You work hard to tighten your abs and tone your arms. But chances are, you've never thought of strengthening your pelvis. Here's why you need to: Your sex life and your health depend on it.
Your pelvic floor, a web of muscles, tendons and ligaments at the lowest point of your torso, is one of the major support structures of your body. "The weight of your abdominal organs rests on it," says Amy Rosenman, MD, the president-elect of the American Urogynecologic Society. A weak or damaged pelvic floor can lead to all kinds of problems, including painful sex, backaches, and incontinence.
More and more young women are being diagnosed with pelvic floor disorders (PFDs). One in four between the ages of 25 and 44 reported episodes of leaking urine while laughing, coughing or exercising. And as many as 20 percent of women ages 18 to 50 suffer from chronic pelvic pain that lasts more than a year.
"Women are having babies later in life, which increases their risk of these problems," says Missy Lavender, the executive director of the Women's Health Foundation. Another factor could be your weight: Extra pounds put more stress on the pelvic floor. The exercise you do can also play a role. Today, we're running, cycling, lifting, kickboxing and otherwise making demands on our bodies that previous generations didn't. "Working out isn't generally the root cause of pelvic floor problems," Dr. Rosenman says. "But the pounding and exertion can worsen underlying problems."
The good news is that there's plenty you can do to avoid these troubles completely. Read on to find out what you need to know.
The Bottom Line
Help for the scary, weird and just plain wacky things that happen down below.
Q. I actually leak a little when I work out. It's mortifying. And I'm only 31! WTH?
A. Female CrossFit competitors laughed about this problem in a video that went viral last year, but losing any amount of urine while exercising is not normal nor is it a badge of honor that shows how tough your workout is. "This indicates that your pelvic floor can't tolerate the increase in abdominal pressure when you're exerting yourself," Dr. Rosenman explains.
Using a tampon while exercising can be a stopgap for mild leakage, she says. Wearing a pad is okay, too, but pass up sanitary napkins for products specifically intended to absorb urine. Neither option should delay you, however, from getting help for the problem, because incontinence can worsen when it is left unaddressed, warns Theresa Spitznagle, an associate professor of physical therapy at Washington University School of Medicine.
If you leak when lifting large amounts of weight, you may need to seek advice from a fitness trainer or physical therapist about how to brace your pelvis properly. "It could also mean that you are taking your body beyond healthy limits," Dr. Rosenman says. Women who experience any amount of leakage during more typical exertion — or anytime at all, for that matter — should schedule an appointment ASAP with a physician, who can check for underlying problems and help determine a course of treatment, which may include pelvic floor strengthening exercises and biofeedback.
Q. I know I should be doing Kegels. But how often and how many?
A. Don't start squeezing just yet, sister. As the field of pelvic health has grown, researchers and clinicians have become less convinced that one exercise suits all women or all problems. In fact, pelvic pain and sometimes incontinence can be attributed to a pelvic floor that is too tight. Kegeling, or repeatedly contracting and relaxing the sphincter (the muscle you use to stop peeing midstream), can actually make the problem worse in some cases, says Cristina Shupe, a physical therapist at the Pacific Center for Pelvic Pain and Dysfunction in San Francisco.
Kegels are most useful for women who have insufficient tone and control due to an overstretched or damaged pelvic floor. If you're having such symptoms as leakage or flatulence, you can give Kegels a shot. But there's still good reason to seek help: "As many as half of women don't know how to do a Kegel properly," says M.J. Strauhal, an instructor for the section on women's health at the American Physical Therapy Association. Pelvic health practitioners can teach you the technique.
Q. In the last couple of months, sex has started to hurt — a lot. What's going on?
A. Internal pain can be a red flag for a range of potentially serious but treatable problems, including endometriosis, ovarian cysts, and prolapsed organs that are pushing into or against the vagina. If you experience rawness and burning in your vulva and/or around the opening of your vagina, it's possible you are among the six million women in the United States who have vulvodynia, or chronic vulvar pain. If you feel as if your vagina is physically unable to accept penetration and that doing so will cause pain, your muscles may be in spasm — a condition called vaginismus. No one can say for sure what causes pain syndromes like these, but it's thought that chemical irritation from soaps and hygiene products, a history of frequent yeast infections, and nerve damage from childbirth or other physical trauma can be contributors. There are no surefire cures, but many women have found relief with antidepressants, anticonvulsants, Botox injections, topical salves, bio feedback and pelvic physical therapy. See your gyno.
