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Pelvic floor, low back pain and urinary incontinence

Updated: Apr 4, 2021

First of all, what is the pelvic floor? The pelvic floor muscles make up a big part of our body's core, the foundation for all movement, balance, stability and flexibility. (1) It is a group of muscles and ligaments which support the bladder, uterus and bowel. The openings from these organs pass through the pelvic floor and it attaches to your pubic bone at the front and the tail bone at the back and ultimately form the base of your pelvis.


What do the pelvic floor muscles do? They support your pelvic organs and prevent problems such as:

  • incontinence (the involuntary loss of urine or faeces)

  • prolapse (lack of support) of the bladder, uterus and bowel.

The pelvic floor muscles also help you to control bladder and bowel function, such as allowing you to ‘hold on’ until an appropriate time and place. If they are weak, holding on might be found very difficult.


What causes pelvic floor muscle weakness? Some of the common causes of pelvic floor muscle weakness are:

  • pregnancy

  • childbirth – particularly following delivery of a large baby or prolonged pushing during delivery

  • being overweight

  • constipation (excessive straining to empty your bowel)

  • persistent heavy lifting

  • excessive coughing

  • changes in hormonal levels at menopause

  • growing older.


What are the symptoms of pelvic floor dysfunction?

- increased frequency of urination (over 6-8 times per day)

- leaking urine when coughing, sneezing, laughing, exercising or exerting oneself

- pain with intercourse or penetration

- difficulties inserting a tampon

- can´t make it to the toilet in time


What does this have to do with low back pain?

Research shows that the primary muscular impairment in people with low back pain is not one of lack of strength but rather motor control of the deep muscles of the trunk, such as the transversus abdominis, the segmental fibers of the lumbar multifidus, the pelvic floor and the diaphragm. (2) There is also increased pelvic floor dysfunction in individuals with low back pain compared to those without low back pain. (3)(4)


One study demonstrated that 78% of the women with LBP also experience urinary incontinence(UI) and the prevalence of UI and pelvic floor dysfunction were greatly increased in the group with LBP. (5)

Studies also demonstrate that treatment focusing on pelvic floor improves low back pain (1) as well as urinary incontinence. (6)


This highlights the importance of the inclusion of pelvic floor exercises in ones exercise program when it comes to low back pain and urinary incontinence.


How is pelvic floor weakness managed?

- Kegel exercises have been recommended to strengthen the pelvic floor muscles since the 1950s. (7) However, contracting the pelvic floor without relaxing it will shorten these muscles, which may aggravate pelvic floor dysfunction. Longer pelvic floor muscles give the tone necessary to hold urine, open for a baby, and enjoy other benefits, like good sex and holding our insides where they belong.

- A neutral pelvis is recommended while walking and standing. Doing an anterior pelvic tilt, while stretching into squats and down dogs, is suggested for a longer pelvic floor span.

- Bird dog, plank and leg lifts should also be evaluated as alternative exercises to kegels as they affect the pelvic floor strength and length similar to Kegels (8)

- The most common approach is to use pelvic floor contraction exclusively or in combination with increased levels of overall physical activity (7)

- It is recommended to do additional abdominal muscle training to optimize the strength of the pelvic floor muscles (7)

- Alternative methods such as yoga and pilates are also considered effective (7)


So how do you contract your pelvic floor?

Step 1 - While standing in the shower, insert one or two fingers into your vagina and focus on drawing the pelvic floor muscles upwards. You should feel a squeeze and a lift around your fingers. Imagine to stop yourself from passing urine. Step 2 - Now tighten the muscles around your front passage and back passage as strongly as possible and hold for three to five seconds. You should feel your pelvic floor muscles ‘lift up’ as you do this and feel a ‘let go’ as the muscles relax. Repeat ten times or until you feel your pelvic floor muscles fatigue.


Below are some additional exercises that focus on contracting your deep abdominals as well as your pelvic floor.


