Pelvic Floor Dysfunction and Powerlifting

Who has ever peed while powerlifting? Raise them hands.

I’m not ashamed to say it has happened to me and I would say it’s a pretty common thing for women in lifting sports. And thankfully I don’t think it’s something that is surrounded by shame. BUT are these small breaks from our bladder ok?

The Pelvic Floor

You can’t talk about pelvic floor dysfunction without talking about the pelvic floor. Your pelvic floor is composed of the levator ani muscle group, the coccygeus muscle, and connective tissue. Additionally, the pudendal nerve runs through this region to supply sensation, motor and autonomic function. The pelvic floor’s role is to support the pelvic organs while also maintaining continence of your bowel and bladder. We do this be tightening and relaxing our pelvic floor consciously and also subconsciously. There is also a role in sexual function for both men and women.

When Something Down There Goes Awry

As with any muscle in the body, it is possible to have dysfunction of the pelvic floor. One of the biggest misconceptions out there, however, is that if you have issues with your pelvic floor it’s because it’s weak. Signal the kegels. BUT you can also have issues from your pelvic floor because it’s too tight or you’re not firing these muscles at the right time. Any of these impairments can lead to the common disorders of this region such as incontinence (leakage), prolapse or pain.

Some signs and symptoms of a pelvic floor include:

• Incontinence
• Lower back pain
• Pain in the pelvic region
• Discomfort during sexual intercourse
• Frequent need to urinate

Don’t Lift Too Heavy... Your Vagina Will Fall Out

Who has ever been approached by someone in the gym and told this. I have. Where does this even come from and is it true?

Bring in the Valsalva maneuver. Some say that women shouldn’t lift heavy because of the pressure from using the Valsalva maneuver will cause distention of your pelvic floor and will cause your vagina to fall out, or prolapse. A little dramatic I’d say. A study by Thompson, et al (2005) found that the pelvic floor has been shown to co-activate with the abdominal muscles during numerous movements, particularly those of the core. This co-contraction causes a supportive sling of the pelvic organs, aka doesn’t push them out.

So why do we get leakage sometimes? Thompson found that when the Valsalva is paired correctly with a pelvic floor contraction, the pelvic floor lifts and prevents incontinence. HOWEVER, when the Valsalva is paired incorrectly with a straining maneuver instead of a pelvic floor contraction, the pelvic floor descends down. This would cause a relaxation effect of the pelvic floor and the potential for leakage.

When It’s Not Leakage

As I mentioned above, urinary incontinence is only one symptom of pelvic floor dysfunction. This has been my experience. For the last two years, I have been dealing with a sharp searing pelvic pain that occurs during arousal. Ok, why did I just tell you that as I’m supposed to be talking about powerlifting? After seeking guidance from 3 gynecologists, my PCP, and now a women’s health PT, we have finally dialed in on that my symptoms are most likely a result from improper pelvic floor function while lifting.

In my 5 or so weeks of physical therapy, we have found that I have

• Terrible L ankle mobility
• R meniscal tear (happened 2 years ago)
• Decreased VMO size B
• The tightness of B piriformis, adductors, and pelvic floor muscles all L > R
• A tendency to bear down on my pelvic floor during Valsalva
• AND a mild prolapse associated with Valsalva. Yup. I’m mildly pushing my vagina out when I lift.

Goodness that a long list. And why do we care that my L ankle is stiff? My issues boil down to two issues:

1. Decreased ankle mobility (which resulted in my R meniscal tear) has caused increased stress and weakness of my L hip muscles. With my frequent lifting, this has caused irritation and trigger points of my L side – the piriformis, adductors and pelvic floor. These trigger points of the pelvic floor will spasm around the pudendal nerve causing my symptoms.
2. I inappropriately bear down through my pelvic floor when I Valsalva. This paired with a too tight belt has caused a mild prolapse during lifting which has in turn caused increased tension on my pelvic floor.

This increased tension and trigger points of my pelvic floor has created tension around my pudendal nerve. Through PT, we have been working to alleviate my pain by working on the issues above.

Keeping her healthy

So how do you not end up in my predicament?

Pelvic floor strengthening

This is the standard recommendation anytime someone talks about the pelvic floor – more Kegels! While this won’t solve every person’s issue, starting with a strong pelvic floor is important. If you can’t perform a pelvic floor contraction at rest, then you definitely aren’t going to be able to during lifting.

Coordinating pelvic floor contraction with Valsalva

The Valsalva maneuver isn’t inherently bad. Actually, if you can coordinate the Valsalva with a pelvic floor contraction, it has been shown to have no harm to your pelvic floor. So how do you make sure you’re coordinating the two? For me, I breathe in and initiate the Valsalva, then I consciously make a lifting motion of my pelvic floor (kegel if you will).

How tight is your belt?

Probably the biggest change I have made is loosening my belt. I have previously worn my belt as tight as possible. This resulted in all my abdominal and pelvic organs getting pushed down. So even if I was to attempt to contract my pelvic floor upwards, the downward force from my belt would overpower it. I have worn my belt so tight that the bottom of my stomach will stay pooched for an hour post lifting. Not Good.

These are only a few simple steps to getting you started on the path to maintaining a healthy pelvic floor. If you find that with these changes you are still experiencing leakage or you have pelvic pain associated with lifting, I highly recommend you consult a Women’s Health PT.

We are so excited for Dr. Horton's live interview in the GWPL: Strong Girls Club on Facebook, Friday, October 19 where she will be discussing more on Pelvic Floor Dysfunction and answering your questions ways to help with prevention. If you haven't signed up yet, CLICK HERE!