Q. I've developed a strange numbness in my crotch. Could my three-times-a-week indoor-cycling routine be the culprit?
A. It's possible that too much time on that hard seat has irritated and inflamed your pudendal nerve, which originates at the base of the spine and provides sensation to the genitals, bladder and rectum. Pudendal neuralgia (numbness) can be triggered by any number of factors, including infections, injuries and prolonged sitting. "If you've recently gone numb after a ride, stay off the bike for at least two weeks and try to avoid sitting for extended periods for several days," Shupe says. Have your bike shop or cycling instructor double-check your fit, because a good adjustment can help reduce pressure on your perineum. Many of us keep our handlebars too low and our seats tilted up too far, which can put excessive stress on the pudendal nerve and prevent blood flow to the perineum. "Switching your bike seat may also be helpful," Shupe says. (The Derri-Air Hornless Bicycle Seat, available for both indoor-cycling and road bikes, takes pressure off the vulva almost entirely; $50, derri-air.com.) If the problem worsens or persists for more than two weeks, make an appointment with your doctor, because pudendal neuralgia can progress and become difficult to treat.
Q. Can exercising give me a yeast infection? I swear there's a connection.
A. Not really. Sweat and tight-fitting workout clothes are more likely the cause. "Wet fabric is rough and can irritate the vulva. That chafed area then makes it easier for an infection to start if yeast organisms are present," says Paul Nyirjesy, MD, the director of the Vaginitis Center at Drexel University College of Medicine. If you are prone to vaginal infections and you need to run errands or grab coffee with your workout pals after class, keep a pair of cotton panties and a fresh set of leggings in your gym bag. Do the same after a race or triathlon. And try to minimize irritation in the first place. "Applying a thin film of Vaseline on the vulva does the trick, especially for those who spend a lot of time on a bike," Dr. Nyirjesy says.
The Safer Way to Work Out
As good as exercise is for you, your pelvis can pay the price if you aren't careful. Studies show that distance runners, tennis players and weight lifters are at higher risk of incontinence due to PFDs as a result of all the pounding, twisting and strain involved in their sport. Even moves like crunches, push-ups and deep squats can cause problems for women whose pelvic floor may already be weakened or damaged. Follow these basic guidelines for protecting and strengthening your pelvic floor.
Practice good posture when you exercise. Poor form increases pressure on your pelvic organs and interferes with the function of your ab muscles.
Activate your pelvic floor muscles (by gently drawing your rectal and vaginal muscles in and up) and your transverse abdominals (by drawing your lower belly up and in during exhalation) just before and while you lift, lower, pull or push any weight.
Never hold your breath during an exercise, because this ups the pressure on your pelvic floor. Breathe out when you are pushing, pulling or lifting.
Stretch frequently and/or practice yoga to increase flexibility and range of motion in your spine and hips.
Avoid running or doing high-impact exercise after the first trimester of pregnancy and during the first six weeks postpartum.
If you do extreme workouts like competitive CrossFit, daily exercises for the pelvic floor may make it stronger and better equipped to tolerate the physical stress of your activities, says Allison Bailey, MD, the founder of Integrated Health & Fitness Associates in Cambridge, Massachusetts. A pelvic physical therapist can create a routine specific to your needs.
Skip intense upper-abdominal exercises if you have symptoms of a weak or damaged pelvic floor, as they are the most likely to put stress on the area. These include crunches and any moves, like bicycles or yoga boats, that require you to have your head and legs raised at the same time. If you have pelvic pain, dial back on core work and focus more on relaxation exercises — restorative yoga, meditation — that can help release your pelvic floor muscles.