Training the Reflexive Response of the Pelvic Floor

Q: Hey, Julie! Can your Pelvic Floor ever act automatically again without having to think about it? L

A: Take heart! I do think many women can achieve an automatic response from their pelvic floor again, as a part of the whole continence system. But we have to train the system for that. So I take a two-pronged attack to try to re-create the reflexive action of the system, so that it will respond when you can’t think about it.

First, I train a voluntary pre-engagement habit via the visual imagery of “kidney bean lifts” with their pelvic floor timed with exhalation before movement, task, or repetition. Ladies think about it. The hope is that conscious preparation will become subconscious over time. That is only one piece of the puzzle.

The other piece is to try to mimic the design for an involuntary response. My favorite cue to help create that is “blow before you go” (exhalation initiated prior to movement and continued through the activity ). This taps into the the internal pressure system to try to trigger a reflexive pelvic floor response before you move. Inhalation generated intra-abdominal pressure (IAP) presses down, lengthening and elastically loading the pelvic floor. Then exhalation eases some of the IAP and the pelvic floor recoils to rest position. Triggering that response before movement will anchor the center, in preparation for a challenge. This is different than exhale with exertion. Instead, we want to turn on or trigger the pelvic floor before we exert, in order to be prepared for the challenge or load. Support for the reflexive pre-contraction of the pelvic floor before every move that we make in this great study by Hodges.

I use ”blow before you go” as a set up for all function, ADLs and fitness to train in that reflexive, involuntary brain strategy in all movement patterns. The key is that I am really trying to train the brain to use this before every move they make. Support for this diaphragm/pelvic floor/pressure system interplay is a great study by Talasz 

My goal is to teach my patients both strategies. If they can sense and perceive that pelvic floor recoil on exhale, I ask them to spend some optimized breath cycles being mindful of how their pelvic floor is responding to the breath-lowering on inhale, and recoiling/lifting on exhale. Then, I have them use that awareness as a springboard for their own engagement through a bean lift appropriate to meet the demand or challenge (a pencil vs a toddler vs a barbell). Feel it first, then use that as you onramp to lift your beans.

For those that cannot perceive that recoil at the start, we start with consciously allowing the pelvic floor lower with inhale (drop your beans) and then exhaling as you lift your beans. Through practice, we gradually build that motor control, coordination, and strategy, just like any other motor skill. Coupled with alignment shifts to optimize the diaphragm relationship with the pelvic floor  (ribcage over pelvis) will help set up the pressure generated reflexive response. This can and does happen even if they can’t feel it. Improving their perception of that pelvic floor response, then becomes a piece of the puzzle to work on.

I look at fitness or training as an opportunity to embed the integrative diaphragm/ pelvic floor/pressure system strategy. “Blow before you go” before each repetition begins to build that automaticity. Fitness can become their pelvic health maintenance program. This is #PistonScience, my friends! By training this as brain strategy, the intention is that it will activate when mama isn’t able to provide full attention: in sport, while the kids are fighting, or an unexpected sneeze, etc. Try it for yourself! Use “blow before you go” to build your automatic response. 


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