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Core Confidence Workshop

Building strength from the inside out!

Thank You

Thank you for being a part of the Core Confidence Workshop. I hope you found it helpful, even if the information isn’t relevant for your life right now. Maybe in five years, 15 years, or 30 years, you can recall some of this information and remember there are strategies and services available to help you.

Working as a pelvic floor physiotherapist, I have heard so many stories of people suffering or thinking that pain or bladder/bowel issues are normal. While these symptoms can be common, they are NOT normal! Sadly, it can take years before they find the courage to finally speak up or seek help. I hope more for you and I want you to feel as confident as you can in your incredible body!

Below is an outline of the information we covered in the workshops. Please read through it and reach out to me if you have any questions. Don’t wait to speak up — take control of your health and remember, I’m here to help you!

note: the information is not intended as medical advice or treatment and serves as education only. Please speak to your health care provider if you have any specific concerns.

Knowing Your Anatomy: Pelvic Floor & Deep Core

Knowing your anatomy and how it functions is important for your overall health.

Pelvic Floor Muscles

These are a sling of muscles at the bottom of your pelvis that connect from your pubic bone back to your tailbone and out towards your sitz bones (the two rounded bones at the base of the pelvis that you sit on). They also help make up your deep core, which includes your breath, your deepest abdominals called your transverse abdominis, and your deep back muscles called your multifidus.

Pelvic floor muscles have five main functions:

  1. Support: they work to provide support to your pelvis and low back

  2. Sphincteric: they contract to help keep in your pee and poo and stop you from leaking.

  3. Sexual: they work during intercourse and help with arousal.

  4. Stability: they work to help control the hips, back, and pelvis.

  5. Sump Pump: they help pump lymphatic fluid through the pelvis.

Why the pelvic floor—and your body—are amazing:

  • The muscles in your deep core must work and coordinate with the whole body and the environment; there is integration and interaction between the brain, spinal cord, nerves, muscles, joints, bones, connective tissue, organs, and the environment.

  • This integration and interaction typically happen without us even trying! Our core and pelvic floor are reactive, especially in sport. When we run, jump, tackle, etc., our deep core will respond to the demands put on it — so, when you jump, you don’t have to think about contracting and then relaxing your pelvic floor to prevent leaking, it just does it automatically!

What Happens When We Have Leaking?

Leaking urine is typically thought of as something that happens later in life or after having babies, so why do younger people have leaking? Recent research shows there is a percentage of young female athletes that leak urine during sport, particularly in impact sports like basketball, gymnastics, and running.

Reasons Why We Leak:

  • Too much tension/tightness in the pelvic floor and it cannot effectively control the pressure or impact that is put on it during sport. Think of a trampoline that is pulled too tight and is too stiff. Eventually, over time when you jump on it, you will break through it. We want the pelvic floor to be dynamic and have a good amount of tension to absorb the pressure and then contract quickly to hold in our pee.

  • Too tight or too restrictive of a core or abdominal wall. As we breathe and perform, pressure will constantly change in our “container”, and that pressure needs to go someplace. If our core is too tense/stiff, that pressure will move downwards to the pelvic floor. Remember, the core must coordinate well with a dynamic and strong pelvic floor for optimal function and support.

  • Fear of more leaking so we try and avoid/prevent this by creating more tension/contraction in the pelvic floor. Unfortunately, doing this only increases the tightness and doesn’t improve the leaking at all.

  • Slouching or rigid posture, which can sometimes play a role in how we hold tension in our pelvic floor and our core. Imagine slouching (see below), standing extremely stiff or rigid with “good posture” (see below), or sucking in our tummy to look flatter — all of these scenarios can cause extra stress on our core and pelvic floor and potentially contribute to leaking and in some cases, pain.

What you can do if you are leaking:

  1. Speak to your family doctor to let them know what is happening. They will ask the appropriate questions to ensure nothing else is going on or contributing to your leaking, especially if you have any other bladder concerns or if you had issues a child.

  2. Find a pelvic health physiotherapist. You do not need a referral from your doctor to see one. Pelvic Health Physiotherapists are specially trained physiotherapists who focus on assessing and treating issues related to the bladder and bowel, among other symptoms (see table). The best part is that they are still regular physiotherapists, so they can often help treat other sport injuries such as low back pain, hip pain, or knee or ankle injuries.

