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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