Day 124: Back to the basics… Kegels 102.

May 3, 2012 By 1 Comment

Fem365: Fitness. Food. Femininity.

I’m calling this post “Kegels 102″ because — to be perfectly honest — it’s recycled from a post I wrote nearly three years ago. THREE YEARS AGO! I have been blogging for a long time!

This post has some great info, and a dear friend of mine recently reminded me that the pelvic health content offered on this blog is truly priceless for women. My pelvic health posts can be a bit difficult to search for, as they are hidden among layers and layers and LAYERS of posts (nearly 300!).

If you want to know why you should do kegels or how often to do kegels or what other exercises are recommended in addition to kegels, check out my book! If you want to know how to do kegels, keep reading.

Let’s talk about the basics:

Kegels 102

You have probably heard of a “kegel,” the basic technique used for strengthening the pelvic floor based on the research of Dr. Arnold Kegel (an obstetrician/gynecologist circa 1940s). Contracting the pelvic floor seems simple, but surprisingly, many women who think they know how to do a kegel are not contracting the appropriate muscles when examined for technique. There are a few steps you need to take to make sure you are doing kegels correctly. If not, your efforts to exercise will be futile and you may even be damaging your pelvic floor.

Try this: Lie down on your back with a pillow under your hips and your knees bent. Place a hand on your belly and breathe normally. Contract your pelvic floor muscles (the muscles that lie at the base of the pelvis and surround the vagina and rectum) by squeezing in and lifting up as if you’re trying to stop the flow of urine. Now ask yourself some questions. Did you feel your abdomen move? Did you feel your buttocks clenching? Were you holding your breath? Were you bearing down? If you answered yes to any of these questions, you did not do the kegel correctly. The aim of a kegel is to isolate the pelvic floor muscles which are internal, so there should be no external movement as they contract. NO ONE who is watching from the outside should have any clue that you’re exercising, when in fact, you’re working a vital group of muscles.

Image © Lindsey White, http://www.colorinblackandwhite.com

Take a Look!

To make sure you are performing kegels correctly, use a handheld mirror as you lie in the position described above. This is best done without underwear. As you contract the pelvic floor, the perineum – the area between the vagina and the anus – should move upward and inward (toward your head). If you see the area bulging outward, stop here! You are not doing a kegel correctly. Read on for more information then try again.

In addition to taking a look, you can also lightly touch the perineum while you perform the exercise. This can be done with or without underwear. Again, the perineum should move upward and inward. If it does not move or if it bulges outward, stop here and keep reading for more tips before trying again.
The above techniques – looking and touching – are called “simple biofeedback.” They provide sensory information (visual and tactile) to the brain to help coordinate the command with the movement.

Visualization

If you are not able to perform a kegel correctly, try concentrating on the following visualizations. After you’ve found one that makes sense to you or resonates with you, try the exercise again with one of the simple biofeedback techniques described above.
Visualization One: The Flower. Think of your vagina as a flower that is wide open, like a rose in full bloom. Now visualize the flower closing up tightly and back into the shape it had as a bud, like time lapse photography going backward from summer to spring. Try contracting your pelvic floor (pull in and up) as you visualize the tightly closed bud. Relax the pelvic floor as you visualize the flower in full bloom.
Visualization Two: The Ball. Picture a small, smooth, round ball. Visualize the ball coming into your body as you contract your pelvic floor. Imagine it rolling out as you relax the pelvic floor.
Visualization Three:The Elevator. Imagine your pelvic floor muscles as an elevator that is stopped at the ground floor or the lobby of a building. Contract your pelvic floor muscles as you imagine the elevator doors sliding closed, then lift your pelvic floor muscles upward as you imagine the elevator rising to the second or third floor. Hold briefly at the top of the contraction. Release the contraction as the imaginary elevator lowers and returns to the starting position (the lobby). Fully relax your pelvic floor muscles as you imagine the elevator doors sliding open.

One More Check-In

The following are some cues that you are NOT performing a kegel correctly:
o You can feel or see your abdominals or your buttocks contracting
o You find yourself holding your breath
o You are pushing or bearing down (as if having a bowel movement)
o You cannot see or feel your perineum lift through simple biofeedback

Please do not be discouraged if your form is incorrect and if, after a week or two of training, you still can’t “get the hang” of it. Up to fifty percent of women are unable to complete kegels correctly with verbal or written instruction alone. If you feel that this is the case for you, don’t give up. Seek out a women’s health physical therapist or an urogynecologist. Both disciplines have special training in the treatment of pelvic floor dysfunction including underactive pelvic floor muscles and poor coordination of the pelvic floor. These providers can help you find the pelvic floor muscles and complete a correct contraction. They will prescribe a pelvic floor strengthening program based on your strength level and your needs.

