BE STRONG: BUILDING STRENGTH FROM THE INSIDE OUT ©2015 National Association for Continence

BE STRONG:BUILDING STRENGTHFROM THE INSIDE OUT

©2015 National Association for Continence

Objectives

Learn the anatomy of the pelvic floor

Understand the role of the pelvic floor and bladder control

Discover your core from the “inside out”

Learn how to enhance pelvic floor muscle function

Incorporate the pelvic floor muscles in your daily activities

First Layer (urogenital diaphragm)– Bulbocavernosus, Ischiocavernosus,

– Superficial Transverse Perineal

Second Layer– Comprised of fascia to support the

urethra

Third Layer (levator ani)– Pubococcygeus, Iliococcygeus,

Puborectalis

– Coccygeus, Obturator Internus

Sources: 1. https://anytimeyoga.wordpress.com/2011/11/06/core-anatomy-pelvic-

floor/2. http://www.pelvicphysiotherapy.com/learning-centre/pelvic-floor

Clitoris

Vagina

Urethra

Sphincter ani externus

Know Your Pelvic Floor

The Pelvic Floor Works With Your Inner Core‒ Diaphragm: the dome shaped

muscle used for breathing‒ Transverse Abdominus: the

deepest layer of the abdominal muscles used for stabilization of the spine and pelvis

‒ Deep Multifidus: the deepest layer of the back muscles used for stabilization of the spine and pelvis

Source:http://fitforreallife.com/2015/02/training-the-core-how-a-physio-looks-at-building-your-core-stability-plus-3-core-stability-exercises-you-can-do/

Diaphragm

MultifidusTransversus abdominis

Muscles of pelvic floor

Know Your Inner Core

Why Are These Muscles Important?

Support for the Abdominal Organs: “Holding Things Up” Appreciation for Sexual Intercourse: “Use It Or Lose It” Bladder and Bowel Control: “When You Gotta Go” Stabilize the Pelvic Girdle: “Your Inner Core”

When Things Go Wrong…

If the pelvic floor is too tight…‒ Muscles have too much tension in them; they are not able to

contract or relax at a normal rate, making them weak If the pelvic floor is too loose…

‒ Muscles lack tension and are too lax; they cannot contract and are weak

‒ If some muscles are too loose and weak, other muscles will often overcompensate

“Are my pelvic floor muscles too tight?”

Some symptoms of pelvic floor tension include:‒ Constipation‒ Painful intercourse‒ Pelvic pain ‒ Inability to empty your bladder completely ‒ Painful urination

If you experience these symptoms, it is recommended you see a pelvic floor physical therapist prior to starting any strengthening program

“Are my pelvic floor muscles too loose?”

Some symptoms of pelvic floor weakness include:‒ Urinary incontinence‒ Urinary urgency/frequency‒ Stool and gas incontinence‒ Pelvic organ prolapse or the dropping of your organs through your

vagina‒ Sexual dysfunction‒ Pelvic girdle pain

This presentation will focus on pelvic floor weakness that comes from muscles that are too loose.

Types of Incontinence

Urinary Incontinence– “Any involuntary leakage of urine that is a social or hygienic

problem and is objectively demonstrable”

– Affects 1 in 3 women

– Impacts women typically between the ages of 15-64

– Only 25% of these women seek help

Stress Incontinence– “Involuntary leakage on effort or exertion, or on sneezing or

coughing”

– Most common type of incontinence

Types of Incontinence

Urge Incontinence– “Involuntary leakage

accompanied by or immediately preceded by urgency”

– Often referred to as an “overactive bladder”

Mixed Incontinence (both stress and urge)

What Causes Pelvic Floor Weakness?

Pregnancy/delivery Trauma to the pelvis/abdominal wall Lack of pelvic floor/inner core exercise Abdominal/gynecological surgeries Bearing down/straining on the pelvic floor in daily life Obesity Menopause

How To Find Your Pelvic Floor

Cues to contract the RIGHT muscles• Tighten the muscles around your vagina like you are stopping the

flow of urine• Pretend that you are sucking a marble up from your vaginal opening• Try tightening your muscles so you are bringing your pubic bones

and tailbone together or trying to bring your SIT bones together

40% of women are doing Kegel exercises incorrectly!


