Start your New Year's workout without exacerbating pelvic floor dysfunction

Happy New Year!
You might be starting a new workout routine to shape up this 2019, but don't let your new regime contribute to pelvic floor problems like urinary incontinence and pelvic pain.

What exercises can contribute to pelvic pain?

Kegels and Clenching the Pelvic Floor
Kegels can cause more tension in the pelvic floor, leading to more pelvic pain.
Men with prostatitis and pelvic pain should avoid doing kegels (pelvic floor strengthening).
Women with pelvic pain and pain with sex should also avoid doing kegels unless directed by their doctor or pelvic floor therapist. 

Cycling
Women and men with pelvic pain sometimes report that cycling is problematic.  
If you love cycling but find it exacerbates your pain, come in to see a therapist, who can help modify cycling postures to keep you pain free.

You can also look for a bike seat that is more comfortable for your body. There are bike seats that have center cutouts, are noseless, and made with soft material. The idea is to find a seat that places less pressure on the prostate, perineal, or vaginal area.

Pilates
Many are under the impression that they should always be contracting their abs and pelvic floor. We see many patients that take pilates 1-3 times a week, and outside of their class they are continually "pulling in" their core. They've trained their body to maintain the contraction so well, that they have lost the ability to relax their abdominal and pelvic floor muscles. In someone that has chronic pain, the abillity to let the muscles go is an important concept we train from Day 1.

What exercises can contribute to urinary leakage and prolapse?

In generally higher impact sports, such as basketball, volleyball, and tennis have a higher prevalence of urinary incontinence vs. lower impact sports such as swimming and pilates (de Mattos Lourenco, et al., 2018).

The following list outlines more:

High impact activities- 58% Prevalence of UI
Basketball
Football
Gymnastics
Tennis

Medium impact activities- 30.46% Prevalence of UI
Hockey
Judo
Running
Softball

Low impact activities- 12.64% Prevalence of UI
Bodybuilding
Cycling
Hiking
Pilates
Swimming

What You Can Do

Exhale with Movement
One common cause of incontinence and increased intra-abdominal pressure is holding your breath. Breathe when you move!

Try exhaling with the following activities:

• Exhale with exertion during exercise. Examples: when you bring a hand weight up into a bicep curl, exhale. When you push up from a squat, exhale.      
• Exhale while lifting (weights, baby, groceries)
• Exhale while pushing anything (luggage, strollers, trash can, shoveling)
• Exhale while you are bending over during exercise (stretching)
• Exhale while reaching overhead (pull-ups, weight lifting)

Steady Breath While you Exercise
Practice a steady breath throughout your entire exercise session. This will help regulate your abdominal pressure and the pressure placed on your bladder.

Some Tips:

• Relax shoulders and upper chest
• Breathe in slowly to fill the lungs fully
• Breathe out slowly through the mouth or nose
• If you are feeling winded, bring your heart rate back down until you can breathe easily again

See A Pelvic Floor Therapist
Pelvic floor therapists are trained to fully assess what is going on in your body in order to fully understand what is contributing to any urinary incontinence. Check out our post on what to expect on your first visit for more info. 

More Tips for Urinary Incontinence and Prolapse

Participate in lower impact activities 
Low impact activities have less prevalence of urinary incontinence. Activities like weighlifting, cycling, hiking, pilates, yoga, and swimming are examples of low impact activities. If you are in an aerobics class that requires a lot of jumping, modify the movement to stay stationary on the ground: an example would be instead of jumping jacks, you could do squats or alternate bringing one leg out at a time.

Strengthen Your Pelvic Floor
Check out this past blog post with yoga poses to strengthen the pelvic floor. 
Are you doing low impact activities and still leaking? You might need to strengthen your pelvic floor. Don't know how? Check out the Femina blog for articles about kegels. Still confused? Come see us! The pelvic floor therapists at Femina PT are ready to help, make an appointment today. 

More Tips for Pelvic Pain

Participate in exercise that reduces stress
Yoga can help reduce tension in the body as well as the pelvic floor. Check out this past blog post for a short sequence for pelvic pain. 

Lengthen the Pelvic Floor
Those with chronic pelvic pain often have pelvic floor tension. You can lengthen the pelvic floor with manual stretching, with the help of tools including your hand and medical dilators. Confused or intimidated? Come see a pelvic floor therapist! Pelvic floor therapists are trained to fully assess what is going on in your body in order to fully understand what is contributing to your pelvic pain. Check out our post on what to expect on your first visit for more info. 

Resources
De Mattos Lourenco, Matsuok, Baracat, Haddad. 2018. Urinary incontinence in female athletes: a systematic review. International Urogynecology Journal 29(12):1757-1763.