In Part 1 we looked at how the pelvic floor works and came to the conclusion that although kegels can be helpful, in most cases they are just not enough. In Part II I would like to explore the effect of lifestyle and “natural movement” on pelvic floor health, and suggest some tips to help you incorporate a strong pelvic floor as part of a healthy, functional whole-body.
Natural Movement and Lifestyle Factors
When we want to figure out if something is “Natural” for the human body (like a kegel for example), we have to take ourselves back to our “natural” environment. Our bodies evolved to a time and place where we hunted/gathered our food, lived in a tribe, walked miles every day, squatted to toilet and rest, and lived without the modern conveniences that now rob of us of most of this “natural movement”.
It is safe to say that our genetics have not changed much since this time, but our world certainly has. Office work, driving cars, heeled shoes, and doing an hour of crazy exercise each day to make up for the lack of movement in the other 23 hours is what our bodies currently experience. Vastly different to our ancestors. What would their bodies be like if we could study them now?
The closest we can get to observing our ancestors in action is to look at the few hunter-gatherer populations that still exist. Some very cool researchers took a look at the pelvic health of around 400 women from the Xiangu tribe in Brazil[i]. These tribal women live as close to nature as you can get, living in huts made of grass and mud with their giant extended families, collecting their food, squatting to toilet, and surviving without any of the modern age’s “helpful” technologies. The women of the Xingu tribe, with an average age of 33 and 4.3 children, average a 5% incontinence rate across the female population. Compared to our 50% incontinence rate in the developed world.
The women in the study still saw average rates of minor prolapse when examined by researchers, but most were asymptomatic (they didn’t notice), and their pelvic floor muscles were found to be very strong compared to the female "norm" of western culture. Another interesting finding of the study was that 90% of these women had their babies at home in a squat position (but before you run and attempt this birth position please remember that these women squat ALL THE TIME).
As the author puts it:
“Instinctively, through their lifestyle, indigenous women have been protected against POP (pelvic organ prolapse) during their daily activities. In contrast, we have a sedentary lifestyle and require physical therapy sessions for training our PFM (Pelvic floor muscles)”[i]
A separate study looking at incontinence in Chinese women found that place of birth (mainland China or Hong Kong China) was the biggest predictor for stress urinary incontinence, suggesting that the environment women were exposed to early in life can play a role in continence later on[ii]. Here is another author’s take on how modernization affected pelvic floor health in this study:
“The old diet based on fibers and grass plants has been replaced by a diet rich in carbohydrates; the preferred delivery position is no longer squatting but rather supine; and a sitting position has been adopted for urination and evacuation. Apparently these changes may have caused increased prevalence of prolapse and urinary incontinence”[i]
There are so many variables at play in these studies that make it impossible to come to any real conclusions. They do, however, provide evidence that our lifestyle could be playing a role in the high incontinence rates in our population. And the evidence fits with the logical thought process that if our bodies were living in their natural environments we wouldn’t need to keep doing our kegels to maintain pelvic floor function.
Now before you decide to sell everything and go live in a cave in the mountains, I believe there are some practical, whole-body solutions for pelvic floor health we can try first. We need to look at what parts of our modern lifestyle are holding us back from the pelvic health we were designed to have, and what we can introduce into our lives to live closer to our natural state. The closer we can align our bodies with what they really need to thrive, the better we can function as happy, healthy, whole-body people.
Natural Movement and Lifestyle Factors
When we want to figure out if something is “Natural” for the human body (like a kegel for example), we have to take ourselves back to our “natural” environment. Our bodies evolved to a time and place where we hunted/gathered our food, lived in a tribe, walked miles every day, squatted to toilet and rest, and lived without the modern conveniences that now rob of us of most of this “natural movement”.
It is safe to say that our genetics have not changed much since this time, but our world certainly has. Office work, driving cars, heeled shoes, and doing an hour of crazy exercise each day to make up for the lack of movement in the other 23 hours is what our bodies currently experience. Vastly different to our ancestors. What would their bodies be like if we could study them now?
The closest we can get to observing our ancestors in action is to look at the few hunter-gatherer populations that still exist. Some very cool researchers took a look at the pelvic health of around 400 women from the Xiangu tribe in Brazil[i]. These tribal women live as close to nature as you can get, living in huts made of grass and mud with their giant extended families, collecting their food, squatting to toilet, and surviving without any of the modern age’s “helpful” technologies. The women of the Xingu tribe, with an average age of 33 and 4.3 children, average a 5% incontinence rate across the female population. Compared to our 50% incontinence rate in the developed world.
The women in the study still saw average rates of minor prolapse when examined by researchers, but most were asymptomatic (they didn’t notice), and their pelvic floor muscles were found to be very strong compared to the female "norm" of western culture. Another interesting finding of the study was that 90% of these women had their babies at home in a squat position (but before you run and attempt this birth position please remember that these women squat ALL THE TIME).