Get familiar with yourself…‒ Use a mirror to see the muscle lift of your pelvic floor‒ Self Evaluation (yup, get up close and personal)‒ Urine Stop Test


Common mistakes ‒ Tightening the buttock muscles ‒ Tightening the inner thigh muscles‒ Holding your breath‒ Sucking in your belly

Remember, this is a gentle contraction. If it feels like you are trying too hard, you probably are!

Myth About Kegels

Your pelvic floor needs to be able to work like any other muscle in the body. It has to:‒ Contract‒ Relax‒ Elongate

Muscles need to be able to go through their entire range of motion in order to be strong!

It’s Not Just About Tightening!

Taking Your Kegel To The Next Level

When activating your pelvic floor muscles, make sure you can feel yourself tighten, relax, and elongate. Note: When elongating your pelvic floor, don’t strain

Pretend that your pelvic floor is an elevator. If your pelvic floor is at rest at the ground, tighten and lift up to the 2nd or 3rd floor, then relax back down to the ground. From the ground, see if you can elongate your muscles down to the basement.

Coordinating the pelvic floor with your inner core

Now that you know how to find your pelvic floor, here comes the tricky part…

The Amazing Diaphragm

When you inhale deeply, your diaphragm pushes down into your abdomen, allowing your pelvic floor to relax

INHALE = pelvic floor RELAXES

When you exhale, your diaphragm returns to its resting position and your pelvic floor contracts

EXHALE = pelvic floor CONTRACTS


Diaphragm

Multifidus Transversus abdominis

Muscles of pelvic floor

The Amazing Diaphragm

It is important that you are aware of your diaphragm. Observe that a big, relaxed, cleansing belly breath results in belly rising.

• Place one hand on your upper chest and one hand on your belly. • Breathe in deeply- a big belly breath. If you are doing this correctly,

you should feel the hand on your belly move, not the hand on your upper chest as much.

• Now do this again and feel what is happening in your pelvic floor.

It’s Not Just About Sit-Ups and Crunches

Those exercises are just one-dimensional and only work the more superficial abdominals

We need to work the entire core, in all planes of motion, which means finding the deeper, inner-most muscles

Layer 1: Immediately below the skin - Rectus Layer 2: External & Internal ObliquesLayer 3: (deepest) Transversus Abdominus


Transverse abdominis

Internal abdominal oblique

External abdominal oblique

Rectus abdominis

Myth: Sit ups and crunches are all I need to do to get a flat tummy and work my abs.


Find your Transverse Abdominus muscles by tensing your lower, inner-most abdominal wall while continuing to breathe.

• Bring your belly button back to your spine• Hug your abdominal organs with your

lower abdominals• Like you are trying to get into a pair of

slightly tight jeans


Core Activation: “On All Fours”

• Start in tabletop position (hands and knees) with the hips and knees at 90 degrees.

• Press hands into the floor and engage the transverse abdominals.

• Lift arm up towards the ceiling. • Hold for 5-10 slow breaths.• Option to extend the opposite leg behind you

with foot on the ground, or leg in the air.


Core Activation: “Bridges”

• Flatten your spine and press your pelvis up toward the ceiling, rolling up one vertebra at a time.

• Keep the pelvis level.• Hold for 5-10 slow breaths. • Option to lift one heel or foot, keeping the

pelvis level.


Core Activation: “Clamshells”

• Lay on your side with knees bent. Roll the entire trunk slightly towards the floor so you feel the abdomen engage.

• Keep heels together as you lift the top knee. You want to feel the action in the rear end, not the front of the hip. (If you are feeling the action in the front of the hip, try rotating your trunk closer to the ground.)

• Repeat 20 times on right and left sides.

