written by Kejal Macdonald

Body Banter

On The Floor II

This is the second post in an ongoing series, written with the help of our resident Pelvic Protector, Lindsey Vestal. Lindsey runs the Functional Pelvis here in New York, and makes house calls to work with women in the comfort of their own homes to help restore and strengthen their pelvic floor.

Lindsey is our beloved sherpa, guiding us through this pelvic renaissance. She is equal parts hummingbird and panda bear.

We left off the last post talking about how the pelvic floor is our center of our bodies, both figuratively and metaphorically. Soooo, when you say, "center of our bodies," do you mean it’s connected to our core?

Yes! The pelvic floor is one of the four components of your core. The core is made up of the pelvic floor, the diaphragm, the lower abs between your belly button and pubic bone, and the postural muscles along the spine. As a system, these 4 parts work so well together to keep us strong and supported.

A big part of what I do in pelvic floor therapy is to first talk about breathing. Starting with the diaphragm is the foundation of pelvic floor work. Being able to understand the rhythm of contracting and releasing of our breath is a great way to start accessing the pelvic floor.

Wait, just by breathing? Does that mean if I’m breathing wrong I could be potentially neglecting or damaging my pelvic floor?


Oh crap! I tend to be a really shallow breather (I know, it’s terrible), but I’m guessing you’re about to tell me I should be breathing from my diaphragm like in high school drama class?

Exactly. So as a shallow breather, you initiate breathing from your chest. This bypasses the diaphragm (in your belly) so you’re not activating a crucial part of your core. And you’re not able to fully access your circulatory and respiratory system that way. Shallow breathing actually makes you feel more on edge or slightly anxious. It’s that whole flight or flight thing.

Story of my life! This explains so much. So one thing every woman can be doing all day every day to help her pelvic floor is breathing from her diaphragm?

Precisely. Think about your diaphragm as the space from the bottom of your ribcage to the front points of your hips. When you’re breathing properly, that part of your stomach should move out on the inhale and come back in when you exhale.


Ok, let's jump right to leaking! When women are having bladder leaks, why is that happening? Wait, I should caveat that I know there’s a really wide range of reasons why - I’ve spoken with several women who've had a spinal cord injury, or are living with a neurological condition such as Multiple Sclerosis - but if a woman is experiencing a little leakage, say, after giving birth, what exactly is happening with her pelvic floor to cause that?

The abdomen is a pressure system, and if the pressure above the pelvic floor is imbalanced, it can cause leaking. An additional factor could be musculoskeletal weakness, perhaps from being pregnant or giving birth. Think about all the weight you carry around right above your pelvic floor for a full 9 months. There’s a lot of nerves down there; some of them can get stretched and compressed. Ligaments, muscles, and tendons are being impacted. So many postural changes happen when you’re pregnant as your center of gravity shifts. That all has an impact on the center of our body.

Then of course, you have the birth itself, which can have a certain amount of physical trauma to these muscles as well. The perineum is a part of the body where a lot of women tear or experience episiotomies. Well, guess what? Your pelvic floor muscles insert at the perineum. That’s where the pelvic floor connects to everything else. So anything that impacts the perineum has a pretty global impact on the pelvic floor in general.

So that very specific trauma that happens to the pelvic floor, with the global changes like postural shifts and the growing weight of the baby over 9 months can all contribute to leaking.

It totally makes sense immediately following birth, in those early postpartum months when those muscles are recovering. But what about a woman who had a baby a few years ago, or even longer, and she’s still experiencing leaks when she’s active?

Yes, and that’s something a LOT of women are living with. If we don’t address muscular weakness, it’s going to continue to get weaker. One of the things I like to tell women is that exercise or rehab could be a small portion of your day - maybe an hour a day if you’re lucky. But what’s happening the other 23 hours? What habits, body positions, and activities are you doing that are also impacting your pelvic floor function? That’s where I really like to talk about everyday movements. How are you picking up your baby? How do you get up out of a chair? Are you breathing shallow from your chest or are you using your diaphragm?

So it’s not just about the therapy? It’s about the way you carry your body and use your muscles all day every day?

Exactly. And that’s why pelvic floor therapy can also be considered re-education, or restoration of muscles. Therapy is the gateway into restoring, reconnecting and getting your muscles back online so they’re a functioning part of your system again, and then integrating that into our everyday lives so that we’re strong and leak free.


 Next up: Kegels! Are you doing them right? Are you doing the right amount? Should you even be doing them at all?