When it comes to exercise, we tend to focus on how it impacts our knees, hamstrings and back. But the effect on our pelvic health needs to be considered too, particularly for women. Vhi Senior MSK & Pelvic Health Physiotherapist, Dawn Cantwell, explains common pelvic floor issues and how women can protect their pelvic floor muscles while keeping active. 

What is the pelvic floor?

The pelvic floor is a layer of muscles that run from your pubic bone (at the front of your body) to your lower spine (at the back of your body). These muscles support and hold your pelvic organs in place, including your uterus, vagina, bowel and bladder. 

What are some common pelvic floor issues?

When a woman has pelvic floor dysfunction ─ including muscles that are weak or too tight ─ it can present in many ways, but five of the more common are:

• Urine leakage. Some women might barely notice it, whereas others might have to deal with a higher volume of leakage. 
• Overactive bladder. In this case, you’ll feel the need to urinate very often, and the urge might be strong each time. 
• Pelvic prolapse. This is when one or more of a woman’s internal organs in the pelvis move down from their normal position and bulge into the vagina. This can feel like a heaviness or a dragging sensation in the pelvis. Depending on the extent and type of prolapse (there are four main types), some women can experience pain and sensitivity too. 
• Pelvic pain. The location and severity of pain can differ for each woman, because it will depend on what part of the pelvis is the root cause of the issue.  

If you experience any of these symptoms, make sure to visit your healthcare provider or physio to discuss what might be going on. They might refer you to a pelvic health specialist for a further assessment and guidance.

How does exercise impact your pelvic floor?

Any high impact activity or exercise where you’re lifting weight places increased force through the pelvic floor. Our pelvic floor is developed to absorb this stress, but we need to keep these muscles in strong condition to avoid issues or dysfunction. For example, when we run, the force of our feet hitting the ground goes up through our legs, into our body, and then comes back down, and our pelvic floor and absorbs a lot of that force. If anything impedes our pelvic floor muscles from performing this way, we can run into issues like bladder and bowel incontinence and pain.

What tips do you have for women to help protect their pelvic floor health?

We can break this down into two areas of focus: general strengthening exercises for everyone and techniques and tips for women that enjoy running or jogging. 

Strengthening exercises

• Pelvic strengthening is obviously important here. Try exercises like Kegels, where you squeeze your pelvic floor muscles for a few seconds and release. It can be tricky to distinguish where these muscles are, but a tip is to engage the muscles you use when trying to hold in a pee. If you’re unsure if you’re using the right muscles or need help with doing Kegels, your healthcare provider or physiotherapist can help. 
• When you exercise, muscles like your glutes, quads, calves, core and abdomen are engaged, along with your pelvic floor. So, it’s important that your training includes strengthening exercises for these muscle groups. 
• Trunk mobility. Your trunk includes your chest, abdomen, and back. Practise movements of rotating your trunk and shoulders, to help with strength and flexibility. In tandem with these exercises, be sure to also do stretches for your spine. 

Running technique and tips

• When you’re running, you want to relax your tummy. A lot of people tense up or suck in their tummy when they run, but you don’t want your abdominals to be tense. If they’re tense, they won’t be able to absorb as much of the force your body takes when running. 
• Coming back to the trunk and thoracic (middle) spine area of the body, when we run, to reduce and safely distribute stress on our muscles, this needs to be engaged. You to be rotating through your shoulders and trunk as you run. This creates good momentum and allows you to transfer weight better throughout your body as you move. 
• Keep your chest forward when running, so it’s in line with your landing foot. This helps keep your weight forward, putting less force on your lower back and pelvic floor. 
• Good footwear is vital. Rather than just buying any pair that catches your eye, do some research, or visit a dedicated running store and speak to them about options. A top tip here is to never change your footwear just before a race, stick with what you’re used to.
• Try to land as softly as you can when you run. The phrase ‘pounding the pavements’ is not helpful for your pelvic floor!
• If you can, go to the bathroom before a run. A full bladder and bowel will put extra pressure on your pelvic floor. 
• Running in the morning (if it fits your schedule) can be beneficial because your pelvic floor muscles are at their strongest. 

This content is for information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Always seek advice from your GP or an appropriate medical professional if you have concerns about your health or before commencing a new healthcare regime. If you believe that you are experiencing a medical emergency call 999 / 112 or seek emergency assistance immediately.