Squeeze tight and... hold on a second… Five myths about your pelvic floor
There are so many misconceptions around pelvic health, from how it affects intercourse to what exercises you should do to maintain it, writes Linnea Dunne. She talks to women’s health physiotherapist Elaine Barry to separate fact from fiction
‘That’s a tight squeeze you’ve got there!” a nurse once told me, halfway through a cervical smear. It’s perhaps noteworthy that it’s stayed with me, this memory of praise of my vaginal strength.
It’s not like I’d done much to deserve it — even after two vaginal birthsrths of 9lb babies, I wasn’t really doingoing my Kegel exercises — so I couldn’t exactly take credit for it. Nevertheless, a tight squeeze sounded like a good thing.
Little did I know that, a few years later, I would find myself at a pelvic floor physiotherapist practice seeking help for bladder issues and pelvic organ prolapse, only to be informed that a hypertonic pelvic floor was triggering and compounding most of my symptoms.symptoms
So much for my pride in that good, tight squeeze; it was deceptive, more of a warning sign than a blessing, it turned out.
It’s hardly surprising that I didn’t know that, of course, when all we ever hear is talk of lifting and squeezing and doing our Kegels better and more often.
It’s not like the pelvic floor is a frequent topic of discussion in secondary school biology books, or even during SPHE class.
As women’s health physiotherapist Elaine Barry reflects on her school days, “I probably learnt more about the reproductive cycle of ferns than I did about the human reproductive system!”
Elaine works at Milltown Physiotherapy, regarded as one of Ireland’s best clinics for pelvic floor hehealth, as well as independently at Bray Women’s W Health Centre. She also runs an Instagram account acco — @elainebarryphysio — with the aim of educating p people on pelvic health and w wellness.
Here she clarifies five common myths and misconceptions about pelvic f floor muscles.
MYTH M 1 : The tighter your pelvic pelv floor, the better it will function
“Think of an elevator. What goes up must come down,” Elaine explains and suggests thinking of your biceps. You wouldn’t go around all day with your arm folded up in the air, nor should your pelvic floor be up all the time.
“The pelvic floor is meant to move up and down in conjunction with the diaphragm.
Think of it like a coffee plunger: when you inhale, the diaphragm descends and so provides pressure downwards, and on the exhale it comes back up again.
“Squeezing the pelvic floor all the time is not what we need. So many women are functioning at about 50pc of their potential — we need to be able to move a muscle from point A to B to get the best support and power from it,” she says, adding that a lot of painrelated pelvic floor conditions are related to people holding the pelvic floor too tightly.
One of the most important things, according to Elaine, is improving your breathing and using it to learn to let go of the pelvic floor. And there’s a positive knock-on effect, too:
“When you breathe effectively, you also tune into your parasympathetic nervous system, which boosts relaxation and relieves pain.”
MYTH 2: A good way to remember is to do 10 quick squeezes while the kettle boils
It’s often suggested to women to try to do their Kegels at the same time every day in order to remember – say when brushing your teeth or waiting for the kettle to boil. It’s a nice idea, but unfortunately it’s not that helpful.
“A lot of women are told to do their pelvic floor exercises when they’re stuck at traffic lights or something like that, but there needs to be a more mindful approach — especially in cases where women are having issues,” says Elaine.
‘Think of it like a coffee plunger: when you inhale, the diaphragm descends and so provides pressure downwards, and on the exhale it comes back up again’
“There’s this myth that you need to be doing all these fast squeezes. You’ve e got women coming out of hospital after having babies, es, doing loads of fast squeezeses to avoid leakage with coughingng and sneezing – but the pelvic floor is made up of 70pc slow-twitch muscle fibres, which work at a lower level to allow you to move around, to support your organs and keep you continent.
“You need to get them working first, and then move on to faster lifts. Ideally, you should be spending some time lying down and getting used to it first, which opens the motor control channels between the brain and the body. When we do things on the go, we’ll often be more distracted.”
MYTH 3: The stronger the pelvic floor, the tighter the vagina — and the better the sex
The glorification of a tight vagina is unhelpful in more ways than one. Firstly, it’s a myth that childbirth always makes the pelvic floor loose, when in fact it’s the fascia and ligaments that tend to stretch, while the muscles are working hard to try to hold it all together.
“We actually see a lot of women’s pelvic floor muscles being too tight and taut after childbirth,” says Elaine.
Moreover, also among those who’ve never given birth, a lot of women are unable to have sex or find it very painful as a result of being too tight.
“Your vagina is meant to stretch and accommodate and respond to sexual pleasure that way. If it’s too rigid, it can be painful. Yes, you can squeeze during intercourse, but you must be able to release as well.
“Approximately 60pc of women have a tendency towards tightness and probably don’t need to squeeze at all. Sex is more about awareness down there, and we should draw attention to the external sex organs like the clitoris and labia as well, rather than just the inner pelvic floor.
“A lot of younger women are suffering from painful conditions like vulvodynia, vaginismus and bladder pain syndrome, and a tight core and pelvic floor can contribute to these.”
MYTH 4: To find a good squeeze, try to stop the flow of urine mid-stream
From imagining that you’re trying to pick up blueberries with your vagina to trying to stop the flow of urine mid-stream, there are endless peculiar analogies when it comes to trying to achieve that perfect squeeze.
But research has shown that none of the above is as good a cue as simply trying to squeeze the anus.
“Where does the squeeze start? There’s a lot of different information out there in terms of what you’re meant to be thinking about, but bringing it back to basics and encouraging women to think about the back passage seems to work the best,” says Elaine.
“You don’t need to do all sorts of fancy stuff — a good squeeze starts at your back passage.”
Different strokes for different folks, you might say, which is of course a valid point. If you can see a pelvic floor physiotherapist in person, they can tell you exactly when you’re doing it right. But until then, keep it simple and start at the back!
MYTH 5: Always engage your pelvic floor and core when exercising
“PeoPeople who have an issue, in paparticular with incontinence, ccan tend to hold their breath aand tighten the belly when exercising, thinking it will help. But more often than not, it’ll actually make incontinence worse,” says Elaine.
TToo much sitting also concontributes to tighter, shorter pelvipelvic floor muscles, so varying your position more can help. OOther than that, the solution yet again comes back to the breath.
“It’s similar to when you jump on a trampoline: it gives a little and bounces back up,” Elaine explains.
“Many women think they have to have tight, toned bellies to help overall function, but it can go too far and get too core-focused. By softening a little when jumping or jogging, you allow the pelvic floor to adapt and do what it’s meant to do.”
Elaine, who started her career in sports physiotherapy, says her love for the women’s health field has grown over the years, much thanks to seeing the huge impact it has on women’s lives.
“I always start by trying to encourage women who come to see me, if they’re nervous, that this is going to be empowering, because it’s opening up knowledge about their pelvic floor,” she says.
“You’re really affecting people’s quality of life. With small tips and pieces of advice, you can lead them down a path they never even knew existed. It makes it all very worthwhile.”
‘Approximately 60pc of women have a tendency towards tightness and probably don’t need to squeeze at all’