Top 7 Habits to Improve Your Pelvic Health
1. Practice breathing properly!
You may be thinking, “Wait... are you seriously telling me I’m breathing wrong??” Not exactly- there are many muscles involved in moving air in and out of the lungs, and it’s easy to rely too heavily on some and not enough on others, which can lead to various problems, including pelvic floor dysfunction.
The diaphragm, a muscle spanning across the bottom of the ribs and separating the abdomen from the chest cavity, is a major player in filling the lungs with air during optimal breathing. Imagine that the abdomen is a “cannister” with the pelvic floor muscles forming the bottom, abdominal and back muscles forming the walls, and the diaphragm forming the top. The diaphragm moves similarly to an umbrella as we breath, flattening and moving down to pull air into the lungs during inhalation and lifting and folding during exhalation.
Why does this matter for the pelvic floor? Because the diaphragm and pelvic floor move in tandem to maintain a steady internal pressure in the abdominal “cannister.” A stiff/underused diaphragm = a stiff/underused pelvic floor. How can you tell whether you’re moving your diaphragm to breath? Watch and feel the movement of your stomach. Place one hand on your chest and one on your belly as you inhale through your nose and imagine that you are sending the air down into your stomach, expanding your belly as you do. Your chest and shoulders will also rise, but with dysfunctional breathing they may be the only areas that move significantly. Practice diaphragmatic breathing by slowly inhaling through the nose and exhaling through the mouth, focusing on seeing or feeling the belly expand first before the chest rises. It is normal for the chest to rise and ribs expand in all directions, just be sure the belly is also moving outward during inhalation (not staying still or moving inward). If this is difficult while standing, try practicing while lying down or in a mirror first.
2. Daily pelvic floor stretches
Did you know that urinary leakage and many other pelvic floor symptoms can be related to muscles that are too tight? Short, tight, and tense muscles are also weak- muscles generate power by moving, and muscles that can't move well can't do their jobs effectively. In the pelvic floor, this can mean difficulty with holding back pee, gas, and/or stool. One of the best things you can safely do for your pelvic floor is make sure it is flexible and mobile, and pelvic floor stretches are generally easier to get the hang of than strengthening exercises. My favorite pelvic floor mobility exercise to teach is a seated version of the yoga position “child’s pose.” Sitting on a chair, spread the knees as wide apart as possible, then bend forward from the hips as far as you can while resting your arms on your knees or reaching for your feet, holding the position for 2 minutes at a time. You can intensify the stretch and help your brain connect to your pelvic floor by practicing some diaphragmatic (“belly”) breathing while in this position.
3. Drink more water
We constantly hear we should be drinking plenty of it, but how much is enough and will you then have more leaks? The current recommendation is to drink about half your body weight in ounces of fluid daily, at least half of that being water. It may seem logical that drinking less will lead to fewer urinary symptoms, but being dehydrated won’t prevent leaking and can even make symptoms worse. No matter how little we drink we can't keep the bladder empty enough to eliminate leaking, and having very concentrated urine is irritating for the sensitive tissue of the bladder wall and can lead to urinary tract infections. The bottom line is that avoiding fluids or drinking too many alternatives to water (including carbonated water) can increase bladder discomfort or spasms and is unlikely to make a big difference in the amount of leakage you experience.
4. Practice urge control
Urinary urgency, or experiencing sudden and overwhelming or difficult to control urges to urinate, is not normal and you CAN combat these sensations. These episodes can result from a sudden spasm of the bladder or a misfire of the nerves connected to the bladder, but there are strategies to normalize the signals and activity. Techniques like being still, sitting or using a hand to apply pressure to the pubic area, slowed calm breathing, rocking your feet from heels to toes, and contracting the pelvic floor muscles strongly can all encourage the bladder to relax and reduce urgency and leakage. In pelvic floor therapy we can learn and practice these strategies to regain bladder control.
5. Start tracking void timing
How often we pee isn’t usually something we think much about until there’s a problem, and by then it’s hard to recall what it was like when things were good. We also tend to change our voiding habits and behaviors to manage pelvic floor symptoms and avoid embarrassment. Unfortunately, the brain and bladder will adapt to any behavior changes and establish that routine as the new normal; so, if you begin going to the bathroom every 30 minutes to keep your bladder as empty as possible and avoid leaks, your body will begin to tell you that you need to go every 30 minutes and it can become difficult to hold it for longer than that. On the flip side, regularly over filling your bladder can lead to overflow leakage when the bladder is at capacity or cause your body to ignore the early signals that the bladder is filling, leaving you little time to make it to a toilet. Although many factors can influence this, with proper, steady hydration the typical time interval between urinary voids is about 2 to 4 hours. If you’re currently urinating more often than every 2 hours, try stretching the time between bathroom trips by 5 to 10 minutes initially and work your way towards the 2 hour mark slowly. If you tend to get busy or distracted and routinely exceed 4 hours between voids, try setting a phone timer or alarm to remind you to take a bathroom break.
6. Sit fully on the toilet
The musculoskeletal system is designed for many muscles to work together to accomplish tasks. Various muscle groups are programmed to “co-contract,” meaning that when one muscle activates, other muscles will automatically also activate. This is true of the pelvic floor muscles, and when we use our legs to hover over a questionable toilet seat, the pelvic floor muscles will also be engaged. This is bad news when trying to urinate, because passing urine requires the pelvic floor muscles to relax and lengthen. The brain is great at recognizing patterns and using that information to plan for and predict the future, so if we routinely link attempting to urinate with activating the pelvic floor muscles we can create or worsen pelvic floor dysfunction. Be prepared for public bathrooms by carrying a supply of flushable seat covers, or line the seat with toilet paper before sitting.
7. Meditation and mindfulness exercises
Between parenthood, careers, school, relationships, deadlines, politics, traffic, and all the other stressors that bombard us on a daily basis, mental health is an often-neglected aspect of wellness. The sympathetic nervous system, often called the “fight or flight” response, produces many body changes when activated, including increased tension in the pelvic floor muscles. Our bodies don’t differentiate between a work deadline and an axe murderer- to the body, stress is stress. Chronic stress, episodic stress, and history of trauma or PTSD can contribute to pelvic floor tension and dysfunction. Meditation and mindfulness exercises are an excellent tool to reset the nervous system and activate the counterpart to the “fight or flight” response, the parasympathetic nervous system. This encourages relaxation, a return to homeostasis (body “baseline”), and therefore a relaxation of tense muscles. Even spending 3 to 5 minutes per day listening to a guided meditation (many can be found on sites like Youtube and Spotify) can provide health benefits, and don’t worry if you feel like you’re “not good at it” or it’s not easy or enjoyable. Practicing anyway can help the brain and body get used to the process, which eventually becomes easier.
What questions do you have about pelvic health? Let me know in the comments or send me a message from the contact page!
~Dr. Katrina
This post is not meant to serve as or take the place of medical evaluation and treatment and is strictly for informational purposes. Please consult with your physician or consider scheduling an evaluation for the most appropriate and personalized care. If you are having a medical emergency, please call 911.