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Day 66: Essential Core Strengthening for Female Runners

March 6, 2012 By Leave a Comment

Fem365: Fitness. Food. Femininity.

I’m so proud of my local friends who completed the Paris half marathon last weekend… Rockstars, all of them! I have fielded a lot of questions over the years about stretching and strengthening exercises to augment running programs. My recommended strengthening exercises are to come, but first, a bit more about me and my running history.

I have a love-hate relationship with running. I ran competitively throughout high school (cross country and track) and continued to “run for fun” (non-competitively) throughout college, graduate school, and beyond. I worked at a running specialty store before I got my PT degree and completed numerous 5 and 10K races, two half marathons, and the world-famous Hood to Coast relay four times. Running always has been — and always will be — a part of my life.

Although I will always have a soft spot in my heart for running, there were a few downsides (for me): It was hard on my joints, especially my knees. It was hard on my pelvic floor, especially since I returned to the sport FAR TOO SOON after giving birth. Psychologically, running can be addictive. It was for me. I was compulsive about it — if I took a day off and tried something new to mix up my routine, I felt like I was going to gain a ton of weight and instantly be “out of shape.” I would see a runner on the road and instantly feel like I should be out there too… Observing other runners filled me with a strange mix of jealousy (that they were getting their run in), guilt (that I was not getting my run in), and fear (that I was getting older and slower and less and less likely to be a “good” runner). About a year ago, I quit running altogether. I went through withdrawals, but I can now say that I am officially over my running addiction and can now dabble in it here and there and feel good about it when I hit the open road. My jaunts are usually  heavy on the walking, and may include 20 minutes of running, or they may only include 5 minutes of running. I no longer strive to fulfill requirements for my training log, beat a PR, or keep up with a particular (faster) training partner. Running — on the rare occasion that I do it — feels good again. It feels healthy.

I realize that everyone is different and some (most!!!) people probably have a healthier relationship with running than I did. But regardless, many runners require extra encouragement when it comes to rounding out their exercise program. It’s such a great workout in and of itself that it can be easy to forget that it’s not necessarily a well-rounded workout. So… Back to the task at-hand: essential core strengthening exercises for female runners.

Running quickly elevates your heart rate and is most definitely a weight-bearing activity (good for maintaining bone mineral density and muscle mass); however, it is also a very linear/straight plane activity and can be hard on your joints and your pelvic floor, especially for women who have recently given birth or who have a history of pelvic floor weakness. Pavement pounding can increase your risk for conditions related to pelvic floor dysfunction including prolapse and urinary incontinence. I feel that it is imperitive to cross train — to do more than just RUN for a balanced, total-body conditioning program. It’s important to train the upper body (which I will NOT address in this post), as well as include side-to-side and circular motions into your fitness program to counter the repetitive straight-ahead motion of running. It’s also essential to include specific core strengthening exercises to maintain a strong and stable trunk and pelvis from which your legs and arms move.

There are hundreds — probably thousands — of exercises you can do to incorporate side-to-side (lateral) and circular motions into your program. Here are two:

Again, there are (literally!) thousands of exercises you can do to incorporate core stabilization into your program. Here are two… Pictures and descriptions are from the “Inner Core Energizer” routine found in my book!

Slalom

Image © Lindsey White http://www.colorinblackandwhite.com

This is an intense abdominal strengthener meant to whittle the waistline and rid you of the dreaded “muffin top.” It works your deep abdominal muscles with a focus on the internal and external obliques.

Find neutral spine position and draw the abdominal muscles in toward your spine. Bring both legs off the floor and straighten them toward the ceiling. Bend your legs slightly at the knees, and then strongly drive both knees to the right. Feel the left side of your abdominal muscles (your obliques) contracting. Next, reverse and strongly drive both knees to the left as you feel the right side of your abdominal muscles (your obliques) contracting. You just completed one repetition.

Continue to twist your pelvis with a focus on strongly driving your knees to the right and left. Complete 10 to 15 repetitions.

Combo Kegels (not pictured)

This is an advanced kegel technique that is effective in the treatment of urinary incontinence. It utilizes the slow twitch (endurance) fibers of the pelvic floor first, and then brings in the fast twitch (quick acting) fibers before fully relaxing. It is a fantastic way to increase pelvic floor strength, endurance, and coordination.