Putting It All Together

If you feel some tension in your low back as you contract your transverse abdominus or even feel that you lifted your pelvic floor…you got it!

This is the ultimate coordination of transverse abdominus, deep multifidus, diaphragm and pelvic floor

Use Your Core Throughout The Day

Use your deep inner core with every day activities such as:‒ Lifting ‒ Going from sit to stand‒ During other exercise‒ Coughing/Sneezing

‒ Squeeze before you sneeze - “the knack”

Finding Balance

There are 45 muscles that attach to the pelvis! It is important to help optimize the pelvic floor function by

balancing the strengthening with stretching of other muscles surrounding the pelvis

Let’s practice stretches for some of the more commonly tight muscle groups

Finding Balance

Piriformis Stretch

• Lay on your back with knees bent.• Place your right ankle on your left

knee.• Reach for your left thigh and pull it

towards your chest to feel a stretch in the right buttocks.

• Repeat on other side

Finding Balance

Hamstring Stretches: Downward Facing Dog

• Start in Table Top (hands and knees).• Send the sit bones back to where the wall

meets the ceiling, keeping the back straight.

• While breathing in this posture, visualize the tailbone reaching toward the ceiling during inhalation, allowing the pelvic floor muscles to release.

Finding Balance

Hamstring Stretches: Active Hamstring Stretch

• Stand with feet wider than hip distance apart and knees bent.

• Clasp hands and place elbows above the knees. Inhale.

• Exhale, begin to straighten knees, keeping the back straight, and raise the pelvis toward the ceiling.

• Extend the knees to feel the first sensation of stretch in the calf/posterior thigh.

Finding Balance

Hamstring Stretches: Standing At Step

• Place heel on the step with your toes pointed up to the ceiling

• Hinge forward at your hips, so you feel the stretch in the back of your leg.

• Repeat on opposite side.• Option to use a strap to deepen stretch.

Finding Balance

Adductor Stretch

• Sit tall, with the bottoms of your feet together, your ankles open wide.

• If your knees don’t open to the ground, place pillows or blocks underneath to help support them.

• For a deeper stretch, hinge forward from your hips.

• This move can also be done in a lying down position to be more restorative.

Finding Balance

Hip Flexor Stretch

• Stand with your feet hip distance apart, left leg in front.

• The left knee is bent, knee aligning over the ankle and second toe.

• The right knee is straight.• Press the pelvis forward and tuck your tail under

to feel a stretch in the front of the right hip.• Repeat on the opposite side.

Finding Balance

Deep squat position for pelvic floor relaxation

• Standing with feet hip width apart, squat down to lower the pelvis below the knees

• If this is too difficult, practice laying on your back, making a deep squat position by pulling knees toward chest, and out to the sides.

• Use your hands to hold and support your legs.

Finding Balance

Pelvic Floor Decompression: Legs Up The Wall

• Lie on your back, and slide your bottom as close as you can to the wall.

• Place your straight legs up the wall.• If this is difficult, place a pillow under your

hips.

Are You Aligned?

http://highpointetn.com/high-pointe-blog/are-you-a-donald-duck-or-pink-panther/

Alignment is key in optimizing your pelvic floor and deep inner core function.

Finding the body’s position of natural ease avoids overworking certain muscles unnecessarily.

• Keep your rib cage over your pelvis• Keep your spine and pelvis in a neutral

position, not tucked underneath you (Pink Panther) or tilting your pelvis forward (Donald Duck)

Questions?Questions?

Help Us Help You!!

The National Association for Continence is a not-for-profit providing education and support to those touched by incontinence. We are proud to partner with your instructor to offer this free class on pelvic floor health.

Before you leave, please sign in with your instructor to receive the NAFC Newsletter, “On The Go”, and to pledge your support to NAFC.

Please DONATE to NAFC at www.nafc.org, so that we may continue to provide programs and support like the class

you attended today!

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BE STRONG: BUILDING STRENGTH FROM THE INSIDE OUT ©2015 National Association for Continence