Thank God people are getting more comfortable talking about the pelvic floor because it affects a lot of us! More and more I’m finding leaking is a common trend amongst athletes with CrossFit/functional fitness related activities, and in this article I am going to address the following points:

• What is the pelvic floor

• Why it’s happening

• What you can do about it

• When you should see a pelvic floor physical therapist

What is the pelvic floor: Our pelvic floor is comprised of muscles that line the floor of our pelvis and work together to relax and contract to assist with bladder control, pelvic stability, arousal/orgasm, and bowel function.

1. Hypotonic/underactive pelvic floor: Symptoms include feelings of heaviness in your vagina/PF, bulging, leaking with exertion, weakness/instability of core/hips/pelvic girdle. When these muscles lose their structural integrity which can happen with pregnancy/post-partum, surgery, trauma, aging, disease, prolapse; then the pelvic floor loses it’s efficiency in contracting in a reflexive manner during exercise to prevent leakage.

   • What to do for hypo: Learn diaphgramatic breathing and tying your breath together with exertion and relaxation with your pelvic floor (PF), and know what relaxation/contraction of your PF feels like. Then try doing core strengthening exercises while lying down, sitting, progressing to more functional exercises in standing such as sumo squats, plate jumps, single unders then progress to dubs. You can also try “The Knack” which is contracting your PF right before you sneeze or laugh, which trains the involuntary part of your PF which is SUPER IMPORTANT to kick in while doing exercise. It uses the Type II twitch fibers to contract in milliseconds that you couldn’t possibly contract quick enough on your own, and this reflex is crucial in re-training to regain continence with exercise.

2. Hypertonic/Overactive pelvic floor: Symptoms include leaking upon exertion, constipation, painful intercourse, painful peeing, abdominal pain, low back and hip pain. This is when the muscles of your pelvic floor are in a constant shortened resting length, so even at rest when these muscles should be relaxed, they’re not and are contracted/shortened. This then puts more pressure on your bladder, urethra, rectum, and sacrum, then add on the increased abdominal pressure when exercising, and then the leakage occurs because there is so much pressure occurring at the PF.

   • What to do for a hypertonic PF: Same thing you’ll want to learn diaphragmatic breathing and incorporating that with contraction/exertion with exercise. Reason being remember in this case the PF muscles are shortened/contracted too often, and they need to be down-trained aka learn how to relax. Next, try doing some self-myofascial release to the PF with a Franklin ball, or lacrosse ball. Follow it up with the happy baby pose, remembering to breathe into your PF, belly, and low back.

When to see a pelvic floor physical therapist: You can see a pelvic floor physio as soon as your symptoms start. Or if you’re not comfortable with that, you can always try the above techniques and similar programs, but if you’re not seeing improvements within 3-4 weeks, I strongly suggest reaching out to a pelvic floor PT in your area. They will tell you exactly whats going on and guide you onto the right path.