Don’t know squat about PFD?

September 13, 2011

 by Ann Waterman

Welcome, Design Mom readers! Zoe here; once you’ve learned the secret to breaking the “pee when you sneeze” cycle in Ann’s interview below, stick around to find out more about what SlowMama is all about; how smart design decisions can help your home age gracefully — even with children (really!);  and a continuing story of the waiting (and waiting, and waiting) in adoption — and the women who make it all bearable. Come in and make yourself at home!

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As I shared with you last week, I was very fortunate to have a VBAC with my second baby, Peter. The birth was wonderful, and the recovery was vastly better than with my C-section: Within hours, I was up and about and feeling good. I felt so good, I almost considered going to Mags’ 30th birthday bash about a week later — except for the fact that I wasn’t sure I could make the hour-plus drive to Baltimore without having a bathroom close at hand. My pelvic floor muscles still hadn’t tightened up after the delivery, and when I had to go, I had to go immediately. I didn’t want to chance it. Fortunately, everything is back in place where it should be now, but it was a real wake-up call, and I began looking into preventative and restorative exercises.

Pelvic Floor Disorder (PFD) affects up to one-third of women, but it’s rarely talked about. I didn’t know much about it until my own experiences prompted me to look into it further. After poking around on the internet, it seemed like the universal remedy for PFD — apart from surgery — was Kegel exercises, and I immediately got right on them…that is, until I saw a link to an interview with Katy Bowman.

Katy is a biomechanical scientist who specializes in body alignment. She is the director of The Restorative Exercise Institute and creator of Aligned and Well, a DVD series about corrective exercises for biomechanical issues. Katy says that the key to remedying PFD is actually in strengthening your butt: Instead of doing Kegels, we should really be doing lunges and squats. Katy was kind enough to talk with me about this new approach to addressing PFD; after the jump, we get down to brass tacks…

AW: What exactly is Pelvic Floor Disorder, and whom can it affect? I always assumed it was only something that happened to moms who had many vaginal births or severe tearing during birth.

KB: Pelvic Floor Disorder (PFD) is a range of ailments: General incontinence, fecal incontinence, tailbone pain, deep hip pain, non-bacterial prostate inflammation, sacro-iliac joint pain, and organ prolapse are some examples. Both men and women have a pelvis and a pelvic floor, so it can affect both sexes. Women who are nulliparous (which means they never birthed a baby) and women who have had only C-sections are just as likely to have a PFD as ones who have vaginal births. PFD is very non-discriminating!

Why should I be doing squats instead of Kegel exercises to battle PFD? Do Kegels serve any role, or are they passé?

Most people aren’t aware that a muscle has a correct length, which is neither too short or too long. When a muscle gets too short, it is no longer able to contract and generate force, which you need to keep things “closed” in the pelvis. All muscles have an opposing muscle group that prevents them from getting into this too-short position. The opposing muscle group to the pelvic floor is the gluteal (butt) muscles.

If we were still living in nature, the glutes would be contracting and stretching when we’d squat to use the bathroom and be active while walking around. Now we have toilets and non-natural gait patterns (because of shoes, chairs, baby walkers, etc.) that have interfered with the natural muscle balance. Squats are a simple way to restore balance and strength to the pelvic floor muscles.

Kegels are a fine way to check if you’ve got contact with the pelvic floor — for example, right after I gave birth I would send out a little “earth to pelvic floor” signal and hope I’d get a sign of life. Loved the Kegel then. But most physio/physical therapists will tell you that pelvic floor disorders are caused by weakness due to the inability to relax the pelvic floor — not the inability to tense it.

Can a woman expect her pelvic floor to be completely restored after childbirth by strengthening her glutes? In other words, no more leaks when she sneezes or exercises?

Yes! For most pelvic floor issues, strengthening the posterior is sufficient, but it’s important to remember that a full squat in correct alignment is foreign to most people who have sat in chairs and used toilets their entire life. You have to spend quite a while opening the backs of the legs so you can squat without using your quads (front thigh muscles). You need to learn to untuck the tailbone first, so the squats aren’t hard on the hips and knees. Then, the final piece is learning how the butt should be participating in everyday walking around. This is really key.

If you have advanced pelvic floor issues, they are still absolutely repairable but require more information and habit modifications.

Can you describe the correct way to do a squat?

A squat should simply mimic the motion we would have done in regular, nomadic life — so, a few times a day to use the bathroom, holding each for 30-60 seconds (coming up slowly is fine). I get mine done squatting down to pick baby up off of the floor, or when I play with him. You don’t need to do three sets of 10, or anything crazy like that.  Think natural exercise. Check out this link for a more detailed description of how to squat properly.