Stand in a neutral position. Feel free to sit or lie down if it is difficult for you to sense a kegel when you are standing. Squeeze and lift your pelvic floor (do a kegel) and hold the contraction for 5 to 10 seconds. Then, before fully relaxing the muscles, do 3 quick kegels (pull up farther, slightly relax; pull up again, slightly relax; then pull up one last time and fully relax). That was one repetition.

If you need additional guidance, try the following visualization: Imagine that you are pulling a marble into your vagina. Squeeze and lift your pelvic floor muscles to pull the marble into your body and hold it for 5 to 10 seconds. Now relax your muscles just enough to let the imaginary marble almost roll out. Before letting it roll out completely, quickly catch it and pull it back in. Almost let the marble roll out again, then catch it and pull it back in. Almost let the marble roll out one final time, catch it and pull it back in. Finish by relaxing completely and letting the imaginary marble roll out of your body.

Complete 5 repetitions, being sure to fully relax after each rep.

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Day 32: A jock strap for the ladies

February 1, 2012 By 2 Comments

Fem365: Fitness. Food. Femininity.

Yes, this is a re-post! But it is my MOST POPULAR POST by far, so I thought I’d talk about the Femme once again, this time with a proviso: I do not sell the Femme. It is not my product. I have had a number of people email me with questions about the product — wanting to purchase it, etc. — and I can’t help you! Sorry! If you are interested in purchasing, please click here  and scroll down until you see the “Femme” information. There’s also a “Homme” now… Pelvic floor support for men!

(Originally published on December 9, 2010)

When I heard about the Femme, I had to try it for myself.

The Femme is “Designed for Female Pelvic Floor Support,” and is described (online) as follows:

Orthotic design created with women’s health care in mind. The Femme helps support both the perineum and rectal soft tissue. A lift reduces elevated pelvic floor muscle tension and supports weak pelvic floor muscles. Femme is designed to be worn over underwear for maximum comfort and support.
Who might benefit? Women who have…
*Hypertonous of pelvic floor muscles
*Varicose veins
*Post-delivery trauma of pelvic floor muscles
*Athletes who run, sail, or climb
*Urinary or fecal urgency
*Overactive bowels (IBS)

I decided to order one to see what it was all about.

Ordering: I had some difficulty finding it online, so before I go any further let me link to a page that allows you to order. The process I went through was quick and easy… I did it the old-fashioned way and picked up a phone! (I obtained the company’s phone number at a continuing ed course I attended about about a month ago.) The Femme arrived in my mailbox within a few days – much faster than I expected. However, on the downside, nothing was included with the order besides the Femme itself in unmarked plastic packaging. There was no receipt for my purchase, no literature that described the product or how to use it, how to fit it, no washing instructions, etc.

Putting it on: First off, you need to be okay with slight camel toe in the front and a bit of a wedgie in the back. I really had to hike it up in order to feel sufficiently supported to go for a run. I wore it over bikini underwear, which wasn’t a good thing (as you’ll read below).

Wearing it: Although I don’t have any incontinence issues when I run, I do have a slight prolapse and usually run wearing a tampon to help me feel more “supported” internally. I was hoping the Femme would help by supporting me externally, and it did… about 95% of the time. I felt great initially, but toward the end of my run/walk I wasn’t feeling as much “lift.” In addition, I have to say that I ended up with some chafing, but I’ll admit I was wearing the wrong underwear. I’ve come to the conclusion that the Femme requires boy shorts, not briefs/bikinis.

Conclusion: It’s amusing and a conversation starter, and it certainly does provide a “lift” + compression in the perineal region! It’s a little spendy ($45) but I think it’s worth trying if you have mild prolapse, mild incontinence, or issues that might benefit from compression in the vaginal and/or perineal regions (for example, if you are recently postpartum, or if your labia are enlarged and they chafe in your underwear when you walk).

A bit big for my son. And a bit femme.

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Top 10

July 14, 2011 By 2 Comments

I was digging around through my old files and found something I created last year for one of my FemFusion workshops. It has some great tips, and I thought it deserved to be revisited! Almost every tip has a hyperlink to a “blast from the past” blog post that provides further information/explanation. Any additional questions? Just leave a comment!

