as you contract the muscles.
3. Squat. Your glutes need to be strong and your sacrum needs to be flexible, hanging in space, not tucked under. Your pelvic floor muscles are attached to your pubic bone at the front and your sacrum at the back, so if you tuck, then you shorten the distance. Squat every day, at least 10 times. Shins should be vertical, weight through your heels and the outsides of your feet.
4. Isolated pelvic floor exercises have their place. To re-connect and identify the right muscles, you need to isolate and focus on them. On an exhale, try that little squeeze at the front where you pee, then on the next exhale lift the middle, your vagina, then on the next, lift your back passage, imagine drawing your rectum up inside but don’t clench your glutes. Try these pelvic floor exercises a few times to focus on the 3 openings of your pelvic floor and re-connect your brain’s neurons to the muscles.