Hi everyone and welcome to Pelvic Exercises, I'm Michelle Kenway.
Today I'm going to teach you how to safely strengthen your abdominal muscles after pelvic
floor surgery. If you're living with a prolapse or incontinence issues. This is probably one
of the most common issues that I'm asked by women: what's safe for an abdominal exercise
and what's not, if you're living with pelvic floor dysfunction? Many women need to know
that if you place downward pressure (so remember that your pelvic floor goes in the pelvis
from the front bone here, to the back, and it's a network of muscles or a hammock. If
you're doing particular exercises such as really strong intense core work (a lot of
sit-up exercises, strong plank, strong hovers,) those types of exercises actually increase
the pressure down on the pelvic floor, mostly making the pelvic floor move downwards. Studies
have shown clearly that when you do those types of core exercises for women who have
had vaginal deliveries in particular, the pelvic floor is forced downwards. This is
definitely not the type of exercise you want to do if you have a prolapse or following
pelvic floor surgery, particularly if your pelvic floor muscles aren't working well.
Pelvic muscles need to be very strong to withstand that kind of downward force.
So, exercises to avoid? Sit-up exercises, ball crunches, tabletop exercises, any exercise,
essentially, where you've got both legs raised off the ground (that uses my upper abdominal
muscles) or my head and shoulders lifting off the ground. Those exercises will all increase
the downward pressure and both at once; even worse. So they're the types of things we want
to avoid, particularly if you have pelvic floor dysfunction.
So, some safe exercises: First of all we need to think about how to activate the abdominal
muscles properly. What I'll get you to do is lie down, or watch me lying down and practice
this later on. I'm going to teach you how to gently activate those deep core muscles.
These are the muscles that actually wrap around and attach to your spine. They're not your
six-pack muscles (the upper abdominal muscles.) They're the ones that help you cough, they're
the ones that help you to vomit, and they increase that pressure downwards. So we're
not trying to train these ones, we're trying to train the lower ones and these ones that
actually are felt lower, they actually wrap right around, like a corset onto your spine.
To activate them properly, it's a very very gentle contraction when lying down so if you
stay in these exercises when you have approval from your gynecologist to start exercises
(particularly following surgery,) this is how you'd start them.
Lie down on your back. I like to keep my heels about fist-width apart and my knees fist-width
apart and my head is obviously down so I'm not using my upper abdominal muscles. You
need to have the normal curve in your back. That means your back's not flat and slumped.
So try to keep that inward curve in your back. Now, you can use your hands and gently feel,
just inside those pelvic bones here (sometimes you feel these bones and think they're your
hip bones; they're actually pelvic bones) You roll over the inside (and use your hands
there,) and you can feel that area there. When you activate these muscles properly it's
a very very gentle in-draw of the area below your knickers, towards your spine. You're
not going to see a lot when I'm doing these if you can just imagine that area below where
my hands are showing you now. That area is drawing inwards very very slightly. If I feel
this area pulling at the same time I'm pulling in too hard. It's a very very gentle in-draw,
and hold it. Sometimes when you're contracting those muscles, you'll also feel your pelvic
floor muscles contracting as well. So let's hold that and contract for ten seconds if
you can.
So, lying down, inward curve in your back, heels in line with your bottom bone, knees
fist-width apart, hands over that area and just feel that area very gently activating,
just gently drawing in towards your spine, and holding it for one, two (keep breathing,)
three, four (keep holding those muscles on,) five, six, seven, eight, nine, ten, relax
down slowly. If you're having a lot of trouble with that, an easy way to find them is by
lying on your side. Lying on your side helps you to identify those muscles I find, if you
put your hand (again) over that lower abdominal area. Let the abdomen bulge, and then very
very gently, draw that area in a small amount, again making sure that you're not tensing
these upper-abdominal muscles too strongly. This area here should be pulling in hardly
at all; down here, very gentle contraction. Try to draw your lower abdominal wall in towards
your spine just a little bit, one, two (keep breathing,) three, four and five, six (can
you hold it?), seven, eight, nine, ten and relax down. Not necessarily as easy as it
looks, is it?
Let's make that exercise a little bit more challenging. These are some nice progressions
you'll actually use for that abdominal area, and very safe ones as well. All right, so
onto your back again, thinking about the exercise that I just showed you, drawing your lower
abdominal muscles in, I'm going to start with a heel-slide exercise. Now, this is a nice
one to do in bed (if you're lying on a flat bed, not a soft bed,) on a flat bed or on
the floor in your home, even with a sock on your foot so that it can slide quite readily.
It's called heel-slide so draw-in your abdominal muscles in the way I just showed you and slow
and steady, sliding your heel (one heel at a time) down, down, down. Maintain that inward
curve in your back. Sliding the heel back up, slide slide slide, and relax down. Okay,
let's try the other side, slow and steady again, slide that heel down, slide slide slide,
keep your toe muscles on just gently as you go down there, keep your inward curve in your
back, slide the heel back, slide and relax. Once again I can feel my muscles working there
and working quite hard too, to control that area.
To progress that exercise, you can take it into a leg extension with the foot raised
off the floor. So you could take it into a small lift and extend it, again, holding your
tummy muscles on just gently. Another nice abdominal exercise: bringing the leg back,
and take it down.
That's not one you'd go into, early days postoperatively. You can start your heel slides fairly soon
post-op (as soon as you're allowed to, as soon as your gyne. says you can,) but then
the lift and raise is a more advanced exercise, and you're probably thinking about starting
that five to six weeks after surgery (again, once you've had approval to do exercise your
abdominal muscles.)
So, you've got the advanced leg-extension, and you've got the heel-slide exercise. Another
lovely exercise for lower abdominal control is called bent-knee fallouts. This exercise
involves your... (and I'll do this with my left leg closest to you so you can see what
I'm doing.) I'm imagining I've got a glass of water balanced on my right knee, and my
left leg is going to lower down to the side just gently, without my hips rolling. I'm
keeping that glass of water stable on that right knee, not letting it tip over, bringing
the leg back up slow and steady, slow and steady and relaxing. Try not to tip that
glass over, and not rolling my pelvis. You can see that I can readily roll and move.
I'm not doing it. I'm using my lower-abdominal muscles to control my spine and control my
trunk and stop that rolling movement.
Let's go again with the other side. This time my glass of water is balanced on my left knee
(my left knee stays pointing towards the ceiling,) slowly lowering my right knee out to the side,
slow and steady, bringing it back up slow and steady. I just take it to point before
where I feel my pelvis is about to start to roll and you can repeat that, each side.
For all the exercises we've done, you can repeat them up to ten times. Just as you start
to feel comfortable with them, working the number that feels comfortable, and that's
the way to progress those exercises, bringing back up, and relaxing. So, how did you go
with all those exercises? We've done a couple of great abdominal control exercises there.
They're for your T.A.'s, or transverse abdominis, or deep abdominal control muscles.
So, we've done our heel-slide exercises. We've done our leg-lift and extend exercise and
we've also done a very gentle bent-knee fallout (once again just drawing the abdominal muscles
in gently when you're doing those exercises.) Try to steer clear of sit-up exercises and
intense core exercises. They will actually place pressure on your pelvic floor.
Well that's it for me, for today. I've enjoyed exercising with you and I hope you've enjoyed
our exercise session. I look forward to exercising with you again soon. If you'd like more information
on safe exercise with pelvic floor issues, please visit us at PelvicExercises.com.au
I'll see you again soon. Bye for now.