Integrating Pelvic Floor Health Into Fitness Programs

The pelvic floor is a crucial yet often overlooked component in women’s wellness programs, regardless of life stage. Its health is paramount to a woman’s overall well-being, impacting various aspects from core stability to urinary continence It also plays a vital role in supporting the bladder, uterus and rectum, and weakness or damage to these muscles can lead to a range of health issues.

Health coaches and fitness professionals are in a unique position to champion pelvic floor health by integrating targeted exercises into their programs. By doing so, they can help women of all ages build and maintain a strong pelvic floor, which contributes to improved core stability, better posture and enhanced athletic performance. 

Incorporating pelvic floor exercises into wellness programs can not only boost athletic performance, but also significantly improve overall quality of life for women.

Understanding the Pelvic Floor

The pelvic floor consists of muscles and connective tissues that form a supportive sling across the base of the pelvis. Extending like a muscular hammock from the pubic bone at the front to the tailbone at the back, this complex structure plays a pivotal role in various bodily functions critical to a woman’s health and well-being.

The pelvic floor muscles (PFMs) act as the foundation for the pelvic organs, including the bladder, bowel (rectum), and uterus in women, offering support and stability. These muscles work in concert to maintain continence, contribute to sexual sensation, and assist in supporting the abdominal and pelvic organs against gravity and the forces exerted by physical activities.

Christina Christie, PT, senior physical therapist and women’s health specialist for Sports and Ortho Physical Therapy in Glenview, Illinois and founder and president of Pelvic Solutions, LLC, says that one in three women have some kind of pelvic floor dysfunction. 

If many of your clients are women, you’re training someone who has some level of pelvic dysfunction,” says Christie. “She may even confide her problems to you. Whether her challenge is urinary incontinence, pelvic-organ prolapse or some other symptom, it is an issue that you can address with the right education and tools.”

Causes of Pelvic Floor Dysfunction

As already mentioned, the health and functionality of the pelvic floor are integral to urinary control, bowel function and sexual health. When the PFMs are strong and functional, they effectively support these systems, ensuring proper organ alignment and function. However, the PFMs can become weakened or damaged due to various factors:

Childbirth: Vaginal delivery can stretch or tear the pelvic floor muscles, sometimes leading to long-term weakness or dysfunction.

Aging: Natural changes in muscle tone and strength occur with aging, which can affect the pelvic floor’s ability to function properly.

High-Impact Sports and Activities: Activities that increase intra-abdominal pressure, such as weightlifting or intense aerobic exercise, can strain the pelvic floor, potentially leading to weakness or injury over time.

Note: Read this case study for more about how it affects athletes. 

Other Factors: Obesity, chronic coughing, and certain surgeries can also place additional stress on the pelvic floor, contributing to its weakening.

A compromised pelvic floor can lead to several health issues, with urinary incontinence and pelvic organ prolapse being among the most common. These conditions can significantly impact a woman’s quality of life, causing discomfort, embarrassment and physical limitations. 

Assessing Pelvic Floor Health in Clients: Understanding Scope of Practice

For health coaches, recognizing the signs of pelvic floor dysfunction (PFD) in clients is a critical aspect of providing comprehensive support. However, it’s equally important to understand and respect the boundaries of one’s professional scope of practice. Here’s how to navigate this delicate balance.

Recognize the signs. Pelvic floor dysfunction encompasses a range of issues. Be vigilant for common symptoms that may suggest a client is experiencing PFD, including:

  • Needing to use the bathroom often or experiencing a sudden urge to urinate.
  • Pain or discomfort in the pelvic region during or after performing physical activities.
  • A visible bulging in the pelvic region, which may indicate pelvic organ prolapse.
  • Any involuntary leakage of urine during physical activity, sneezing, or coughing.
  • Experiencing discomfort or pain during sexual activity can also be a sign of PFD.

Creating a safe and supportive environment for clients to discuss their health concerns, including those related to the pelvic floor, is essential. Encouraging open communication helps in identifying potential issues early and adapting training programs to avoid exacerbating any existing conditions.

While health coaches and personal trainers can play a key role in identifying signs of PFD and providing general wellness advice, diagnosing and treating medical conditions is not within scope of practice. Remember to:

Refer to specialists: When signs of PFD are observed, refer clients to a healthcare provider specializing in pelvic health, such as a physiotherapist with training in pelvic floor rehabilitation.

Collaborate: Working collaboratively with healthcare providers can ensure that the program aligns with the client’s medical needs and rehabilitation goals.

Invest in continuing education: Pursuing specialized training in pelvic floor exercise design can enhance a health coach’s ability to support clients, provided it is used within the context of training and not as a substitute for medical treatment.

Assessing pelvic floor health and recognizing symptoms of dysfunction are important skills; however, it’s crucial to stay in your lane and refer to medical professionals for diagnosis and treatment.

Designing Pelvic Floor-Friendly Fitness Programs

Creating a fitness program that supports pelvic floor health involves incorporating exercises that strengthen without overburdening these muscles. Christie, for example, teaches a course called the Female Kinetic Chain® that addresses women-specific biomechanics and pelvic floor dysfunction. 

Movements such as deep abdominal breathing, pelvic tilts, and specific kegel exercises can fortify the pelvic floor. Equally important is modifying or avoiding exercises that exacerbate pelvic floor strain, such as traditional crunches or heavy squats, for those with known issues.

A 2020 study compared the effects of 10 common exercises to traditional Kegel exercises on the levator hiatus (LH) area, pelvic floor muscle (PFM) length, and strength in 15 healthy postpartum women. 

The exercises included variations of leg, core and back exercises used in yoga, Pilates, strength training and physical therapy. The study found that bird-dog, plank, and leg-lift exercises affected PFM strength, length and LH area similarly to Kegel exercises, with leg lifts generating stronger contractions than Kegel. 

The study suggests that these exercises should be evaluated as alternatives to Kegel exercises for postpartum women.

The following exercises are generally regarded as safe to perform for women who have been cleared by a medical professional.

  1. Pelvic Tilts: Engage the pelvic floor by gently tilting the pelvis forward and back, focusing on controlled movements and deep breathing.
  2. Bridge Pose: Lying on the back with knees bent, lift the hips while engaging the core and pelvic floor, then slowly lower back down.
  3. Deep Abdominal Breathing: Encourage diaphragmatic breathing, emphasizing the expansion and contraction of the abdomen to engage and relax the pelvic floor muscles.

Advising clients on the proper form and gradual progression of these exercises ensures a foundation for both pelvic health and overall fitness achievements.

Pelvic Floor Health for Life

Integrating pelvic floor health into wellness programs is not just about enhancing athletic performance; it’s about fostering long-term health and well-being. Recognizing its importance, understanding the factors that can compromise its function, and taking proactive steps to maintain or improve pelvic floor health are essential for women of all ages. Wellness professionals have a unique opportunity to integrate this knowledge into their practice, offering guidance and support to clients for better health outcomes.

Amanda McClure is a health and wellness journalist.

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