Can strengthening your pelvic floor make for a better and easier delivery?

Having the pelvic floor at the right length can make for a better delivery. The tighter the pelvic floor, the closer it pulls the bones of the pelvis together; but the longer the pelvic floor, the more space the baby has to pass through. (Can someone say bonus?) Many women experience a lot of perineum tearing because they have no idea how to soften the pelvic floor, and the middle of pushing is not the time to learn!

In your DVD series Aligned and Well, you have a DVD called Down There for Women that particularly addresses PFD. What can women expect from it?

This title was designed to prepare all of the large joints for squatting and helps get the muscles back to the correct length for a gait (walking pattern) that uses the butt more.

What first sparked your interest in talking about PFD?

Good question! My first paper in graduate school was The Biomechanics of Second Stage Delivery — Vaginal Expulsion. Catchy title, right? My all-male professors were used to reading papers on the biomechanics of pitching, so I am sure they liked having the word vagina in all my research. I’m a “big picture” kind of gal, and basically everything biological starts in the pelvis, for every human. If we could all have a little more info about the area — how it works best — then we’d all have a leg up. Pun intended.

Why aren’t more people, particularly women, talking about PFD? It seems we have no trouble talking about fairly personal things — nursing, birth stories, our relationships — but you don’t hear a lot about struggles with PFD.

I’m pretty sure it’s as simple as people not being comfortable saying the word vagina. So it’s hard to say, hey, something is hanging out of my vagina. Is that normal? Or, my vagina hurts when I’m making love. Is that weird? Or, I feel pain in my vagina when I’m sitting at work; pass the stapler. It just doesn’t fit into our culture. In fact, it’s pretty weird that, until very recently, FCC regulations didn’t allow the word on television — hence, Oprah’s “vajayjay.” I mean, come on.

OK, fun question! I understand you recently had a baby boy — congratulations! What’s your favorite thing about being a mom? What surprised you the most?

Yes! I had a little boy, Finn, who is now three-and-a-half months old. And, by the way, my perineum did beautifully — not a rip or tear or drop of blood. It was pretty cool. The whole thing hurt like a son-of-a-gun, but I didn’t care. (Well, I don’t care right now. Three months later.)

As you can imagine, as a body physicist, I love practicing movement with my son. We walk everywhere. He is carried everywhere in our arms — can you say holy-buffness? I love creating physical “games” like punching chimes. We lie on our backs and find our feet. I feel like Dian Fossey with my lone gorilla. And what surprises me the most would probably have to be the fact that I don’t care if I have to be tired during the day or wet down the front of my clothes. Any sort of make-up routine has fallen of the map. My excellent memory…um, what was the question?

And I don’t care one bit. It is totally worth it. What a blessing, right?

Images: Katy Bowman

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1 vicki means September 13, 2011 at 11:43 am

I am a big fan of Katy Bowman, and this interview is typical of her easy-to-digest style of teaching. I hope everyone who reads this will try to learn more about PFD, and how to avoid it at any stage of life.
Congrats to little Peter and Finn. You boys picked some great mamas!!


Ann Waterman 2 Ann Waterman September 13, 2011 at 12:45 pm

Thanks, Vicki! I really wanted to interview Katy about this because it’s such an important subject to share with other women. I imagine many suffer in silence and just accept that sneezing = peeing not realizing that something can be done about it.


3 EML September 13, 2011 at 12:10 pm

This is very interesting. Ever since I was expecting my first baby I was told to do lots of squat and I have never had a problem with PFD even after three kids.


Ann Waterman 4 Ann Waterman September 13, 2011 at 12:46 pm

And that’s why midwives are awesome:)


5 caroline September 13, 2011 at 1:19 pm

Nice article! All the more reason I love my jazzercise – after 5 kids no issues here, its gotta be the lunges and squats!


Ann Waterman 6 Ann September 16, 2011 at 1:36 pm

That’s really encouraging, Caroline! And good for you for making time for exercise even though you’re a super-busy mom. I think it’s so important for your physical and mental well-being.


7 Tara S September 13, 2011 at 4:00 pm

Oh my goodness THANK YOU!! Expecting my third and I have been pretty nervous about the “aftermath.”


8 jo September 16, 2011 at 12:33 pm

wow. thank you! i’m expecting my third and i’ve already had slight problems with this. kegels don’t seem to help very much, so it’s nice to find the reason why. great information, thanks!


