Since January is the month for resolutions, let's resolve to take back control of our continence. What will it take? As with all resolutions - it will take commitment and consistency. Here's our plan:
Make a commitment to 8 pelvic floor lift and holds/day. This is a 2 step exercise. Elevation of your pelvic floor is the tough part of a pelvic floor contraction. The easy step is to squeeze your sphincter muscles as if to stop the flow of urine or the passing of gas. The tough part and possibly the most important part is to draw your pelvic floor up into your pelvic outlet as if there is a string attached from your belly button down to your pelvic floor and you are attempting to pull it up. You want to work to draw your pelvic floor up higher and higher for a full 8 count before you release. When performing a correct pelvic floor elevation, you will feel your belly button draw in as your pelvic floor elevates and you will keep breathing. It is easiest to train pelvic floor elevation lying on your back because you don't have to work against the force of gravity, but you eventually want to challenge your body in seated and standing positions that are more functional.
Find your neutral spine posture and hold it. You will need a mirror for this. What you are looking for are the natural curves of your spine. These are a slight concave curve of your neck, a gentle rounding of your upper back, and again a slight concave curve of your lower back. Exaggerations or lack of any of these curves will take you out of your neutral spine positioning and compromise your pelvic floor function among other things. When finding your neutral spine you want to stand with soft knees, meaning that your knees are not locked back, but rather have a slight wiggle to them. Next, with your hands on your hips, rock your pelvis, tucking your buns under and then rock it back so you are standing in a gymnasts posture. Once your have found this extreme (gymnast) position, bring your pelvis back slightly to find a neutral position. In this neutral spine position, draw your belly button in to tighten up your own inner corset around your spine. Holding neutral spine throughout your daily activities puts your pelvic floor muscles at the optimal length/tension ratio so that it is better able to react and contract when you lift, cough, or laugh. Let it be your goal to become aware of those times when your posture is the worst, i.e working at the computer, standing in line, etc and consciously find your neutral spine at these times. With consistency, your body will naturally hold this neutral position.
Commit to 3 exercises/day to work specific muscle groups. Rotate exercises working your low back , your inner thighs, your transversus abdominus, and your hip rotator muscles. All of these muscle groups are important because they all work to either stabilize while your pelvic floor elevates or they work in a coordinated fashion along with your pelvic floor muscles. I often refer to a pelvic or abdominal basket weave to give patients a good visual of the interdependence of these muscles. Weakness of the front, back, sides, or floor of the pelvic/abdominal basket effects the basket as a whole, so we have to strengthen all the parts. You can learn effective strengthening exercises for all of these muscle groups from a local physical therapist or personal trainer.
Drink more water! This is the exact opposite strategy of what many women do when incontinence begins, but it is exactly what a healthy body needs. The nutrition experts say eight cups or 64 oz of water/day (and I agree) but lets simplify - how about drinking one full glass of water before each meal and you will be giving your body what it needs. Why? Because water helps to flush your system. There are many foods we eat that can be bladder irritants. The irritation of our bladder can lead to increased urge as well as increased frequency of urination. The equation is simple: the more water in our system, the more diluted these irritants will be.
Get out and move! - Exercise in the form of walking, dancing, swimming, etc. is beneficial to your neuromuscular system, your cardiovascular system, your respiratory system, your digestive system, and your brain function. In a nut shell, I can't give you a negative effect of exercise, so don't get pulled into the downward spiral of pelvic floor muscle weakness (incontinence) limiting your activities which leads to more pelvic floor and coordinating muscle weakness (worse incontinence). Our bodies are amazing and our muscles, our bones, and to some degree our cartilage will adapt to the stresses placed upon them. So as long as you care committed to a specific pelvic floor strengthening routine and good posture, a regular cardiovascular exercise routine will help condition your entire body and help you toward your goal of resolving incontinence.
Tasha Mulligan MPT, ATC, CSCS
Creator: Hab It: Pelvic Floor dvd
Published On: January 11, 2010