This blog is a sequel to STOP the DRIBBLE. If you haven't read that one yet, go back and look through it before you read on.
Here are 5 steps to stop the dribble:
1. BREATHE MINDFULLY!
Many people are not aware of their breathing patterns during the day. They may be taking shallow breathes, or holding their breath especially during tasks that involve exertion. Of course, breathing is necessary to keep you alive and from passing out, but it also helps the pelvic floor muscles move. Remember, your body needs to respond to movement. Well, breathing is a movement of air through your system, which in turn moves forces through your body. It is a simple way to start. I find it easiest to lay or sit in comfortable supported position in a quiet space. You may want to lie on your back with a pillow under your knees (see image below), or sit upright maintaining a tall spine (slumped sitting compromises the efficiency of your diaphragm, breath and pelvic floor function). Place one hand on your belly and one on your lower ribs. Close your eyes (after you have read this) and allow your hands to feel your breathing pattern. Start by noticing your current breath, don't change it yet. Do you feel your hands move when you inhale/exhale? Is one hand moving more than the other? Is your breath shallow or deep? Is your inhale and exhale the same length?
Now that you have some awareness of your breathing. Pay attention to the movement of your hands on your belly and ribs. Can you even out the movement of your belly and ribs? You should feel your belly gently expand and your lower ribs gently fan out like an umbrella on your inhale. You don't want to strain or push the belly out on inhale, just allow for the expansion of the belly and ribs. As you exhale, you should feel the belly and ribs return to their starting position. You may not realize it, but you are engaging your diaphragm and pelvic floor. This should be a calming exercise. Don't stress if you aren't sure if you are doing it right, keep calm and breath on! The more you practice mindful breathing, the more in tune with your body you will be. Try to slow down the inhale and exhale. In for a count of 5 and out for a count of 5. Great. Try 4 more slow breaths.
You can do mindful breathing in various positions such as child's pose or prone on your forearms with your hips in the air. You may not have you hands on your belly or ribs to feel in these positions, but close your eyes and focus your attention on your breath and the inner movement you feel in your belly and pelvic floor.
2. GET TO KNOW YOUR PELVIC FLOOR
What is going on down there? Find out for yourself and get acquainted with your body. It is time to take out a hand mirror and take a look at how your mysterious pelvic floor works. If you are not ready for this part, you may skip the mirror and still try this exercise. But a mirror is a beautiful tool to give you visual feedback about what you are doing and if you are doing it right. People at the gym use mirrors all the time to view their posture, muscles moving and technique with movements, this is the same, just a different body part.
In a quiet safe space, lay in a comfortable, supported position. This is to be done without bottoms on ladies, so you can see yourself. Bend your knees and have your legs supported on pillows by your sides. Grab your mirror and take a look. Imagine that beneath your vulva and anus are muscles that function for keeping you continent (leak free), sexual pleasure, stability and support. As you breath, do you see your pelvic floor move? Do you see your perineum (the space between your vaginal opening and anus) move in/out a little? If you don't see any movement, it's fine, just take note of it.
Lets try some pelvic floor muscle exercises. Can you gently "wink" or close your anus as if holding back gas? Did you see the back passage close? Great you are starting to do some pelvic floor movement. Now move forward, can you gently close your vagina and urethra as if holding back urine? Did you see any parts move? If you aren't using a mirror, did you feel anything move? Maybe your labia felt like they closed, or your clitoris felt like it nodded down. Remember, you are trying to activate the parts between your sit bones, so you don't want to squeeze you buttock or lift your hips for this one. Now try to wake up the deeper muscles of the pelvic floor. Can you pretend (key word pretend, don't literally do this) as if you are sucking a cherry tomato up through your vagina or anus. Or lift inside your vagina as if you are grabbing your underwear and pulling it inside you. Great, you did all the parts of a kegel! Now put it all together. Close the back passage, close the front passage, then lift (or suck in that tomato)! Always relax fully between each repetition. Quick check, did you breath when you did that? Don't forget to breath as you practice activating your pelvic floor muscles.
3. GET IN SYNC
Let's get more coordinated with the breath, pelvic floor and core together. You may put the mirror away, or keep it out if the visual feedback was helpful. First return to your mindful breathing in step 1. As you inhale, feel your belly expand, the lower ribs flare out and your pelvic floor soften downward. As you exhale, feel your belly return and your pelvic floor move up and in. Inhale again and on the next exhale, start to activate the pelvic floor by closing the back passage, the front passage and lifting inward. Did you feel your lower belly muscles engage too? If so, that is great! If not, try to exhale through pursed lips (like you are whistling out). Did that help? Another cue that may help is bring your belly button to your heart or connect a string from one pelvis to another in the front. You should feel a tightening through the belly. Good, inhale and feel the passages open or soften as your belly and lower ribs expand. Exhale and activate your pelvic floor and core with the cue that works for you. Repeat this rhythm 6 times. Make sure that with each inhale you are feeling the pelvic floor lengthening and a gentle descent. Do not push downward or strain to make this happen, simply allow for the softening to occur. Sometimes it helps to use imagery such as your sit bones gently spreading apart with each inhale or a rose bud opening. If you are confused, don't worry, it takes a lot of practice. Go back to number 1 and 2 and get them down first, then come back to this step again later.
