by Ali Bennatt, PT

The muscular floor of your pelvis provides support for your bladder, intestines and uterus. Your pelvic floor also helps keep urine from being released accidentally through your urinary sphincter.

Much like a cardboard box on moving day, the pelvic floor is stronger when supported from the bottom. Without this support, pressure can cause the box to sag. Over time, or with enough force, the bottom of the box may give way and spill its contents… often at the most inconvenient time.

As a middle school PE coach, Jill was always on the run. Chasing kids and balls all day left little time for the most personal of needs. Over time, Jill developed some bad habits that led to problems emptying her bladder. Eventually, embarrassing urine leaks forced her to ask for help.

Bad habits are a huge contributor to pelvic floor weakness and can lead to incontinence, urinary urgency, and even pelvic organ prolapse.

At work, Jill had little time for bathroom breaks. Always in a rush, she got in the habit of pushing her urine out as quickly and forcefully as she could. As time went on, it took more and more pushing to empty her bladder.

In addition, Jill had a chronic cough that often lasted for several minutes at a time. When she coughed, her belly would push out, indicating that she was not supporting herself. This meant that her bladder and the muscular floor of her pelvis were being strained and weakened with each and every cough. Jill’s posture was also very poor, as she tended to slouch forward and tuck her pelvis. This put her bladder and pelvic floor in a very vunerable position, and made it even more difficult for her to use her muscles for support.

Generally it is important to avoid straining when your pelvic floor is unsupported. Straining increases abdominal pressure causing downward stress on pelvic organs and forced lengthening (distention) of the pelvic floor muscles.

Proper exercise can help. Like many women, Jill tried Kegal exercises to help correct her bladder problems and increase sexual function. Unfortunately, research shows that most people do not do Kegal exercises correctly or effectively.

Fortunately, there are five simple things you can do to protect your pelvic floor.

1. Relax to release. When its time to pee, take your time. Avoid bearing down or pushing your belly out to empty your bladder more quickly. Relaxing the pelvic floor tells the bladder to contract and empty itself; bearing down causes the pelvic floor to tighten closing off the urethra and preventing the bladder from emptying effectively.
2. Don’t blow, cough or sneeze on the pot. These actions fight against the reflex that tells your pelvic floor to relax while you are sitting down to pee. Over time these confusing signals make it more difficult to purposely contract your pelvic floor for support, and much like the cardboard box, it may eventually give way under stress.
3. Support your seat. Try to sit or stand with your legs close together when you are blowing your nose, sneezing or coughing. Sitting is ideal because the seat underneath you helps to support your pelvic floor and resist downward pressure. You can also learn to pull in the pelvic floor and lower abdominal muscles for added support.
4. Strain leads to bladder stress. Treat constipation and avoid anything more than a gentle strain when initiating a bowel movement. Chronic straining with constipation can create significant pelvic floor weakness.
5. Use good posture and body mechanics. Slouching increases pressure on pelvic organs creating pelvic floor strain and abdominal weakness. When getting out of bed, roll to your side first, then use your arms to assist you in sitting up (jack knifing straight up causes strain). You should also hinge at the hips (squat) to get up and down from a chair. Finally, be sure to use your legs and keep objects very close to your body when pushing, pulling or lifting heavy objects, like our cardboard moving box.

It took some time for Jill to change her habits. We worked together for several months to help her learn to relax and take her time in the bathroom. Jill also learned to support herself when she coughed by using good posture and pulling in her pelvic floor and lower abdominal muscles to resist the downward pressure on her bladder. Eventually Jill was able to empty her bladder without straining.

By reducing the strain on her pelvic floor and consciously using her muscles for support, Jill was able to build back the strength in her pelvic floor and her bladder issues resolved.