Pelvic Floor Party: Kegels are NOT invited

[AlaaJ]

http://mamasweat.blogspot.com/2010/05/pelvic-floor-party-kegels-are-not.html        I found this to be super logical and totally fascinating. Has anyone else heard of this? What do you guys think? I thought about posting it in the POP thread but didnt want to lose it amongst the five million pages. Whatchoo all think???

[Dot-to-Dot]

I read this article several months ago when I was trying to fix my stress incontinence problem.  Then I got pregnant...and super sick and I just didn't care anymore!  However, I agree, it makes a lot of sense.

The one thing I wanted, though, was a clear perscription of how to do the squatting.  Not just how to physically squat correctly, but I mean, for how long?  How many times a day?  How long would it take to feel results? 

I have a really hard time setting aside time to just squat.  But, I know I should.  I bought a video that was mentioned somewhere in the article or in the comments, I can't remember, but it's called something like Exercise for Down There.  It was not helpful AT ALL!  A total waste of money.  It was kind of the same thing...advocating squats but not really clear on how much or how long is needed to feel results.

[A_Random_Phrase]

Edited by A_Random_Phrase - 12/7/10 at 3:46pm

[SpuglyRoo]

nak, sorry for typos The person who was being interviewed (katy bowman?) also has a blog where she describes the squat she is talking about, pictures included.  I just perused it for a minute, but I wanted to pass on the info since it seems pertinent.

http://www.katysays.com/2010/06/02/you-dont-know-squat/

There are other posts that might be relevant on her blog, but I haven't read through it yet. I'm visual, I know that the pictures will help me see if I am doing them right.  I'll try anything to help reverse POP without surgery.

[AlaaJ]

Maybe too much info for some: When I was a kid, visiting my grandparents in the middle east, I would have to use the "hole in the ground" to pee and poo for a few weeks each summer. Since then, I've known that squatting is a much more better position for 'emptying out' than any other. So finding out that it's also so good for your pelvic floor fit right along in there. Now, I try to incorporate squatting into my day, like, while getting things from lower shelves or drawers, tying my kid's shoes, tying my OWN shoes, cleaning up an orange juice mess, etc. Has anyone with any sort of pelvic floor disorder been squatting for a while now and noticed the difference? If so, I'd love to hear about it. Here's to happy squatting! :)

[kittywitty]

This has been talked about ad nauseum on here already, but I have yet to see the proof behind her anti-kegel theory. Because research supports kegeling when done correctly, or better yet, with biofeedback. Not that squatting may not help but kegels should not be discounted at all. So keep that in mind. Because it's just one lady against kegels here you're trusting (especially one specifically trying to sell you her books/dvd), even other pro-squatting researchers talk about how kegeling is necessary and proven to increase or maintain sexual pleasure and aid against incontinence.

[AlaaJ]

Katy Bowman isn't crossing out kegels completely, she's just saying they're not that effective -- at least not by themselves. When performed while squatting, she claims, they yield much better results (her words below). Again, Im just wondering if there's anyone out there who's a tried-and-true of her theory?

"So now you may be wondering “who to trust.” Why would you listen to me? Why am I saying something soooo different than other “experts”? These are all good questions, and questions you should be asking. First off, let me fill you in on the Kegel exercise. Dr. Kegel, an OBGYN, had a device that he invented that he thought would help many of his (caucasian) patients recover from the birthing process.

Before I go any further: It is well documented that Western, modern-living women have much more difficult births than their less-modernized counterparts. During these times (mid 1800’s to the 1930’s) pelvic floor damage and baby-head smashing was a problem for “civilized women,” but not the “Tinkers” (Irish gypsies) or tribal-living women. The only differences in these groups turned out to be the size of their birthing space. The size of the birthing space (the obstetrical conjugate) is created by the bony surfaces of the pelvis. The sacrum (the base of the tailbone) makes up the back side of this birthing space. The cool thing is, the sacrum is not attached to the pelvis, but floating against it. Less-civilized women (like their male counterparts) have squatted to “bathroom” their entire lives. This squatting increased their birthing space by activating the glutes (pulling the sacrum back to open the birthing space). This extra space meant less pressure on their PFs during birth (less tearing of the muscles and tendons) and required less damage to the ligaments in between the bones.

Another way to say this is the life-long habit of squatting is what prevented the PF from being damaged in the first place. The balance between the perfect amount of glute contraction and the perfect amount of PF tone give you what you want. Good pelvic (and abdominal) organ support. [Kara's Note: read Katy's post about the Hunter Gathering Mama for more about squatting for birth preparation.]

