Whenever I instruct my group fitness class to skip, jump or perform burpees, there’s always at least one participant who decides that this is the perfect moment for a bathroom break. As a midlife mother of three, I completely understand this. It’s the reason I always make a last minute dash for the toilet before beginning a workout myself 🙂
Stress incontinence (the leaking of urine while engaging in higher impact activities, heavy lifting or in response to coughing, sneezing and laughing) is relatively common amongst women of a (ahem) particular age. Thankfully, it’s a reversible condition that can be counter-acted with some fairly simple exercises.
Today, I’m thrilled to have my friend, neighbour, fellow fitness professional and core function specialist Krista Dennett share her thoughts and expertise on re-training your core and re-building core strength in midlife. You can read more about Krista’s background and approach to fitness on her website, KDFitness.ca.
Fitknitchick: Other than stress incontinence, what are some other symptoms of a weak or dysfunctional pelvic floor?
Krista Dennett: While leaking is the most common form of core dysfunction (affecting approximately 1 in 4 women over the age of 35), there are several other issues that can seriously impact our quality of life.
If you have incontinence, or are experiencing any of the issues I’m discussing below, it’s in your best interest to seek the help of a pelvic floor physiotherapist. As well, you need to take a step back with some exercises and learn to re-connect and retrain your core for it to work correctly in movement.
- Low Back Pain and Hip Pain
Often where we feel the most pain in our back is directly related to the weakest point of our abdominal area in the front. Without strength and support of the deep internal abdominal muscles, the transverse abdominals, and a lack of proper alignment from poor posture – we place constant strain on our back.
Poor posture plays an integral role in our core function, as our internal core team of muscles can’t function in an optimal manner when out of alignment. We tend to rest the weight of our bodies on our joints, particularly our hips and knees, which contributes to our weakened core muscles.
Hip pain can be a result of several issues. Particularly scar tissue from a C-section or on the pelvic floor muscles caused from natural birth. These are both very common, and fortunately they can be reversed. A form of massage called myofascial release, softens the scars tissues. Allowing the pelvic floor muscles to working correctly, promotes core support and allows your hips to move freely.
- Diastasis Recti Admonis (DRA)
DRA is the separation of your rectus abdominis muscles, and is the common trait of a ‘mummy tummy’ pooch. This separation happens naturally in pregnancy, as the connective tissues holding our abdominals together relax and stretch over 9 months. The connective tissue can regain its integrity and strength, provided we re-connect and retrain our internal core system of muscles. Rushing back into exercise too quickly can prolong and even prevent these tissues returning to their pre-pregnancy state.
- Pelvic Organ Prolapse (POP)
POP occurs when the bladder, uterus or bowel presses against the vaginal wall and ‘fall out’. One of the roles of the pelvic floor muscles is to keep our pelvic organs in place. Signs or symptoms of POP may be frequent trips to the bathroom and peeing for short periods of time, you may also experience an intermittent stream of urine, or when you stand up you feel like you still need to go. You may also feel pressure in your pelvic floor, or the sensation that something is falling out.
FKC: What are the primary causes of pelvic floor dysfunction in midlife women?
KD: One of the most common causes of pelvic floor dysfunction in aging women occurs as a result of hormonal changes during the perimenopause phase, which cause the pelvic floor muscles to weaken. Without continually connecting to and strengthening the pelvic floor, over time women will experience issues such as leakage, back pain and prolapse.
Other factors that can contribute to pelvic floor dysfunction include obesity, build-up of stool in the bowel (constipation), bladder infections and high impact exercises (including jumping, running and burpees 😉 )
FKC: What are ‘kegels’ and how effective are they for strengthening the muscles of the pelvic floor?
KD: Kegels are definitely the buzzword among doctors and fitness professionals. While the kegel is a good thing, it’s very limiting and not necessarily the right thing for all women.
First, it’s very common for women to clench their anus and butt cheeks and hold their breath when performing a kegel. Coordination of breath and core activation are key when learning to activate the pelvic floor muscles.
Second, kegels are an isometric contraction, meaning they are typically done without any movement in the rest of the body. We need to learn to activate our core in movement.
Learning how to activate your core correctly first requires an understanding of what makes up your true internal core system of muscles, how posture and breath play an integral role in performing a contraction correctly, and how the contraction should actually feel.
Here is a quick tip to get you on the right track to learning core activation:
- lie on your back with knees bent
- place one hand on your belly and one hand on your rib cage
- breath in filling your belly with air and feeling your rib cage expand
- as you exhale, draw your belly button in gently and imagine you’re gently picking up a blueberry with your vagina
FKC: What are your ‘go-to’ exercises for improving pelvic floor strength and function?
KD: Our core is the stabilization centre of our body and responsible for all movement. Therefore, pretty much every exercise will require some level of core activation and strength.