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Exercises To Put Into Practice

Here are a few of the exercises we went over in our session. They can help to create awareness of your pelvic floor and improve your breathing and core connection.

Exercises:

  • Breathing: 3-way, piston with the pelvic floor

  • Pelvic Floor Awareness: contractions (also known as kegels). Focus on the relaxation as well.

  • Core Activation & Awareness: tension to task.

What Happens When We Have Constipation?

Constipation is the irregularity or difficulty in pooping. Research shows that constipation can actually aggravate the bladder in both children and adults. So, improving your bowels is another way to help if you are having bladder issues such as urgency or frequency.

Regular and easy bowels movements are important to your health, and it also feels very satisfying to have a really good poo!

Bowel movements should be daily, and have stool that is soft, formed, easy to pass, and of good size or leave you feeling complete. Ideally, you should have a bowel movement every day, but if you have been constipated for a long time, then working towards a bowel movement every other day may be optimal as well.

What does a good poo look like? You can reference the Bristol Stool chart below. Ideal is a score of 3 or 4.

Chart of different types of stool consistency.

Solutions if you experience constipation:

Here are some variables that you may need to focus on.

  • Water/fluid intake: Females aged 14-18 years should consume around 1,400- 2,500 ml of water/fluid per day. You can also gauge how much you need to drink by looking at your urine color: it should be light yellow; very dark urine is a sign that you’re likely already dehydrated. Note that you may also have to increase your fluids on your heavy training days.

  • Fiber: Aim for 25 g of fiber per day. Speak to a dietician or nutritionist if you have specific concerns or questions about your diet. A simple approach is to try adding fruit and vegetables / leafy greens to each meal.

  • Toilet positioning: How we sit and poo can greatly impact the ease of our elimination and completeness. The main strategies are to get your knees elevated above your hips, relax your pelvic floor, and try not to strain or hold your breath to eliminate. See the picture below for an example of ideal toilet positioning. Using a stool or squatty potty can help to elevate the knees.

  • Relaxation of the pelvic floor: Learning how to relax your pelvic floor can help the stool come out. Being able to control the tension of your pelvic floor can greatly help elimination. Many people who have constipation also have tight pelvic floors.

  • Exercise and yoga: Gentle movement such as walking or yoga can help stimulate a bowel movement. If you are already quite active, your goal may be to integrate some gentle stretching or yoga, which includes twisting poses, that can help the movement of stool and relax the pelvic floor.


  • Listen to your body’s cues and allow some time: A stimulus for a bowel movement can happen about 20-30 minutes after eating, as chewing helps to stimulate the reflexes for digestion. For example, eating some food in the morning is important if you want to have bowel movements in the morning. It is important to listen to your body cues (pressure in the anus, gurgling of the tummy, gentle cramping, etc.) and give yourself more time in the morning to allow this stimulus to happen.

If you try these strategies and see no change in your bowels, then you may want to consider speaking to your family doctor, naturopathic doctor, or nutritionist/dietician.

What Happens When We Have Painful Periods/Dysmenorrhea?

Dysmenorrhea is defined as painful menstruation with high intensity symptoms of strong cramps and increased pain. Mild pain and cramping are considered normal and not considered dysmenorrhea. Cramping occurs when the uterus is contracting to shed the lining, so some mild cramping is considered normal.

Facts about “normal” periods

  • Average age of onset is 12 years old, but normal range is between 10-16 years of age.

  • Average cycle length (days between the start of one period to the start of the next) is 21-35 days.

  • Bleeding typically lasts 3-8 days, with the first two days being the heaviest.

  • Common symptoms are mild cramping, back pain, and discomfort.

Track your period

Each female experiences their periods uniquely and with varying symptoms month to month, so it’s incredibly important to track your period. This is especially true if you have concerns with it, as this data can help you and your health provider find a suitable treatment.

Two reputable apps are Flo and Period Tracker.

Personal products for periods

There are many options available to use during your period: pads, tampons, cups/discs, or reusable underwear. It is hard to say what is the best option and you may have to experiment with what works best for you.