Back to Dr. Kegel. Now he had all these women who were noticing weakness and invented the Kegelizer, or something like that. It was equivalent to the Kegel-exercisers you see now. Just insert and squeeze. The squeeze improved the lost mental connection between a damaged PF and one that was firing correctly. Firing correctly meant that when the PF was done contracting, the muscles could restore to their optimal length. This part of Dr. Kegel’s research protocol has been left out and the only part that has been passed on is the contracting part.

Science Note: The muscle tissue in your PF is the same as the muscle tissue in your biceps. When you’re done realllly working your biceps, you’d like your arm to go back to its original length, right? What if, when you were done doing your curls, your elbows stayed as bent as they were when your muscles were the TIGHTEST? If you equate strong with tight, then you’d have “strong,” contracted arms with bent elbows all the time. Tight muscles. Unusable arms.

That’s not what TONE is. Tone is having the MOST strength and the MOST length.

Doing Kegels all the time will get you a TIGHT, unusable pelvic floor. This is why people’s ORGANS ARE FALLING OUT OF THEIR BODY.

Probably the worst time to be doing Kegels in the way we think “Kegels” is during pregnancy. If you looked at the research for birthing mechanics it is clear that women (especially Western women) are allowing their pelvic girdle to collapse based on our lack of glute (and calf and hamstring tension). The research shows that PFD isn’t a problem in other parts of the world.

So, all you Hot Mamas-To-Be out there HAVE TO SQUAT THREE TIMES A DAY until these joint motions come naturally. That’s how you tend to your PF before delivery. To all of you Hot Mamas out there with your birthing days behind you: Don’t let your PF gripping become stronger than your glutes.

I came up with the perfect solution, Kara. Gently tense and fully release (shy of urinating) your PF 10 times while you are in a squatting position. That way you know you are keeping all the pelvic muscles balanced."

[mwright]

I just had my son 6.5 mo ago. He was my VBAC baby and he weighed 9lb 10oz. He was HUGE being my first vaginal birth. It took me 2hrs to push him out and he sat on my perineum for a very long time. Thank goodness I had him at home and allowed to push in many different positions to "cork screw" him out.

I noticed at 2 weeks post partum, things felt really heavy down there. I did not feel normal at all. With further investigation with the mirror, things down there looked much different. I thought maybe I had a prolapse of some sort.  The walls in my vagina bulge at the opening. My hips, lower back and pelvis all hurt. My hips would wake me up at night they were so sore. I couldn't nurse my baby laying down cause of the pain it caused me. I was afraid to have a BM cause it hurt. My parineum was extremely sore and tender. I was afraid to have sex. We waited a loooong time. It hurt the first time. It hurt my perineum. The friction on my one vaginal wall made it very uncomfortable.

It was very upsetting to me as just walking in the grocery store was uncomfortable. Carrying my son for long periods left me in pain. Sex was extremely uncomfortable and painful. I am only 28yrs old and would love to have more babies in the future.

I started reading the POP thread and someone suggested the Katysays Blog. I read it. It made sense and I had nothing to lose.  I started doing the squat excersize and right away, I could feel how tight my hips were. They were very stiff. It felt amazing to stretch thim. I changed my posture. Ever since my sons birth, I tuck my tail bone in. I think I was trying to give my perineum slack to aid the healing. I didn't tear but there was some good muscle damage. I now stick my butt out. I make sure to do the squat excersizes with my rear stuck out.  I have to tell you ladies. It worked for me!! I am practically in tears writing this out. I instantly noticed a change in my perineum. I dont have the pain anymore. My hips no longer give me pain when I sleep. I even stick out my bum while sleeping. hehe I feels amazing to just allow my perinium to be relaxed.  I still get the heavy feeling when my flow shows up or right after dtd. I can now see myself wanting to have another baby and not have fear of making things worse.  Things still look the same down there but I don't mind. I can now walk, carry my baby, clean my house, grocery shop with out feeling like my pelvic organs were gonna fall out. oh and sleep and nurse in comfort!!

I owe a HUGE thank you to whoever shared that blog. It has made my life so much better. I will be forever grateful.  Anytime things are bothering me, I get down on my hands and knees and get my booty in the air, then stretch my hips, then get into the squat. I get instant results!! I am a HUGE fan of Katy! I no longer do kegels. I thought that was my answer, but stopped cause it would leave me worse than better. Squats are awesome!! Its all about getting those glutes sronger!!

[AlaaJ]

Woah. Thanks so much for sharing your experience!

