Pelvic Floor 101

Fact: It is unbelievably common for females to have pelvic floor dysfunction prior to ever being pregnant. 

Fact: Pelvic floor dysfunction is MORE common in the female athlete 

Fact: Post being pregnant, athletic or not, it’s a 75% possibility. That's 3 in 4 women.

That’s huge. This is why I want to talk about pelvic floor dysfunction, whether you’re pregnant or not. It’s a socially challenging topic and we don’t talk about this enough. If at all.

Regardless of what anyone says, research shows sport and fatigue does put you at an increase risk of pelvic floor injury. So if 3 in 4 reproductive women of any athletic background will have this issue at some stage in their life, what percentage does that mean for those of us who do high intensity sport? 

Here’s a fact that applies to our demographic: 70% of women who exercise with intensity regularly – yes a whopping 70% – have an altered menstrual cycle. And before you roll your eyes and count yourself out of this one – what is meant by altered menstrual cycle is ANY form of menstrual or hormonal change or irregularity which differs from a having a ‘normal’ cycle prior to commencing an intense exercise routine. This can range from having a period a few days out of whack each month, to full blown amenorrhea (absence of periods). I’ll briefly get sciencey on you. This happens because:

• Changes to hormonal balance (follicle stimulating hormone FSH, luteinizing hormone LH, neuropeptide-Y NPY, endorphin B, cortisol, prolactin, thyrotropin and thyroxine…amongst others…) leads to a hypo-oestrogenic state. In plain English: reduced oestrogen levels.

• Changes to body composition. Oestrogen isn’t only produced in the ovaries, but in the adipose tissue. Reduced body fat composition as a result of an intense exercise regime will also lead to lowered oestrogen levels.

But it’s not just a missed period that is a side-effect of reduced oestrogen levels. The basic fact is decreased oestrogen means thinner tissues. The urethra widens and the pelvic floor muscles themselves weaken, just like they would in a post-menopausal woman. 

What this means, then, is for any athlete that has worked out to an intensity that has altered their monthly cycle, contrary to popular opinion that you may possess a pelvic floor of steel, there may well be an additional need for focussed pelvic floor strengthening and attention to pelvic floor function.

And so what about a pregnant athlete? It’s all beginning to make sense: after all, pregnancy involves a stretching and a pressurising of an already vulnerable area. I’m afraid this bumps us up again, into one of the highest risk categories for pelvic floor dysfunction that there is.


But what exactly is pelvic floor dysfunction?


In brief this can mean increased urgency, pain, incontinence, prolapse or long-term diastasis rectus abdominis.

💥Urgency: you are desperate for a pee but there’s less than about 8-10 seconds worth of peeing to be done… This is aside from being pregnant where I do empathise with running to the toilet every 30 minutes to do a second's worth of pee. 

💥Pain: usually as a result of an overactive pelvic floor, either because you’re responding by adapting to existing weakness or dysfunction. Can result in excessive menstrual pain, painful urination or bladder pain, painful sex or feelings of pressure. It goes without saying that if you have any pelvic pain during pregnancy this isn't normal either. 

💥Incontinence: it’s not normal to pee (even a little) if you jump, skip, laugh or sneeze. Nope, not even when pregnant. Fitness coaches who joke to the female population to go for a nervous-wee prior to a workout with double-unders in it should be shot. And the biggie here? Continence issues can happen over time – a long period of time. Just because you don’t have problems now, they can occur later. 

Fact: 30% of athletic women who had no problems with continence during pregnancy or in the immediate post-partum period, reported some form of incontinence 5-7 years later on.

💥Diastasis Recti: there will be an entire entry on this one (how to check for it, how to manage it during pregnancy and what to look for post-partum) but for now let’s summarise this as a persistent stretched linea alba - the fascia that connects your abdominals. Coning or doming even on the slightest abdominal movements during pregnancy? 6 months post-partum but still look 6 months pregnant? This is a sign you have a diastasis problem. 

By the way, diastasis during pregnancy is completely normal. In fact 100% of women from weeks 35-41 of pregnancy have a diastasis, but a poorly controlled diastasis during pregnancy or a persistent diastasis post-partum is a problem for pressure regulation in the longer-term.

💥Prolapse: I guess the end game, and it sounds rather dramatic, is wanting to avoid pelvic organ prolapse (POP). I won’t go into the specifics here and the different types, but it’s more common than you think. POP mostly occurs during the childbirth or in the post-partum phases, and especially so in the post-partum return to exercise phase. 

In the name of transparency I'll lay down some personal truths. 

Prior to becoming pregnant I was a CrossFit athlete who had experienced both altered menstrual cycles and a short phase of amenorrhea. That scared me enough to address a better balance with my training, diet and recovery. I will also admit to struggling to manage leaking during double-unders.

And now? From 16 weeks pregnant I have had a rather large diastasis that I've struggled to control. It's been coning and doming central over here so I've really had to take things back to basics. 


What can I do about it?


1. Take responsibility. If you’re an athletic mum or a mum-to-be, it isn’t enough to trust a trainer, a single blog, or advice from people who have done it before. No one size fits all – and it’s almost negligent to presume that it does. Learn how to make exercise modifications  having learnt more about your body. It's not necessarily WHAT you do but HOW.  Take responsibility. Ask questions. Research. Just because you don’t have the symptoms doesn’t mean you don’t have the problem. All post-partum women should get a check. Get a women’s health physio appointment. Learn.

2. Be aware of signs and symptoms. Don’t ignore warning signs from bladder and bowel - this goes for pregnant and non-pregnant women.

3. Timing and breathing. As in my previous entry: ensure you are contracting/switching on your pelvic floor and breathing out before all lifts or exercises involving any kind of effort. Especially important during pregnancy but may also be applied at any time.  

4. Perfect your technique. Everyone - ensure you are capable of achieving a good and efficient pelvic floor contraction by coordinating all of the pelvic floor muscles. How do I know? I won’t go into it today but message me – I can go through it for you. Or google can teach you – here’s a link that explains it pretty well http://www.bladderbowel.gov.au/assets/doc/brochures/06PelvicFloorWomen.html or this video https://www.youtube.com/watch?v=DyMsntVWE9U. Or go and see a pelvic health physiotherapist. It’s imperative we all know how to do this.

5. Remember: park the ego. Moving ‘as you always did’ well into pregnancy may be met with rapture and applause from onlookers, but I’ve learnt it isn’t very clever at all. "The pregnant and post-partum athlete isn’t fragile, but she isn’t invincible either. Certain considerations MUST be made during this chapter.” @twopeaswellness.


A special nod goes to to Antony Lo the @physiodetective as a vital information source for this entry. Look him up and do his online Bulletproof course. I can’t recommend it enough.


Oooh look - a POLL! I'd love for you females out there to contribute to a little research project of our own. After all, how common is this thing really? We can use all the science-talk we like, but what about the incidence of pelvic floor dysfunction in our actual community? 

Please take part in my poll below. I'll update you all with final results on my next blog post.