Pelvic floor exercises are really not necessary or effective for most women. They can be 100 percent effective for those who experience extreme urinary incontinence. For everyone else, however, there is life beyond Kegels, says Claire Mockridge, a fitness and Pilates instructor who bases her work on body biomechanics.
“I don’t work with Kegels at all,” she says, “I help people to change the way they move instead. I look at lifestyle and how to learn new habits.” In fact, some bad habits are becoming so ingrained in our culture that a study predicts 80 percent of women over the age of 18 will have a pelvic floor dysfunction by 2050—regardless of how often they do their pelvic floor exercises.
Life Beyond Kegels
“Kegels can certainly be effective in the short-term, but there’s more than one way to peel an orange,” Claire explains, “which means there are all kinds of different approaches we can take to resolve physical dysfunction. That’s why I embrace a full body approach.”
Symptoms of pelvic floor dysfunction can return after months (or even years) of doing Kegels. “The pelvic floor muscles remain strong as long as they can withstand a cough or a sneeze without any leaks, but these returning symptoms don’t always mean the muscles have weakened.”
Too Tight Isn’t Right
“Your pelvic floor could be too tight,” says Claire. “If you’ve been squeezing and squeezing, it can get bunched up. Whereas you actually need to relax your pelvic floor so you can get more length into the muscles—any muscle in the body actually needs length before strength. The longer a muscle is, the more load it can withstand. Think of a hammock that’s hanging between two trees and loaded with rocks. If the trees are further apart, the hammock can hold more rocks and more weight.” So how do you relax and lengthen your pelvic floor?
“Start with your feet,” says Claire. “I check them first to see how immobile they are. This is something that’s impacted from an early age by shoes with a raised heel then exacerbated by high heels later in life. If the foot doesn’t move well across the floor, the calf becomes tight.”
This tightness is transferred up the leg and has an adverse effect on the way the knee, femur, and pelvic floor function. “High heels also push your weight forward into your toes, so try removing your shoes and transferring your weight back into your heels. This distributes the weight more optimally into the ankle joint and switches on the glutes.”
It’s All About the Butt
Your posterior chain is equally important—or the way your calves, hamstrings, pelvis and lower back interact, which brings us to the butt. “Strengthening the glutes actually unlocks the key to pelvic floor function,” says Claire. “If you have no strength in your butt, your sacrum, which is attached to the glutes, will move up into the pelvic bowl and the tailbone will tuck in. Your sacrum is also attached to your pelvic floor muscles, meaning they will get shorter as a result.”
This can be brought on by too much time spent sitting or slouching with your tailbone tucked under, causing the pelvic floor muscles to become passively shorter. The good news is that you can actively make them longer. “A squat or lunge pulls the sacrum back out of the pelvic bowl and away from the pubic bone to create length and strength. Try squatting to pick things up instead of bending over, and always stick your butt out as you move up and down.”
Walk With Confidence
Claire believes we should address all the ways in which we move our bodies, from how we breathe, to how we sit, stand, and walk. “Many of us have tight pectoral muscles from hunching over our phones or computers. This leads to a forward head posture. Considering the head is very heavy, this affects the spine, the sacrum, and the pelvic floor.”
That said, we’re often told to stand up tall and push our chest out, which is advice that Claire frowns upon. “This pushes our ribs out and throws off all our alignment. When we’re standing, the ribs should ideally sit flush with the hips, and the pelvis should align with our ankle joints.” Yet many women habitually curve their lower spine and push out their chest while wearing high heels.
“Women have also learned to walk like they’re on a catwalk, meaning their stride is very narrow. Keep your feet hip-width apart, or the same width as your pelvis, and make sure they’re facing forwards. I’d also say ditch the heels completely and walk more often.”
Resolving pelvic floor-related issues like pelvic dysfunction or urinary incontinence, according to Claire, takes more than a Kegels exercise program. It takes a whole lifestyle review, resulting in renewed ownership of your body. “There may be certain movements that your body requires that you’re not currently doing, and there will certainly be ways that you can move better.”