As the author puts it:
“Instinctively, through their lifestyle, indigenous women have been protected against POP (pelvic organ prolapse) during their daily activities. In contrast, we have a sedentary lifestyle and require physical therapy sessions for training our PFM (Pelvic floor muscles)”[i]
A separate study looking at incontinence in Chinese women found that place of birth (mainland China or Hong Kong China) was the biggest predictor for stress urinary incontinence, suggesting that the environment women were exposed to early in life can play a role in continence later on[ii]. Here is another author’s take on how modernization affected pelvic floor health in this study:
“The old diet based on fibers and grass plants has been replaced by a diet rich in carbohydrates; the preferred delivery position is no longer squatting but rather supine; and a sitting position has been adopted for urination and evacuation. Apparently these changes may have caused increased prevalence of prolapse and urinary incontinence”[i]
There are so many variables at play in these studies that make it impossible to come to any real conclusions. They do, however, provide evidence that our lifestyle could be playing a role in the high incontinence rates in our population. And the evidence fits with the logical thought process that if our bodies were living in their natural environments we wouldn’t need to keep doing our kegels to maintain pelvic floor function.
Now before you decide to sell everything and go live in a cave in the mountains, I believe there are some practical, whole-body solutions for pelvic floor health we can try first. We need to look at what parts of our modern lifestyle are holding us back from the pelvic health we were designed to have, and what we can introduce into our lives to live closer to our natural state. The closer we can align our bodies with what they really need to thrive, the better we can function as happy, healthy, whole-body people.
Whole-Body Pelvic Floor Treatment: the long term solution?
Please don’t give up your kegels just yet. Especially if they were prescribed to you for continence help, back pain, etc, as the research shows they can help. For your long term pelvic floor health, I would ADD IN these tips to help the pelvic floor function as part of a happy, healthy WHOLE you.
1. Treat the body as a whole:
Your pelvic floor is only as functional as the rest of the body, and the rest of the body functions best with a healthy pelvic floor. Everything from tight neck/shoulder muscles to tension in the bottom of the feet can effect the workings of the pelvic floor so we need to look at the WHOLE picture. Which leads to point #2…
Please don’t give up your kegels just yet. Especially if they were prescribed to you for continence help, back pain, etc, as the research shows they can help. For your long term pelvic floor health, I would ADD IN these tips to help the pelvic floor function as part of a happy, healthy WHOLE you.
1. Treat the body as a whole:
Your pelvic floor is only as functional as the rest of the body, and the rest of the body functions best with a healthy pelvic floor. Everything from tight neck/shoulder muscles to tension in the bottom of the feet can effect the workings of the pelvic floor so we need to look at the WHOLE picture. Which leads to point #2…
2. Alignment:
When your bones are in the right place in relation to each other and gravity (correct body alignment), the core muscles should function naturally as a unit creating dynamic stability throughout the body. Our modern lifestyle and lack of natural movement is forcing us out of our natural alignment and robbing the core of the work it could be doing (automatically) all day.
Corrective exercise can help you get into better alignment, but more importantly you need to observe your daily habits and the postures you are spending large amounts of time in to discover what got you out of alignment in the first place.
For more information please head to the goddess of alignment and “Nutritious Movement”, Katy Bowman and Restorative Exercise.
(I would especially recommend Al Fo' the Pelvic Floor Snackbyte)
When your bones are in the right place in relation to each other and gravity (correct body alignment), the core muscles should function naturally as a unit creating dynamic stability throughout the body. Our modern lifestyle and lack of natural movement is forcing us out of our natural alignment and robbing the core of the work it could be doing (automatically) all day.
Corrective exercise can help you get into better alignment, but more importantly you need to observe your daily habits and the postures you are spending large amounts of time in to discover what got you out of alignment in the first place.
For more information please head to the goddess of alignment and “Nutritious Movement”, Katy Bowman and Restorative Exercise.
(I would especially recommend Al Fo' the Pelvic Floor Snackbyte)
3. See a trained professional if you need help:
Sometimes you just need an outside pair of eyes to look at the WHOLE YOU and help you retrain your funky motor patterns, put you back into alignment, and prescribe exercises that can help keep you in a place where you can be your strongest, most stable self. I have a team of different health/wellness professionals that I use when I need an outside pair of eyes or hands to give me a fresh perspective. We have quite a blind spot when it comes to our own bodies sometimes, so never be afraid to ask for help.
