Happy February! This month, I’ll be covering resilience. From illness, pain, setbacks, etc. Essentially, how to get back off your ass when life gets in the way.
Every year, I get an influx of a certain type of patient. Whether new to me or basically an old friend, the person always tells me the same story: I pee myself when I’m REALLY sick, and only when I’m sick.
Of course, incontinence of any stripe happens all the time, any time, for a lot of folks. (Shout out to my pals who struggle with holding in farts and poop — I see you!) But I think we can all agree that shit (sometimes literally) hits the fan under illness. You might only experience leakage when you’re sick, or your existing issues might get real real intense. Either way, not a joy.
Here’s the tl;dr:
Illness is like the Olympics for your pelvic floor. Be kind and gentle to yourself.
Many folks experience decreased thoracic rotation due to chronic coughing/respiratory drama, which can be a huge contributor to incontinence and sensations of pressure.
Similarly, less movement means less hip extension and internal rotation, which can drive dysfunction.
You’re not screwed — simple breathing and stretching from your bed can be a game changer. Paid subscribers can scroll down for a cute little instructional class from bed!
The deep dive:
I wrote an article all about the basics of sickness and the pelvic floor a while back and I highly recommend it. Today, I’ll be moving through some higher level hacks.
One of my first clinical mentors in graduate school said something I’ll always repeat: “Having a flu/stomach virus/gnarly respiratory illness is like the Olympics for your pelvic floor.” (Thanks Justine, if you’re out there!) This is true. In any of these situations, we have a chronic and often violent impact of intra-abdominal pressure (IAP) going down until it hits the last stop on the train of your torso: the pelvic floor.
Your pelvic floor should act like brakes. Theoretically, there should be a responsive, reflexive engagement of the pelvic floor when an influx of IAP occurs (i.e., you do a kegel without even thinking about it). However, many folks bear down with a cough instead.
If your pelvic floor is not effectively closing the urethral or anal sphincters and the pressure is great enough, that’s when leaking comes into play. That’s the basic story.
But there are so many more factors that go into why a vulnerable pelvic floor could go into a state of dysfunction.
Let’s look at the abdominal canister again:
I think this image pretty well illustrates the relationship between the diaphragm (breathing muscle) and the pelvic floor. There’s a feedback loop happening, wherein when the diaphragm expands by taking a breath in, the pelvic floor also lengthens. The opposite happens on an exhale.
But what can often get missed are the following:
Thoracic rotation: how well your rib cage expands laterally is a huge deal for your pelvic health. If the rib cage can’t expand or rotate, your body will try to find that expansion and rotation elsewhere, down the line. This often results in pressure in your pelvic floor, leading to more leakage and more prolapse symptoms (if you have them). Obviously, if you’re coughing, sneezing, and generally hunched over and immobile, your thoracic mobility is going to suffer.
Abdominal wall tension: I went on about the importance of abdominal wall pliability in this newsletter, but suffice to say, it’s really fucking important. This tension can build during illness for simple reasons of not breathing as deeply (because ow), or protectively bracing to prepare for a cough or sneeze. If the abdominal wall isn’t resilient, then the pelvic floor will be less dynamic with shock absorption, meaning you’re more likely to leak.
Hip extension and rotation: This is one of the first things I look at in my clients. If a person doesn’t have optimal hip extension or rotation (usually internal rotation, but both matter — I’ll get there in a minute), that has a direct impact on the potential available range of motion in the pelvic floor, therefore affecting its functional strength and response to impact (i.e. cough/sneeze). Let’s take a look:
See how the purple line is longer in hip extension? That’s more or less the image of a lengthened pelvic floor. It’s not that we want to live in that place — it’s that we want to go there often so that the body has that stretch and range of motion. It’s all about resilience, pliability, and ultimately, as I’ve already said, shock absorption.
Similarly, internal rotation creates more space in the pelvic floor, and is especially critical if you experience pelvic tension and pain.
If you’re not moving as much, whatever that means for you, it’s likely that all three of these factors will take a hit at some level.
Here’s the take-home:
Before I had kids, I was much more hard-core of a person. But now I have twins. I am no longer a “no-excuses” person. I am a chronically exhausted mother who is also a business owner and an introvert.
Which is to say, I know you don’t need another routine. I know you’re tired. So here are some recommendations that you can do from bed, watching Netflix or whatever.
Breathe. You knew I’d say it, right? I know. It’s unsexy. But you should do it. Think about the concept of of 360 breathing, which means that when you inhale, your torso will expand in all directions. To get lateral expansion of the ribs, I recommend taking your hands on the side of your rib cage (bra line, if you have one) and trying to expand air into your hands. You can also imagine your inhale gently spreading your sits bones apart to get expansion into your pelvic floor. Ideally, this would all happen on the same inhalation. Be gentle with yourself — this takes time and practice. Try on your back, on your side, on your belly. All have benefits.
Twist. I kept this instruction vague, mostly because I want EVERYTHING to rotate. Move in the ways that feel good to you, and focus on twisting your upper torso (thoracic spine) as well as rotating the hips. This can look as simple as a “thread the needle” pose from bed and “windshield wipers” for your legs. It doesn’t need to be fancy to be effective.
Extend: To get hip extension from bed is tricky, but it’s worth going after anyway. I recommend lying on your side and take your top leg back in space. You can do this actively back and forth, like a classical dance warm up, or place a pillow (or two!) under that top leg and hang out there.
Would I prefer you do these without holding your phone? Yes. Do I accept that you’ll probably be scrolling insta or whatever? Also yes, and that’s totally fine. Do you, drink some tea, and feel better, okay?
Paid subscribers, keep scrolling to get my from-bed dispatch recommendations!