[cyclamen]

Yes, this worked for me.  I also do kegels but once I started squatting with my butt out and my knees up (not going over my toes)... basically squatting like my mom sits, aka the "asian squat"  and doing it weightbearing.. until I started doing it while holding my daughter, it seemed like I was never going to get "flexible" enough... well ladies, I am here to tell you, flexibility is a function of strength.  Anyhow, I noticed a huge change too.  Stuff was starting to fall out of me and now everything is almost back to normal.  I also had horrible back and leg pain and that is all gone now.  My sex drive is up.  I sound like a snake oil salesman.  Anyhow I am trying to build up my glutes in anticipation of trying to have another baby someday.

I do spend most of my time in my computer chair (just a regular kitchen chair) squatting.  I squat to eat, to rest, to tie my shoes, while I am wearing a backpack or my daughter on my back.  I squat all day long now and it's awesome.

Anyhow, when I squat down and then start to stand back up, I also squeeze my coochie because it just feels better and like it's holding stuff in. 

[AlaaJ]

Cyclamen, with all that squatting, I'd think your glutes are more than ready to push out another baby by now!! :)

I can't imagine the type of squat that you are talking about, though. How do you manage to squat with your knees not going over your toes? Is it like a half-squat, half-sitting kind of thing? In Katy Bowman's tutorial on how to squat, her knees are positioned over her toes during the squats. I'm curious as to how you do it..

[A_Random_Phrase]

That's what I was wondering, too. How do you get from a squat where "your shoes are in danger of being peed on" to the kind of squat she recommends?

[cyclamen]

So Bowman is obviously more knowledgeable about this topic than I am so take my experience with a grain of salt, but like I said my mom sits a certain way.  She sweeps the floor that way.

And I figured if was good enough for millions of old Korean ladies, it was good enough for me.  I am tight, so my knees don't come past my toes unless I really try or lift my heels up.  Basically I lean back a little bit more and my knees line up with the tips of my toes.  I have peed this way and it does not get on my shoes!  LOL  I look like the guy in black on the right probably.  I aspire to look like the middle picture of the weight bearing squat on this page: http://www.stumptuous.com/dork-diva-squat minus the boots, hah.  You can see that she does have that lumbar curve.  

I engage my glutes as I sit back into a squat, and I engage them as I stand as well.  As I come up, I am always drawing my pelvis backwards.  When I am in the squat with my knees together, my sacrum doesn't round, but is sort of flat up and down.  So there isn't as much curve as Bowman recommends.  If I squat with my knees spread apart there is a slight curve.  However, I've noticed by always doing this drawing back of my pelvis as I move up and down, that I am getting closer and closer to keeping that curve the deeper into the squat I get.  I think my glutes were very very weak, as I had spent almost ten years tucking my pelvis into what I thought was "neutral spine."  I also bounce in the squat and lift up and try to create space between my butt and the backs of my ankles.  Sometimes squat wide and bring my heart forward while leaving my pelvis back in order to lengthen my spine and encourage that curve.

Again, I'm not a specialist in this like Bowman, but this is what feels good for my body.  I am going to do some squatting with a mat in my knee crease like she recommends because it does feel good!  And I think I need to do still more glute activation.  But I feel the main advantage that I have gotten from squatting the way that I do is that I squat much much more during everyday activities, like cleaning the floors, sitting at computer, or waiting for the bus, and I am able to squat comfortably while holding my daughter or another heavy weight.  I feel that the load-bearing squat has been the most advantageous to me.  And I always try to be active in my squat as much as I can, so I have seen an increase in both flexibility and strength over the last year. 

[cyclamen]

Oh here is another picture of a natural squatter

And when I saw my daughter doing this,  I decided that it was okay for me to squat resting on my heels.  I would say actually, that I started out looking like the guy in black in the pic in my previous post, but I look more like this kid now.

[cyclamen]

Aaand... sorry I'm not editing my post... my computer is being wonky... I do all the stuff Bowman recommends about glute stretching, activation, and posture.  I 100% believe what she says about needing the glutes to pull sacrum back in order to keep the pelvic floor in the right position.  I have stopped sitting on my sacrum, pulling my pelvis forward (though I have to make a conscious effort) etc.  I really believe this has been what has helped.  I'm trying to get a big butt, guys, lol.

[lifeguard]

I find this all very fascinating. I had third degree tears after ds was born due to a forceps delivery. I don't need to tell you it was awful.

Just before I got pregnant I had started to get into powerlifting. I have since resumed that. It took me a YEAR to get decent depth & positioning on my squat because of how tight my hips were but I have to say I feel SO much better about things & more confident in my body. There are often jokes amongst the women at my gym about peeing while doing different activities (jumping jacks is one) but I do not have that difficulty. I NEVER do kegels. Could never remember to do them regularly & hated them when I did remember.