Sometimes you just need an outside pair of eyes to look at the WHOLE YOU and help you retrain your funky motor patterns, put you back into alignment, and prescribe exercises that can help keep you in a place where you can be your strongest, most stable self. I have a team of different health/wellness professionals that I use when I need an outside pair of eyes or hands to give me a fresh perspective. We have quite a blind spot when it comes to our own bodies sometimes, so never be afraid to ask for help.
| 4. Re-learn how to breathe: The diaphragm and pelvic floor work together in an amazing, complex, dynamic system. Certain breathing habits (breath holding, stress breathing) can create abnormal increases in Intraabdominal pressure that can weaken the pelvic floor over time. Ideally we would like our ribs to expand 3-Dimensionally as we inhale, and posture or repetitive habits (eg. tight chest from desk work) can prevent this from happening. Spend some time opening your chest, mobilizing your ribs and just noticing your breath (especially when life gets busy). Before bed tonight get in a position that encourages good alignment, set a timer for 10 minutes and just breathe. Try not to force your breath, just be with it and observe. |   |
5. Re-introduce some natural movement: When I am outside with my son at the park we often play “What would the hunter-gatherers do?” I know it sounds corny but we think it's super fun, and we spend our time gathering sticks and nuts, building, carrying, climbing, squatting and trying to get a decent amount of walking mileage in each day. Squat to cook something on your kitchen floor, get rid of the furniture in one room of your house, create a work-station that allows you to get some movement into your day.
Have a play or check out MovNat for more fun ideas.
Have a play or check out MovNat for more fun ideas.
 |  |
6. WALK and Build a bum: Walking is a fundamental human movement and a fantastic way to strengthen the pelvic floor (when done properly). You need to be walking EVERY DAY (even if you are an athlete with an intense training regimen) as this is a movement that the human body was designed to do and needs to do a lot of to stay healthy.
The bum muscles are what hold the sacrum in place so that the pelvic floor gets an eccentric (lengthening) contraction with each step. Without a bum that knows how to activate there is no stability to the sacrum, which can cause shortening of the pelvic floor or reduce the leverage the pelvic floor needs to function properly.
Build a bum in functional ways like walking, squatting, lunging etc. To start your squat progressions I will send you again to the wonderful Katy Bowman:
http://www.katysays.com/you-dont-know-squat/
http://www.katysays.com/you-still-dont-know-squat/
Why do none of us have bottoms that works well? We sit on them way too much! Leading to the next two points…
The bum muscles are what hold the sacrum in place so that the pelvic floor gets an eccentric (lengthening) contraction with each step. Without a bum that knows how to activate there is no stability to the sacrum, which can cause shortening of the pelvic floor or reduce the leverage the pelvic floor needs to function properly.
Build a bum in functional ways like walking, squatting, lunging etc. To start your squat progressions I will send you again to the wonderful Katy Bowman:
http://www.katysays.com/you-dont-know-squat/
http://www.katysays.com/you-still-dont-know-squat/
Why do none of us have bottoms that works well? We sit on them way too much! Leading to the next two points…
7. If you have to sit:
Sitting on your tailbone (pelvis in a posterior tilt, picture a) can put your pelvic floor in a shortened position and reduce the activation of pelvic floor if done all of the time. Find your ischial tuberosities and learn how to sit on them, use a wedge or cushion to get rid of the bucket seat slope in the car, and invest in a proper chair that helps you stay in a “neutral” (c) pelvis position if you are going to be seated in a chair at work.
Find more details and ideas in my "sitting" article here.
Sitting on your tailbone (pelvis in a posterior tilt, picture a) can put your pelvic floor in a shortened position and reduce the activation of pelvic floor if done all of the time. Find your ischial tuberosities and learn how to sit on them, use a wedge or cushion to get rid of the bucket seat slope in the car, and invest in a proper chair that helps you stay in a “neutral” (c) pelvis position if you are going to be seated in a chair at work.
Find more details and ideas in my "sitting" article here.
 |  |  |
8. Explore other positions: I have nothing against rest and relaxation, honest, I’m actually really good at it. I do however recommend varying your rest positions to place different loads on the body and ensure you are not "casting" your body in a single position. As Westerners we tend to get stuck in “sitting”, “standing” or “lying”. Gordon Hewes in 1955 came up with this collection of other positions from studying cultures around the globe[iii]. Have a play!
9. Mindfulness and Meditation: A study in 2013 showed that depression and anxiety were correlated with increased pelvic floor dysfunction in a group of postnatal women[iv]. If this is the route cause of your pelvic floor dysfunction it may need to be treated first. Mindfulness Based Cognitive Therapy can be an effective way to manage depression and anxiety, and directed meditation can help people that hold tension in their pelvic floors to learn how to relax it. And of course, please see a professional for the best kind of help.