As a Bellies Inc. Core Trainer, I’ve been using the ‘core confidence program’ with my clients for 2-1/2 years. The purpose of the program is to re-connect to your internal core system, and improve pelvic floor strength. Through my experience of working with women one-on-one, and using the Bellies Inc. philosophy for core exercise, I’ve created an 8-week program to achieve foundational core function. The base of the program is broken up in to three areas of focus:
- Release Work: identifying and releasing overworking muscles taking over for our dysfunctional core team
- Core Connection: a series of core connection exercises to correct posture and pelvis alignment, build a mind-connection to your core, and teach activation in movement
- Core Strength: progressive exercises that are safe and effective in building your core strength from the inside-out
Here are three moves, one from each of these categories that will help you start building a connection to your true core system:
C-Stretch (Release Work)
The most common muscle group to take over for a dysfunctional core system is our obliques; these are part of the abdominal family that run down the sides of our torso. As well, tight hip flexor muscles pull our pelvis out of alignment and affect the optimal function of our core. The C-stretch is great to release these overworking muscles.
- Lie on your back with your legs and arms outstretched.
- Move your shoulders over to the right and use your right hand to gently pull the left arm into an arc towards the right.
- Move your feet to the right and cross your left ankle over the right. Do not allow your left side to lift – gently press your left hip into the floor.
- Hold the stretch until you feel tension start to release.
- Without changing position, switch ankles so your right ankle is over your left, and again hold the stretch until you feel a change.
- Imagine the side of your body getting longer and releasing out of your hips.
- Feel length along the entire left side, holding for 60 to 90 seconds or more if needed.
- Switch sides and repeat.
Bridge with Ball (Core Connection)
This exercise is the first move in the Bellies Inc. Core Confidence series, and is the first step to help you connect to your core and activation in move.
- Lie on your back with knees bent and feet on the floor pelvis width apart. Spine is in neutral, there should be a gentle curve in your low back with your pubic bone in the same line as your hip bones.
- Place a ball between your knees.
- Exhale to engage using the core visualization indicated above, and then lift bum off the floor pressing the hips up to the ceiling keeping bum untucked.
- Inhale down and release the engaged pelvic floor
Crouching Tiger (Core Strength)
This move is ideal as the first step to teaching your core to activate in a plank position. The crouching tiger reduces the amount of load on your core. In doing so, you can better prepare your core to support this exercise as you progress to planks in the future.
The purpose of this move is to create a strong, stable platform. Imagine placing a rectangular piece of foam on the legs of a table, without strength it dips in the middle. The crouching tiger helps you start firming up the ‘table top’ and creating an overall strong core from front to back.
- Get onto all 4s with a neutral spine, hands under shoulders and knees under hips
- Place a ball or towel between your knees
- Using core breath, exhale using your core cue to engage/activate your transverse abdominals and squeeze the ball lifting knees 2 to 3 inches off the floor
- Inhale to expand and release, and lower your knees to start
To progress this move, start holding it for 5 to 30 seconds. Be sure to breath through the move, gently contracted and release your pelvic floor as you inhale and exhale. Once you can comfortably hold this move with little pressure on your wrists and toes, you are ready to progress to planks!
FKC: How might women incorporate these exercises into an existing strength and conditioning program?
KD: The release and core connection exercises can be done daily as a way of solidifying the mind-body connection to your core system. In the 8-week core training program I include a variety of release exercises depending on your body’s needs and overworking muscles; and the core connection exercises progress from lying, seating to standing moves. This program is not meant to replace your workout, but rather compliment any exercise you’re currently doing.
As for the core strengthening exercises, I always do them at the beginning of a workout after warm up. Since our core is working in almost every exercise, it can get tired by the end of the workout. So, to build core strength focus on it first.
The best method to prevent or eliminate common pelvic floor dysfunction issues, such as leaking, is to re-train and re-connect to your internal core system. Our core works without us even knowing it, and anticipates our every movement. If the right muscles aren’t doing their job, the wrong ones automatically take over.
If you’re experiencing leaking, back or hip pain, or pressure on your pelvic floor, it’s advisable you stop doing any high impact exercise moves, seek help from pelvic floor physiotherapist, and learn how to train your core correctly. By taking the time to address the issues, you will be able to reduce and even eliminate them, and get back to doing the exercises you enjoy.
You can find foundational information, and build a better understanding of the importance of core function, in my eBook ‘Finding Your Core Strength, What every women needs to know.’
And coming this fall, my 8-week core program ‘Finding Your Core Strength: Building Your Foundation’ will be available online for everyone!
(You can sign up for email updates to Krista’s newsletter and be the first to hear about registration for this brand new program here >> KDFitness)