Been working out and noticing urine leakage or vulvar pain?

Many of us look to increase our exercise routine and reduce or waist size in preparation for summer fun!

However, sometimes that very beneficial exercise can be a source of pain and frustration so we need to make sure we have proper form and function and not over do certain types of exercise.

Thirty (30) percent

of women/biological females have urine leakage when they jog, skip, play a sport, or do HIIT workouts due to weak pelvic floor muscles that can’t withstand the high impact downward motions.

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Doing resistance exercises like body weight, resistance bands, bar/dumbbells lifting, or doing core strength workouts such as abdominal exercises, or Pilates (which is core heavy), many times cause us to strain downward because we don’t first engage our pelvic floor muscles, don’t engage our core muscles correctly or don’t engage them AT ALL!  This downward pressure of improper engagement can cause your pelvic floor to weaken, or worsen, the pelvic floor muscles if performed too much/too often.

How to correctly engage and protect the Pelvic Floor while exercising:

  • Start by pretending you are stopping the flow of urine.
  • While holding in your urine, imagine also preventing flatulence/gas/fart from escaping.
  • Lastly, while holding both of those pretend bodily functions in, visualize also pulling those muscles upward like there is a string attached to them and the top of your head and someone is pulling on the string.

Like these sting puppets-but the string pulls from the top of the head and pulls the insides upwards….it’s harder to explain than I thought lol!

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Once you have that action figured out, and it’s time to exercise- be sure to also maintain proper abdominal form with all exercises you are doing. There are a ton of YouTube videos and resources online to show you how to properly engage your core however here is an easy visualization:

Visualize a string attached to your belly button through to your back. When performing an exercise exhale during the hard part of the exercise and picture the belly button string being pulled through your back. 

Many people believe they are contracting their abdominals correctly but are actually just flexing which is most likely pushing the pelvic floor downward.

It’s helpful to practice these movements a few times before starting your exercise regimen or just as a refresher especially as we age.  Practicing these movements and contractions helps us to be able to have proper form while exercising without having to focus so hard because our body has learned and remembered!

Now that you’ve practiced and feel comfortable in your ability to properly protect your pelvic floor when exercising here are some tips to prevent over loading the pelvic floor until your symptoms have resolved:

  • Lighten your weights or resistance so that you don’t feel pressure down on your pelvic floor as you move
  • Avoid holding your breath by exhaling with effort (e.g. when you pull, push, lift or lower weights)
  • Maintain good posture
  • Reduce the level of your abdominal muscle exercise programs
  • Reduce the depth of your squats and lunges – aim to keep your hips at a higher level than your knees
  • Choose supported positions (e.g. seated machines or sitting on a fit ball to use hand weights)
  • Keep your legs closer together during exercise
  • Lift your pelvic floor first before you move, and relax afterwards. Notice how many reps you can do before your pelvic floor muscles tire. You may need to add some rests, or reduce the number of reps that you do in a row, while your pelvic floor muscle fitness improves.

Those tips are pretty common but I sourced them from this website and I give credit where credit is due: http://www.pelvicfloorfirst.org.au/pages/pelvic-floor-muscle-exercises-for-women.html

Next we’ll move on to something called the Pudendal nerve and how that plays a role:

(I promise I’m not going to get too technical in this article so stay with me)

The Pudendal nerve supplies sensations to the external genitalia and has 3 branches:  Dorsal clitoral, posterior labial(pereneal), and inferior rectal. See the yellow lines on the image below.

These branches provide sensory, motor, and sympathetic innervation to the vulva and vagina.  Injury to the entire nerve or any of its branches may result in urogenital pain, dyspareunia, and female genital arousal disorder, digestive difficulties leading to bloating, diarrhea and constipation, urinary symptoms or incomplete emptying and difficulty initiating, and sexual function problems with orgasm and lubrication.

You can see why you want to make sure to have proper form and protection of not only your body but pelvic floor as symptoms of an angry pudendal nerve doesn’t look like a lot of fun.

Squatting, stair master, elliptical, CYCLING/SPINNING, lifting, some ab exercises, leg presses, Pilates, and sit-ups are many examples of exercises that can cause irritation to the Pudendal nerve so monitor that:

  1. You have proper form
  2. Don’t conduct the higher risk exercises too much, too often
  3. Allow for plenty of recovery and rest time to the muscles worked

The pudendal nerve can sometimes get trapped in the fascia (or a thin casing of connective tissue) of what’s called the Obturator internus muscle.  The Obturator muscle has a channel for the Pudendal nerve but mishaps happen and the nerve gets trapped where it doesn’t belong due to poor movements, inflammation, injuries, etc. 

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Because of the intimate location intertwined with the Pudendal nerve, an injury or irritation to this muscle can cause the same symptoms as listed above, as well as itching, tingling, and shooting pains into the groin and abdomen.

Something called the obturator internus muscle can also become injured, irritated, or spasmed from overworking, muscle imbalances, sports injuries like an improper kick or a fall, or hip rotation extremes, and postural changes.

Exercise is great and most of us could probably stand to do a little more, am I right? But e need to make sure we are not overdoing things, and rather build up our routines properly and slowly over time. 

Going really hard right away or lifting your maximum amount of weights if you haven’t been accustomed to that level/routine isn’t going to get you in shape faster, won’t build bigger muscles faster, and won’t cause you to lose weight any faster-you will just end up with injuries, which will put you on the bench, or couch, and set your whole goal back.

Make sure to have proper form and posture which can be pretty difficult during HIIT workouts due to the quick nature of the movements so pay special attention to those.

And give yourself rest.  I love a good sore muscle the day after a workout but if something actually hurts or persists, take extra rest days or contact a physical therapist who can see if you are using improper form.

If you start noticing any of the symptoms I mentioned above such as urine leakage or sexual symptoms, also call a dr or physical therapist for assistance, they will direct you to a pelvic floor therapist if necessary but many times only a couple visits are needed to get you back to normal.  It’s usually a matter of we went too hard, too quick in attempts to see results in a short window of time and ended up with poor form and a body that didn’t take too kindly to it!

I won’t try and put any other exercise tips or links to videos on how to have proper form as I find each person gravitates towards different “how to” videos just based on personality so go ahead and do an internet search or youtube search for how to do “X” exercise properly or proper form for “X” exercise and you should be have more results than you know what to do with!

Last note, this info doesn’t only pertain to “older” women.

Women of all ages can and do have pelvic floor issues of some kind or another and causes ranging from genetic to an injury to age or hormone level status so don’t discount this information because you think you care too young for this to be something you have to consider.  Having good practices and techniques at any age can prevent issues from happening in the future. Whether you want to build up or maintain a great functioning pelvic floor, having the right tools and techniques can make all the difference!

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