Should I Really Be Able To Hold Up A Surfboard With My Vagina???
I remember when I came across this image in social media and, as I’m sure you did too, I had to do a double-take. Is she really holding up that surfboard with her Vagina????? Indeed she is, but does that mean her pelvic floor is any better than yours or mine? No! Read on and find out what really matters when it comes to a effective pelvic floor.
Clinically, I find it is not uncommon for a patient to present with complaints of leakage with running, jumping, coughing etc, but upon assessment find that they have quite strong pelvic floor strength and endurance. So what’s going on then to cause the leakage?
The pelvic floor is not just used in isolation. It is a responsive element, which is part of a dynamic system....your body. Yes, it is important to have sufficient muscle strength and tone (or tension) of the pelvic floor to provide appropriate support and closure, but it also has to work well with the rest of the body, especially the breath and core muscles. To give a different example of this, you may have super strong biceps and can lift heavy weight with a bicep curl, but that doesn’t mean you can do a push up well. You need to also have a good core and shoulder mobility and strength.
The two key factors here are that the pelvic floor is RESPONSIVE and PART of a SYSTEM.
Lets start with the system! When we consider our deep core, we are talking about 4 key elements: the breath/diaphragm, the pelvic floor muscles, transversus adominis (the deepest of your core muscles) and the multifidus muscles (deep spinal stabilizer muscles). These four elements must work together to manage the pressure with in your abdomen (the intra-abdominal pressure), as well as activate together to create a solid “base” for the rest of your muscles to work from. When there is a break down in the system, ie. too much pressure being generated, or the muscles not coordinating properly, it can create extra stress to the pelvic floor and urinary system and ultimately leakage.
The second factor to consider is how the pelvic floor muscles REACT to the stimulus and force (jumping, coughing etc). The pelvic floor muscles have to react at the right time and in the right way in response to the force that is being applied. If it doesn’t react at the appropriate time and create the right closure then again leakage can occur. The example I like to use for this is a trampoline. When you jump on a trampoline, it has to lengthen with some tension and then rebound back up so that you don’t hit the ground, and then be ready for the next bounce. The pelvic floor muscles work in a similar way. They cannot just be held under constant contraction or tension. They must be able to lengthen and then be ready to react to the next force or impact.
I should also say that these are very simplified explanations of how the pelvic floor muscles and body work. There are obviously many more elements that can contribute to incontinence, but I hope that this has at least expanded your understanding of how your body is working.
So to recap, yes Kegels are important! But if you are still struggling with leakage then maybe you have to look beyond those exercises and consider how the muscles are working and how to integrate them with the rest of the body. Thankfully, a Pelvic Floor Physiotherapist can help with that. But don’t worry, we won’t be having you try and hold up any surf boards with your vagina!