““To visualize how the pelvic floor responds to stress, one need only look at the movement of a dog’s tail: when the dog is happy, the tail wags loosely from side to side; when the dog is stressed, the tail is tightly under its legs. It is the pelvic floor muscles that control the tail. In fact, the pelvic floor muscles are still attached to the rudimentary tail [in man], the coccyx, which is pulled forward when contracted, thereby compressing its penetrating organs. Therefore, man’s pelvic muscles, as the dog’s, may be the ultimate representation of the mind/body connection, for they are constantly responding to fluctuations in feeling.” – Jerome Weiss, MD[v]
““To visualize how the pelvic floor responds to stress, one need only look at the movement of a dog’s tail: when the dog is happy, the tail wags loosely from side to side; when the dog is stressed, the tail is tightly under its legs. It is the pelvic floor muscles that control the tail. In fact, the pelvic floor muscles are still attached to the rudimentary tail [in man], the coccyx, which is pulled forward when contracted, thereby compressing its penetrating organs. Therefore, man’s pelvic muscles, as the dog’s, may be the ultimate representation of the mind/body connection, for they are constantly responding to fluctuations in feeling.” – Jerome Weiss, MD[v]
10. The right food choices:
You need to make the right food choices for your body, as something as simple as a food intolerance can create bloating and gut inflammation which will affect the muscles of the core. Chronic constipation caused by dietary issues will also affect the pelvic floor.
I am not an expert in this area but I know that sorting out digestive issues has made such a difference for so many of my clients, so please seek help with a nutrition expert if you are struggling in this department.
You need to make the right food choices for your body, as something as simple as a food intolerance can create bloating and gut inflammation which will affect the muscles of the core. Chronic constipation caused by dietary issues will also affect the pelvic floor.
I am not an expert in this area but I know that sorting out digestive issues has made such a difference for so many of my clients, so please seek help with a nutrition expert if you are struggling in this department.
As you can see, when I said the WHOLE YOU I really did mean the entire picture of your mental and physical health can affect the pelvic floor. As a culture, as researchers, as health care providers, as people with pelvic floors, let’s start asking the right questions. We need to think more about why our pelvic floors got so weak/tight/overused/underused in the first place and start to come up with some long term solutions to this very common dysfunction.
These tips should get you started on the road to long-term pelvic floor health. Please get in touch with any questions and let me know how you’re traveling!
Stacey xx
p.s. My 30 Day Postnatal Workshop “Restore your Core and Pelvic Floor” will be launching in January. Please sign up for my newsletter here or “like” my Facebook page to get updates on the big launch!
References
[i] de Araujo M.P., Takano C.C., Girão M.J., Sartori M.G. (2009). Pelvic floor disorders among indigenous women living in Xingu Indian Park, Brazil. Int Urogynecol J Pelvic Floor Dysfunct, 20(9), 1079-84.
[ii] Brieger G. M., Mongelli M., Hin L.Y., Chung T.K.H. (1997). The epidemiology of urinary dysfunction in Chinese women. International Urogynecology Journal, 8(4), 191-195
[iii] Hewes, G. (1955). World Distribution of Postural Habits. American Anthropologist, 57(2): 231-244.
[iv] Khan Z.A., Whittal C., Mansol S., Osborne L.A., Reed P., Emery S. (2013) Effect of depression and anxiety on the success of pelvic floor muscle training for pelvic floor dysfunction. J Obstet Gynaecol 33(7):710-4
[v] From Chronic Pelvic Pain and Myofascial Trigger Points. The Pain Clinic, December 2000, Vol.2. No. 6:13-18
These tips should get you started on the road to long-term pelvic floor health. Please get in touch with any questions and let me know how you’re traveling!
Stacey xx
p.s. My 30 Day Postnatal Workshop “Restore your Core and Pelvic Floor” will be launching in January. Please sign up for my newsletter here or “like” my Facebook page to get updates on the big launch!
References
[i] de Araujo M.P., Takano C.C., Girão M.J., Sartori M.G. (2009). Pelvic floor disorders among indigenous women living in Xingu Indian Park, Brazil. Int Urogynecol J Pelvic Floor Dysfunct, 20(9), 1079-84.
[ii] Brieger G. M., Mongelli M., Hin L.Y., Chung T.K.H. (1997). The epidemiology of urinary dysfunction in Chinese women. International Urogynecology Journal, 8(4), 191-195
[iii] Hewes, G. (1955). World Distribution of Postural Habits. American Anthropologist, 57(2): 231-244.
[iv] Khan Z.A., Whittal C., Mansol S., Osborne L.A., Reed P., Emery S. (2013) Effect of depression and anxiety on the success of pelvic floor muscle training for pelvic floor dysfunction. J Obstet Gynaecol 33(7):710-4
[v] From Chronic Pelvic Pain and Myofascial Trigger Points. The Pain Clinic, December 2000, Vol.2. No. 6:13-18