“I should have known that!” Top 10 pieces of pelvic health advice we should have been taught as young women (but probably weren’t):

  1. Engage your pelvic floor and abdominal muscles and breathe out (exhale) when you’re lifting. This will protect your back and your pelvic floor.
  2. Don’t strain when urinating or having a BM
  3. Remember: “squeeze before your sneeze!” (or cough, or blow your nose)
  4. Don’t pee in the shower
  5. Don’t “hover” over the toilet when urinating
  6. Don’t do kegels when urinating (at least not on a regular basis!). Explanation: it’s okay to try a kegel or two while you’re on the toilet to make sure you’re using the correct technique, but do it once a week rather than once (or twice, or three times) a day. Regularly doing kegels while peeing can lead to incomplete evacuation of your bladder and urinary retention. This will result in more frequent trips to the bathroom… Who wants that?!
  7. Don’t rush to the bathroom as soon as you feel the slightest urge. Wait until your bladder is comfortably full, then slowly and calmly walk to the restroom.
  8. Don’t just “suck in” your belly when engaging your core — “zip up!”
  9. Sit tall… Don’t slump!
  10. Exercise! Move! Every day! Make total body fitness a habit.

And a bonus, just for fun:

11. Get to know your lady parts! Use a mirror, take a look, and know the proper terminology (even if you don’t use it). You should know more about your own female anatomy than your partner does.

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On the road again…

April 21, 2011 By 2 Comments

After a long, LOOOOOONG break…. If there’s anyone still reading my blog… I’m back!

It hit me like a ton of bricks. After months of focusing inward, spending time with my family and getting familiar with the new German landscape that surrounds us, I’ve decided to get back in action. It all started with a pair of running shoes!

Yes, running. Once a runner, always a runner. Although I tend to advise women with pelvic floor weakness to avoid running (or other high impact activities) in favor of low-impact activities such as dance, biking, elliptical training, or walking, I have to admit: nothing else gives me the euphoric “runner’s high” (and an incredible workout in minimal time) like running.

So what’s a girl with a history of pelvic floor weakness to do when she wants to run again? If you’ve followed my story, you may recall that I started running far too soon after giving birth which resulted in a mild cystocele. Things significantly improved after a regular program of pelvic floor and core strengthening, made easier by the fact that I am a women’s health physical therapist and was — at the time — seeing patients on a regular basis. I did my kegels right along with them, and let me tell you — my pelvic floor was strong! But now, things are different. I’m not working outside of the home, and DANG. My poor pelvic floor is weak. I can fully admit and relate to women around the world who say that kegels are boring and easy to forget. It’s difficult to stick to a regular pelvic floor strengthening program! I really have to make an effort to remember to do my kegels along with my other core strengthening exercises since I know (from the research and from experience) that kegels only work as long as you’re doing them. But — weak pelvic floor and all — as the frost thaws in Germany and spring reveals some of the most beautiful scenery I have ever seen, I can’t resist the lure of the open road. So I bought myself some pretty new running shoes and I’m forcing myself to prepare my poor pelvic floor for the pavement pounding by doing daily kegels. Every day. Not skipping once.

Here’s my plan: Daily kegels, 10 reps of 8-10 second holds, working up to 20 second holds (endurance is important for runners). To increase my running tolerance, I’m starting with easy run/walk intervals: 30 seconds of running followed by 1-2 minutes of walking. I’ll try to gently draw my pelvic floor “in and up” and hold the contraction as I’m running.

As my pelvic floor strength improves I’ll drop down to a maintenance program of kegels only 3 times per week. As my running tolerance improves I’ll lose the intervals and simply run until I feel like stopping.

If I have any issues with leakage or a feeling that my cystocele is increasing, I’ll use a tampon before I head out the door for a run. I may also look into a pessary, although that would require a medical appointment and that’s proven to be difficult here in Germany!

The point of the story is that I finally feel like I’m ready to be ”back in action” in multiple areas of my life… Not just running. I am going to be easier on myself than I was back home in Oregon; I’m not going to push myself to be in great shape, be a mom, be a physical therapist, nurture my blog, write a book, and run a business. Motherhood and culture-shock have acted as co-conspirators to soften me a bit… Loosen me up a bit. Let me tell you, I needed it. And the glorious news is that over the last few months I have found myself happier than I’ve ever been before. But I have also felt a small hole in the “purpose” and “direction” categories of my life that the running shoes seem to have filled! I am going to start running again. I am going to start writing again. I’m going to start blogging again — periodically. It’s a good thing. Thank you, new running shoes, and thank God for running.

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