[AlaaJ]

I tried squatting like that cute kid and those Asian guys (with my heels on the floor and tailbone tucked in) and toppled over sideways the first time, backwards the second time. I think you have to be lean to squat like that, folding all your body together -- it's just not for you if you have a bulging pg belly in front of you!

I live in the middle east and I always see people (Arabs, Bangladeshis, Pakistanis, etc.) squatting like that, sometimes for hours on end. For many people, it's the most comfortable position to be in, while eating, chatting, hanging out, etc. Once I saw an old man in an alley, dozing while in that squat position! So how good for you is it, especially since it seems to come more naturally to most people than the other squat position? It would be interesting to know.

Buuut, for our pelvic organs purposes, keeping Bowman's explanations of how the pelvis should be positioned and why, I'm thinking the tailbone-out squat is what we women are looking for, right?

PS -- I also find stuff like this totally fascinating! :weird: 

[Franci]

I'm 32 weeks pregnant now (and I'm going to attempt a VBAC) so all this topic is very interesting to me.

This time around I've been having Sacroiliac pain that is really bothering me. In the last week, thanks for posting this, I've been trying to do some of the exercises Katy reccomends (the squatting and the transverse abdominal) and I'm trying to stick my butt out more.

I'm a little confused though if I read the spinningbabies web site where in posture for pregnancy they suggest to "let your lower back sway forward as you stand and walk". Anybody has a tought about this.

Thanks for the interesting conversation.

[Italiamom]

Originally Posted by cyclamen 

Okay, so my question here is, if the above is a healthy squat for the pelvic floor or not?  Because I could sit in a squat like these guys all afternoon...  Yes, their feet are flat on the ground, not lifted, but all of them have backs that are curved inward, it appears that all of them have their knees at least partially in front of them, and all of them have toes splayed outward.  But looking at Katy's two weblinks about this, both the "You Don't Know Squat" and "The Hunting and Gathering MAMA" pages say that in order to "properly" squat, your butt should be coming out and your toes pointed forward, and not out.  Is the idea just to squat and hold it?  Or if you have to curve your back in at all, that it means you're actually damaging your pelvic floor?  I'm confused...

Also, I've been getting into all these positions (both the one above, and then the ones from Katy's page) all afternoon out of curiosity, and I feel absolutely NOTHING in my butt, despite my feet being positioned correctly, and despite making sure that my butt is jutting WAY out in the mirror.  Any tips from other squatting mamas?

[cyclamen]

Italiamom - I think the guys look a little tight to me, hence the splayed feet. But I've been looking at picture of women squatting on flickr all afternoon, and that is the basic work/rest squat for women all over the world. Their feet tend to point more forward and parallel, and sometimes the knees come past the toes, sometimes not, and the butt rests on their heels. Sometimes they are leaning through their legs to work, sometimes sitting very upright. They look very much like pictures of the kid, or a more supple version of the men squatting. The sacrum sometimes is pointing back, but at the least doesn't round inward and stays up and down - not pointing back, but probably still keeping the pelvic floor taut. I wonder if Katy recommends butt out squatting because as her audience is chair-sitting westerners we are chronically tight and need something more extreme to get us into the correct posture. Or perhaps the pictures I found are just part of a range of motion of squatting that includes both butt out squatting and butt resting on heels squatting? I am convinced that I need to lengthen my glutes, at any rate, but I also find this sort of butt on heels squatting an improvement to sitting in a chair. I'd be interested to hear what she has to say.

These two are kind of hard to see but they show a similar posture.

http://www.flickr.com/photos/noborders2/2835716191/

http://www.flickr.com/photos/jrosario/318229661/

http://www.flickr.com/photos/7902219@N08/1269840299/

http://www.flickr.com/photos/sleep-walker/3602945361/

http://www.flickr.com/photos/followtheboat/4833013761/

this one actually looks like what katy recommends http://www.flickr.com/photos/nygus/896516490/

this one too http://www.flickr.com/photos/boycebw/851587768/

None of the feet are splayed in these, which suggests that these people do more squatting than the men in the picture I posted above.  But it's hard to tell if the tailbone is tucked or not.  I think a good indication is if the upper body has freedom of motion.  You will be unbalanced if you try to move your upper body with your tailbone curled in. 

At some point in her blog Katy does talk about how it's good to change up the sitting posture so it's never exactly the same, too. So there are all kinds of squat variations.

Also, you might want to google "glute activation" - sometimes we are so out of balance that we do not use our glutes when we should be using them. Or you might just have great glutes and great posture, lol!

Edited by cyclamen - 12/19/10 at 9:55pm