Protecting Your Pelvic Floor & Core During Pregnancy
There are many variables we can’t control during pregnancy. We all experience new weight distribution and postural changes, and with that, lengthening of our deep core and pelvic floor muscles. What we can control however, is how we breath when we move, and how we move mindfully during pregnancy, to protect the integrity of the coordination of our muscles as they lengthen. When a few simple principles are applied to movement during pregnancy, a whole host of impairments and pain can likely be avoided. The inevitable changes don’t have to become quite so drastic, and it is easier to tap back into optimal coordination and function postpartum.
The first key to protecting your pelvic floor and core during pregnancy is EXHALE TO EXERT. Our abdominal and thoracic cavities are pressure management systems. Pressure management is how we describe the mechanism of bowel and bladder function, e.g. creating downward strain when we need to void, and maintaining good closure of the pelvic floor muscles and sphincters when we need to keep things in. Imagine that your abdominal container, diaphragm at the top, pelvic floor at the bottom, deepest layer of core muscles corseting around the sides, Visualization is a bag of chips. Take that bag of chips to the top of a mountain and watch it expand in all directions. This is the pressure we put on our system when we hold our breath and lift, squat, roll in bed, or strain to have a bowel movement. Now consider that as we evolve during pregnancy, our pelvic floor and abdominal wall are lengthened and subsequently weakened, and most of us will develop a Diastasis Rectus Abdominus (DrA), or separation of the abdominal wall at the linea alba. Though these are natural processes associated with pregnancy, if we hold our breath when we exert, now we have overloaded a compromised system. The pressure we are not letting out through an open glottis puts pressure on the weakened parts of our system. This can lead to increased DrA width, low back strain, urinary leakage, pelvic organ prolapse (POP), or even constipation as our ability to direct pressure downward is now compromised by a DrA. The good news: this solution is so simple! Breathe out when you do the hard part of any activity. E.g. standing up from a chair, rolling in bed, picking up your bigger little one, or rising from a squat, lunge, or lifting weights. Once this principle is understood, it can be applied to literally any activity.
Another layer of this concept is engaging the pelvic floor, or performing a kegel, as you exert. I call this breathing technique the SUPPORTIVE BREATH, otherwise known as the PISTON BREATH. This type of breathing maintains even pressure in the system by ensuring that the pelvic floor and diaphragm move in the same direction at the same time, like the piston in a car.
To perform the SUPPORTIVE BREATH, begin in a comfortable, quiet position. This may be in seated, lying on your back (supine) or side lying. In 2nd or 3rd trimester you may want to prop yourself on blocks, blankets, or a bolster to reduce pressure on the Inferior Vena Cava (IVC). (The IVC returns blood to your heart and can make you feel dizzy or nauseous if compressed, known as hypotensive syndrome). Once comfortable, find your hip bones in front, then drop two fingers onto the soft tissue just inside of them. Now you are touching the deepest layer of your core, a muscle group called Transverse Abdominus (TrA). TrA automatically fires when the pelvic floor is activated. Try a kegel and notice a gentle tensioning under your fingertips. This feels different than the strong activation of bracing your core.
(A little more context: the amazing thing about TrA is that it fires all day to keep us upright. It activates before we even take a step under the rotational forces of the spine. This type of muscle is called “tonic”. 70% of the pelvic floor fibers are also “tonic” and “on” as soon as we stand up and support 40# of organs! The other abdominal muscles, rectus abdominus (6-pack muscles) and obliques (man V muscles) are big movers, known as “phasic” muscles. They are not designed to be stabilizers, but will try to take over when our system of pressure management and stability is compromised, e.g. during pregnancy when TrA and pelvic floor become lengthened and inefficient. You can imagine how this could contribute to all kinds of challenges including POP, low back pain, and incontinence, to name a few. The supportive breath helps our “tonic” muscles stay activated and well-coordinated throughout pregnancy.)
Ok back to the breath: your fingers are on your TrA. As you inhale, the diaphragm contracts downward to allow air into the lungs, and in kind your pelvic floor should lengthen down and be relaxed. You can imagine your sitz bones moving away from each other, or an elevator moving down the levels of the pelvic floor to the vaginal opening. As you exhale, the diaphragm contracts to expel air, and the pelvic floor lifts (kegel) to echo that motion. Imagine sitz bones moving together and the muscles of the pelvic floor lifting toward the heart. This may feel like the muscles rising the levels of an elevator, or my personal favorite, picking a blueberry with your vagina.
Once this breath coordination is mastered, it can and should be applied to all mobility. Start small. Sit at the edge of your bed and inhale, relaxing the pelvic floor. Begin the exhale, kegel, feel the deep core tension or hip bones pull gently toward each other (not a brace of the core), and rise to your feet as you complete the exhale. If you apply this to a squat, you will inhale to lower, begin the exhale, kegel, feel the deep core tension, and then rise. This is easier said than done at first, but I promise, will get easier with practice, and the long-term benefit of integrating this motor plan will pay off!
Just remember learning new things is hard. This will take lots and lots of repetitions to become automatic. Be gentle with yourself. The worst-case scenario is you lie down and take 10 deep breaths.
