An extremely common issue for postpartum women is pelvic floor weakness. This is a main contributor to the common postpartum complaint of leaking pee.
Jumping on the trampoline, sneezing, or even laughing can all cause urine leakage with a weak pelvic floor.
So how do we correct this?
Unfortunately, the solution that gets the most press is…kegels.
However, kegels are NOT always the solution. And, for some women, kegels can actually make the situation worse.
So let’s dive a little deeper and uncover the root cause of your pelvic floor weakness.
WEAKNESS DOES NOT ALWAYS MEAN UNDERACTIVE MUSCLES!
This first point can be a little hard to understand, but it’s important!
Pelvic floor weakness does not necessarily mean that your muscles are underactive (a.k.a. On permanent vacation).
For many women, pelvic floor weakness is caused by OVERactive pelvic floor muscles (a.k.a. Muscles that are working really hard all day long).
What you need to remember: Whether the muscles are not engaging enough, or are holding on for dear life, both of these scenarios cause weakness in the pelvic floor.
What happens in an underactive pelvic floor?
Underactive pelvic floor muscles are weak in the same way a muscle that never gets exercised is weak. If you never strengthen your bicep, that muscle will be weak. If I place a 10 lb weight in your bent arm, that arm is going to immediately drop to your side. Your muscle doesn’t have the strength to contract against the load of that 10 lb weight.
The same thing can happen with your pelvic floor. If your pelvic floor muscles are underactive, they have trouble contracting fully and/or holding that contraction. So when you sneeze, and put a large amount of pressure on the pelvic floor, the muscles can’t hold the contraction and you likely end up pee-ing yourself.
Underactive pelvic floor muscles do not have the strength to contract fully. This means that when you sneeze, they don’t have the strength to protect you from leaking.
What happens in an overactive pelvic floor?
Overactive pelvic floor muscles are weak because they are trying to contract all the time.
Imagine your bicep again. If I ask you to bend your arm and squeeze your bicep for the entire day, that muscle is going to get TIRED because it is working so hard.
Then when I place a 10 lb weight in your hand, the arm will, again, drop to your side. In this case, it will happen because the muscle is so worn out from the work it has been doing that it has become weak. Weak from overactivity.
This is similar to what happens in an overactive pelvic floor. Overactive pelvic floor muscles are weak because they are being held in a constantly contracted position. So, when you sneeze, those pelvic floor muscles can’t contract fully because they are worn out from being in a constant state of contraction. The end result…you pee yourself!
Do You Have An Underactive or Overactive Pelvic Floor?
How do you know what is happening in your pelvic floor?
First, it’s helpful to see a physiotherapist who specializes in pelvic floors. They will be able to assess you internally and tell you exactly what is happening in your muscles.
However, that isn’t always accessible or possible. Luckily, there are some other ways you can get a sense of what is happening in your muscles.
Signs of an underactive pelvic floor
If you have an underactive pelvic floor, you likely feel that, when you kegel, it is hard to hold that engagement. You likely feel quivering in the muscles and that the muscles stop engaging relatively quickly.
You may also feel like tampons don’t stay in as well as they once did. Or you may feel that you have less sensation during sexual intercourse.
Also, the muscles often reflect the personality of a person. So, if you are more of a relaxed, Type B, person in general, it’s likely your pelvic floor muscles are underactive.
Sound like you? You’ll want to check out this post on strengthening a weak PF.
Signs of an overactive pelvic floor
If your pelvic floor is overactive, you might feel that you can’t kegel. Or that nothing happens when you try to do a kegel. This happens because your pelvic floor is already contracted!
You may experience pain during intercourse or find it difficult to insert tampons.
You may find it difficult to take deep, full breaths. This happens because the tightness in your pelvic floor prevents the diaphragm from dropping down, which makes your breaths more shallow.
You may find that after you pee, you feel you haven’t emptied your bladder completely and you have to pee again.
Also, odds are you tend to be more of a Type A personality that tends to hold tension in her body, in general.
If this sounds like you, you’ll want to check out our post about how to relax an overactive pelvic floor.
How to Properly Strengthen Your Pelvic Floor
I’ll have more posts coming on these topics soon but, in general:
Underactive Pelvic Floor
If you have an underactive pelvic floor, you want to get your muscles back in the game.
Practicing kegels, and other core strengthening exercises, can be very helpful for you.
Overactive Pelvic Floor
If you have weakness caused by an overactive pelvic floor, your priority is to first get your pelvic muscles to relax.
The best way to do this is by focusing on deep breathing that reaches all the way to your pelvic floor.
If you are getting a nice deep breath, you should be able to feel that when you inhale your pelvic floor relaxes and expands.
For more tips on releasing an overactive pelvic floor check out our post here.