Most of the time when we hear the word “core” we think of our abdominals. And in fact it is important to keep the abdominals and all the other muscles of the trunk strong. These muscles work together to maintain good posture and to support and move the shoulders, the back and the hips. They are often referred to as the powerhouse of the body, stabilizing the trunk and allowing us to move our arms and legs powerfully and safely during exercise.
Beneath these core muscles are the muscles of the inner core and they have an important job to do. The brain is protected by the skull, the heart and lungs are protected by the rib cage, and the female reproductive organs are protected by the pelvic bone. But the remaining organs are protected by the inner core. The muscles of the inner core are the diaphragm at the top, the multifidus in the back, the transverse abdominis in the front, and the pelvic floor at the bottom. A weakness in the diaphram can lead to reflux. A weakness in the multifidus can lead to slipped discs, a weakness in the transverse abdominis can lead to a hernia. And a weakness in the pelvic floor can lead to incontinence.
Women are more likely than men to suffer from incontinence. However, in men sometimes an enlarged prostate exerts pressure on the urinary tract, controlling the flow of urine, and then the pelvic floor becomes weak. If the prostate is surgically removed, men will have a more serious issue with incontinence. Therefore, both men and women are encouraged to include pelvic floor exercises in their fitness routine. The Harvard Medical School recently published an article entitled “5 of the Best Exercises You Can Ever Do” which listed Kegel exercises as one of the five for both men and women. You can access the article at https://www.health.harvard.edu/staying-healthy/5-of-the-best-exercises-you-can-ever-do
Exercises to strengthen the pelvic floor are less often called Kegels because the research has changed the way the exercises are performed. To perform core contraction correctly, lift the pelvic floor and then gently draw in the transverse abdominis. There should be no change in your breathing. Incorrect core contraction involves strongly bracing the abdominals before lifting the pelvic floor, but this bracing puts downward pressure on the pelvic floor. Furthermore, you typically hold your breath during a strong brace of the core. Instead, keep your upper abdominals relaxed. Perform the exercise gently and slowly. Activate the pelvic floor smoothly. Draw in from the pubic bone. Use 30% effort when drawing in the transverse abdominis. Your breathing is gentle and continuous.
How long to hold the core contraction depends on the type of incontinence you are having a problem with (or wish to avoid). Stress incontinence is leaking when sneezing, coughing, etc. For this do 10 quick pelvic floor lifts 2 or 3 times a day. Urge incontinence is leaking on the way to the bathroom. For this do a maximum of 10 repetitions at a time, hold the contraction for 10 seconds at most, and take a 30 second break in between contractions.
My resource for this information is Marietta Mehanni, the pelvic floor ambassador in Australia, who presented a workshop entitled “Aquacise Your Pelvic Floor” for the Metroplex Association of Aquatic Professionals in Dallas on October 5, 2019. As you might guess, pelvic floor exercises can be done in a water fitness class.
See you in the pool!