4. TRAIN FAST & SLOW
Once you have mastered numbers 1-3, you have gained awareness of your pelvic floor and breath, and you can coordinate the two together. That's the basics (not so basic is it). Now you can start training the pelvic floor for the marathon of life.
Here is a brief anatomy 101. Skeletal muscles are comprised of two types of fibers: fast and slow twitch. This means you have to train two ways to get to all the pelvic floor fibers working for you. 1) longer holds for endurance and 2) quick flicks for bursts of power when needed.
The slow twitch endurance muscle fibers you need at a lower level of power for its role in postural support and stability. Try about 50% kegel power for this contraction (start with 100% contraction, then reduce it by 1/2 and you are left at 50%). Once you notice a quivering inability to maintain this level of contraction, rest for 10 seconds. You are aiming for a endurance. Don't focus on the coordination of breath, just maintain breathing for this one. If you count out loud, you are breathing. How long could you hold that kegel for before the muscles got tired? Do another one for that same time. Work your way up to being able to do this about 10 times in a row. Don't worry if you are tired at 2x, its a great start!
For the speedy ones practice 2 second holds with a stronger 100% kegel, followed by a 2 second relaxation (or how every long it takes for you to fully relax the pelvic floor). Make sure you feel a full relaxation between each one. Try to get up to 10 of these ones as well. Again, no worries if you can't do all 10; it isn't a magic number for reps per set, its just an average I chose. Feel free to do more/less. The most important concept is that you feel more in control of your pelvic floor and can gauge success such as being able to do 5 in a row vs 2 in the beginning. You will get stronger with practice.
How many could you do of each before your muscles got tired? Good, that is your baseline. Do that many of each type 2x/day on a daily basis until you notice you can either hold for a longer endurance or can do more of them in a row without fatigue. Then increase your hold length for slow twitch or reps for fast twitch. Once you are good at this lying down, try sitting and finally stand up and get your kegel on! You should be able to do this anywhere because no one should know you are doing a pelvic floor exercise when they look at you. No need to snarl your face, keep relaxed. Also, don't walk around all day kegeling because your muscles will be overworked and your body won't like that.
PLEASE NOTE: if you are experiencing any discomfort, stop and consult your health care provider such as a pelvic PT. This is for women with pelvic floor weakness, if your muscles are overactive and/or you are experiencing discomfort in the pelvic region, this work may aggravate your symptoms.
5. MOVE STRONG
Lets be honest, no muscle in your body works only when you are lying on your back or sitting still. "Isolating" a muscle group can help you with awareness, but you can't stop there. If you want to stay dry when you lift groceries, go for a hike, get up from a chair, crawl on the floor with your baby and enjoy your favorite exercises, you need to train for those movements. Remember, you need pelvic floor awareness, control, strength, and the ability to respond with activity? Here is where that comes together.
By now, you should have mastered awareness of your breath, pelvic floor and the ability to do quick or slow contractions. If that is still a challenge, you may need more practice before you put it all together with functional movements. Stick with it and you will get it.
To be able to activate that your pelvic floor, core and breath with squats, begin with a gentle pelvic floor and core contraction (only about 25% of your max strength - this way you are active, but NOT gripping or tucking anything), go into a squat (your pelvic floor is working as it lengthens), then as you exhale, increase that pelvic floor and core contraction strength as you stand up from your squat (during this phase, the pelvic floor is working as it shortens).
Did you get lost at 25% contraction strength? Try 100% strength, go ahead, close, close, lift your pelvic floor with all your might! Release that about 50%, then another 50%. That is your starting strength. I told you it is gentle! You can do the same thing with lunges. Start with a 25% gentle pelvic floor contraction, lunge down, add more strength to the pelvic floor as you exhale slowly push with those legs to bring yourself up.
Congrats on beginning the journey to STOP THE DRIBBLE. You can do this!
FYI: Upper body movements can be core and pelvic floor strengthening a well. Squats and lunges are not the only functional movement pattern you can do. Be mindful that pelvic floor training can be incorporated into tons of fun exercises that you may already be doing. Enjoy!
If you are having difficulty getting to know your pelvic floor and need some one on one guidance, contact your local pelvic floor therapist! We are here to help you stop the leaks, get you back to the activities you love, and empower you to live the active life you had before this all began! Let's keep you diaper free!
Please note, this information is for educational and entertainment purposes. If these exercises aren't working for you, if you are confused with them or if you are having ANY discomfort with the above exercises, please stop! It is always advised to seek a medical provider if you are concerned with beginning a new exercise routine or you are having discomfort.