Ann Waterman 9 Ann September 16, 2011 at 1:36 pm

You’re welcome, Jo! Hope it helps!


10 Tara September 19, 2011 at 3:31 pm

Thank you so much for this! I am expecting my second (and very much hoping for a VBAC) and have had major problems with sneezing my pants both pregnancies (sometimes even when I’m not pregnant – yikes!). I have been doing daily squats, lunges, and stretching since I read this last week and already feel like there is improvement. Anything I can do to help my chances of a VBAC I’m open to trying and I feel like this will help. Thanks again!


Ann Waterman 11 Ann Waterman September 19, 2011 at 5:13 pm

Hoping you get that VBAC, Tara! I also found this really helpful when preparing for mine:


12 Tara September 20, 2011 at 12:18 pm

Wow, thanks, Ann! That website looks awesome. Looking forward to spending some time checking it out!


13 Kate the Great September 19, 2011 at 8:34 pm

Since we’re in the spirit of being open and talking freely about our bodies, I’ve got a question for Katy:

Is there anything I can do to hasten or help the *shhhhlup* process for the connective skin tissue that expanded around my belly area during pregnancy?

After my first birth, I asked (almost) all my nurses and doctors this question, and they all had the same answer: you can’t do anything–you just have to be patient and let time take its toll.

I think some of them might have misunderstood me; I’m not talking about losing weight. I’m a thin person by build, and having all that floppy skin with no fat behind it was just discouraging. It’s been one month shy of two years since my boy’s birth and it’s still *shhhhhlup*ing back into place.

I tried Google; it didn’t help, and I know Google-fu. I can’t believe it–no exercises, no diet tweaks, nothing short of surgery. Katy, have you found any tips?


14 Muria September 19, 2011 at 9:25 pm

Kate, Teresa Tapp has some information on skin tone. She recommends skin brushing to stimulate lymph and improve skin tone, and an alfalfa supplement to stimulate collagen production in the skin (which will help it tighten up).

I’m a little concerned that her exercise program (with its constant pelvic tilting) may be partially responsible for my PFD, but since I didn’t do her gluteal exercises, I may also be responsible.


15 Katy Bowman September 20, 2011 at 10:59 am

Hi Super Kate – It sounds like you are talking about Diastasis recti which, strangely enough I just blogged about yesterday. It is a very common issue in women (and men) and occurs when you couple the loads of pregnancy with poor alignment. You can read more here – this is Part One, Part two to come this week!


16 Rebecca September 24, 2011 at 1:40 pm

Any advice for those of us who cannot squat? The osteoarthritis in my knees means I can no longer do this movement.


17 Katy Bowman September 25, 2011 at 10:17 am

Rebecca, about 80% of the Western population is unable to squat because they haven’t their entire life :) That is why I put 5 non-squat exercises to help with PFD on the DVD. Squatting may not be an option, but loosening the muscles down the back of the leg that prevent the pelvis from sitting neutral is still an option!


18 P Flooers June 27, 2013 at 4:48 am

My midwife told me, after the birth of my second child, that one orgasm a day will fix the pee when you sneeze issue. She was right. Way more fun than kegels or squats!


Ann Waterman 19 Ann Waterman June 27, 2013 at 9:45 pm

I’ve never heard that before! Who knew?!?!


20 P Flooers June 27, 2013 at 9:53 pm

I know, right?! You’d think that little gem would be easy to sell. I guess a lot of women feel too shy to discuss it? It works. Tell everyone.


21 anonymous January 17, 2014 at 3:31 am

Thank you so much for this information. I’m only 23 and I’ve been so asamed. I never gave birth or had kids. I never bothered going to the doctor or telling anyone.


22 Renee July 27, 2014 at 9:46 pm

Great post! I’m 5 months pregnant and have been doing lunges and squats during this pregnancy…I hoping for an easier tear free delivery this time around…I will also be passing this info on to my post menopausal mom.


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24 yesenia March 14, 2016 at 12:57 pm

Hello i started to have problems after my third child, i pee myself at times when i cough or sneeze and i was wondering if there are different types of squats to do for PPFD i also dont plan on having anymore kids.


25 Liz May 25, 2016 at 4:42 am

I have trouble finding a professional to help me with this. I experience intermittent pain in my pelvic floor muscles, and incontinence only when I have a cold or allergies and keep sneezing for several days. I suspect I have pelvic muscle hypertension that fatigues after repeated stress of sneezing. Will your DVD help you think?


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