Pelvic Tilt

On your back, keep your knees bent and your arms down by your sides. As you exhale, tuck your tailbone under so your lower back is flat on the floor. As you tuck yourtailbone under, squeeze your pelvic floor. Repeat 10 times.





Bridge Tilt

On your back with your knees bent and your arms down by your side. Exhale as you tuck your tailbone under and slowly lift your hips up into a bridge. Squeeze your pelvic floor on the way up, exhale as you lower your hips back to the ground relaxing your pelvic floor. Repeat 10 times.



Alternating Foot Lifts

On your back, keep your knees bent and your arms down by your sides. As you exhale, tuck your tailbone under so your lower back is flat on the floor. As you tuck your tailbone under, squeeze your pelvic floor and lift one leg up to 90 degrees. Relax your pelvic floor as you lower the leg down. Repeat with the other leg and to it 10 times per leg.


Foot slides

On your back with your knees bent and your arms down by your side. Exhale as you tuck your tailbone under and slowly slide your foot until it is straight. Squeeze your pelvic floor on the way down, inhale as you return the leg and relax your pelvic floor. Repeat on the other side. Repeat 10 times with the same leg before you do the other leg.


Bent knee fall out

On your back with your knees bent and your arms down by your side. Exhale as you tuck your tailbone under and slowly let one leg fall out towards the side without letting the other hip move off the floor. Squeeze your pelvic floor on the way out, inhale as you return the leg and relax your pelvic floor. Repeat 10 times with the same leg before you do the other leg.


All of these exercises form part of my pregnancy e-book. Buy them here to get the full benefit of the exercise programs based on where you are at in your pregnancy journey.

PERIFIT

If you still struggle with contracting/relaxing your pelvic floor or you just want quick results try the Perifit to help combat your incontinence and other pelvic floor issues.

This is an easy and fun way to strengthen your pelvic floor by doing kegel exercises to control video games. When you contract your pelvic floor the bird goes up, and when you relax it the bird goes down.

Use my discount code EMMA for 15% off or order via this link https://perifit.co/discount/EMMA



References:

1. Bi, X., Zhao, J., Zhao, L., Liu, Z., Zhang, J., Sun, D., ... & Xia, Y. (2013). Pelvic floor muscle exercise for chronic low back pain. Journal of international medical research, 41(1), 146-152.

2. Wittaker, J. (2004). Abdominal ultrasound imaging of pelvic floor muscle function in individuals with low back pain. Journal of Manual & Manipulative Therapy, 12(1), 44-49.

bdominal ultrasound imaging of pelvic floor muscle function in individuals with low back pain. Journal of Manual & Manipulative Therapy, 12(1), 44-49.

3. Arab, A. M., Behbahani, R. B., Lorestani, L., & Azari, A. (2010). Assessment of pelvic floor muscle function in women with and without low back pain using transabdominal ultrasound. Manual therapy, 15(3), 235-239.

4. Dufour, S., Vandyken, B., Forget, M. J., & Vandyken, C. (2018). Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskeletal Science and Practice, 34, 47-53.

5. Eliasson, K., Elfving, B., Nordgren, B., & Mattsson, E. (2008). Urinary incontinence in women with low back pain. Manual therapy, 13(3), 206-212.

6. A., Kheslat, S. N., & Oskouei, A. E. (2016). Effects of stabilization exercises focusing on pelvic floor muscles on low back pain and urinary incontinence in women. Urology, 93, 50-54.

7. Marques, A., Stothers, L., & Macnab, A. (2010). The status of pelvic floor muscle training for women. Canadian Urological Association Journal, 4(6), 419.

8. Siff, L. N., Hill, A. J., Walters, S. J., Walters, G., & Walters, M. D. (2020). The effect of commonly performed exercises on the levator hiatus area and the length and strength of pelvic floor muscles in postpartum women. Female pelvic medicine & reconstructive surgery, 26(1), 61-66.

9. The Royal Women´s Hospital. (2019). Pelvic Floor Exercises. The Women´s. https://www.thewomens.org.au/health-information/fact-sheets

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