If you are interested in using a menstrual cup or disc, there is a great website that can give you some direction: www.putacupinit.com.

If you have never tried a tampon or cup/disc, it is not uncommon to have some discomfort inserting it. However, if you find the pain is extreme and/or not improving as you continue practicing, then you may want to check with a pelvic floor physiotherapist. They can help you understand how to relax the pelvic floor and nervous system which may be contributing to your pain.

Clues of “abnormal” periods

Typical Signs and Symptoms of Heavy periods:

  • Bleeding that lasts more than seven days.

  • Bleeding that soaks through one or more tampons or pads every hour for several hours in a row.

  • Needing to wear more than one pad at a time to control menstrual flow.

  • Menstrual flow with blood clots that are as big as a quarter or larger.

When to see your doctor or get a referral to a gynecologist:

  • Period stops for more than 90 days (and you are not pregnant or on extended regimen birth control).

  • Periods become irregular when you usually have regular periods.

  • Bleeding for longer than normal (e.g., your period normally lasts five days and is suddenly nine or 10 days long).

  • Bleeding between periods, particularly if you are not on any birth control.

  • Pain during your period where you have not usually had pain.

  • Bleeding has become very heavy, soaking through more than one pad or tampon per hour or staining night clothes.

*source: www.yourperiod.ca

Concerns about your period go beyond just the amount of bleeding. Some individuals also deal with heightened pain and cramping. Other conditions may be contributing to these feelings and should also be discussed with your health provider, especially if you feel it is interrupting with and taking you away from your daily life, such as going to school, training, and/or work.

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Endometriosis occurs when tissue, like the lining of the uterus (the endometrium), grows and implants outside of the uterus on other parts of the body. It can be found on the ovaries, fallopian tubes, bowel, rectum, bladder, or on other pelvic organs or surfaces in the abdominal area. That said, endometriosis has been found on every organ in the body, except for the spleen.

This is a condition that occurs in approximately 10% of females.

Endometriosis must be diagnosed by a family doctor or ideally a gynecologist, either through ultrasound by a specially trained technician, or laparoscopic surgery (a surgical procedure used to examine the organs in the belly/abdomen using a thin lighted tube that has a video camera). Often, a doctor may consider the diagnosis with the signs and symptoms you are presenting with and try hormonal medication to see if symptoms improve. Pelvic floor physiotherapy can also be extremely beneficial to help individuals manage their symptoms.

Interestingly, some individuals can have endometriosis and not have any pain either.

Common symptoms of endometriosis

  • Menstrual pain (dysmenorrhea)

  • Heavy periods

  • Pelvic pain

  • Painful intercourse / sex

  • Bladder pain/urgency/frequency

  • Pain with bowel movements, especially during periods

  • Low back and leg pain

  • Fatigue

  • Depression/anxiety

  • Digestive issues, irritable bowel syndrome (IBS), bloating

  • Fertility challenges

  • Family history of painful periods and/or fertility challenges

Remember, it is important to speak to your family doctor if you’re having concerns with your period and symptoms. There is help for you! Helping treat your painful periods is considered a “whole person” approach so working with a pelvic floor physiotherapist is another great resource to help you start feeling better.

How to manage painful periods

Extreme periods (heavy flow, long cycle, etc.) can leave us experiencing a lot of sensations like abdominal and/or back pain, cramping, pain into legs or butt area, fatigue, etc. Typically, we don’t move into pain; we usually curl into a little ball and wait for it to pass. But movement, breathing, and relaxation can be helpful for getting through that time.

Helpful exercises to manage painful periods that can also help with constipation and the relaxation of the pelvic floor:

  • Pelvic tilting

  • Cat/cow

  • Child’s pose


If you find these exercises and strategies don’t help and that periods continue to be worsening or irregular, speak to your parent, family doctor, and possibly a gynecologist to get some additional support.

Other strategies to help with your symptoms include:

  • Apply heat to your abdomen or back.

  • Speak to a physiotherapist about TENS (transcutaneous electrical nerve stimulation) on the abdomen or back.

  • Take a warm bath.

  • Go for a gentle walk.

  • Speak to your pharmacist or doctor about appropriate medications.


Conclusion

If you have questions, please reach out!