PELVIC FLOOR THERAPY: A Q+A WITH EMILEE WISE

Part of my pelvic floor therapy: bridging while activating the pelvic floor.

Part of my pelvic floor therapy: bridging while activating the pelvic floor.

“No, honey. You and Daddy jump by yourselves. The trampoline just isn’t for me.”

I zipped the mesh safety barrier shut and took a step back as James scrambled to his knees, weaving his pudgy toddler fingers through the nylon netting and as he peered through it. We were on vacation in Los Cabos, where we’d found a killer play space for James. His favorite part: the ultra-bouncy trampoline.

“Awwww c’mon Mommy! I want to jump with you!” he complained.

“C’mon Moooooom! You’re no fun!” my husband, Scott, teased.

I felt my cheeks flush as I weighed my options: disappoint my family, or pee my pants. Either way, I was losing.

I hadn’t told anyone but my closest girlfriends and OB what was happening to me. It was just too embarrassing! I’d lost count of the number of times I’d leaked pee when I sneezed, had to change my underwear after jumping jacks, or completely soaked my shorts while I was out for a run. It was physically uncomfortable and absolutely mortifying! I didn’t want my husband to see me like that, and I sure as hell wasn’t going to risk a telltale stain on my white golf shorts.

The most frustrating part was that I knew I could do something about it, yet the solution always seemed just out of reach. My doctor had referred me to a physical therapist, but her office was an hour’s drive from my house and my prescription called for twice-weekly visits. I kept promising myself I’d make the time, but I could never spare the 6 hours a week it would take to make it happen. Instead, I’d tried Kegels and every other useful-seeming exercise that Google suggested, but nothing helped. If I got on that trampoline, I was going to be soaked.

As I looked into my son’s pleading eyes, I knew I had to do something about my urinary incontinence problem. That’s when I started my deep dive into pelvic floor therapy.

Can’t Hold It? You’re Not Alone!

An estimated 25 million Americans suffer from stress urinary incontinence, and up to 80% of those are women. The most common causes: pregnancy, childbirth, and menopause. The same muscles that stretch and tear to allow a baby to pass through the pelvis also support the bladder. Even if a woman doesn’t immediately experience postpartum stress incontinence, hormonal changes can cause those muscles to further weaken, causing incontinence later in life as the bladder begins to descend into the vagina; a condition called “prolapsed bladder.”

 On average, women wait 6.5 years before addressing their bladder problems. I’m sure many are just too embarrassed to bring it up with their medical provider, but there is also a startling lack of care. Most women don’t have access to the right kind of physical therapy, and many doctors aren’t aware that the problem can be addressed before the bladder prolapses and requires surgical intervention.

Fortunately, there’s another option: Pilates for the pelvic floor. Shortly after my guilt-and-embarrassment-inducing trampoline experience, I got an email that Metta Yoga was hosting a Pilates series for Pelvic floor and diastasis recti. I signed up for the series of classes with Emilee Wise, a Certified Pilates Instructor and Nutrition Consultant who has dedicated part of her wellness practice to helping women strengthen their bodies and avoid invasive bladder surgery.

After just a few sessions with Emilee – and lots of at-home practice in between – my symptoms are about 80 percent gone! Emilee also happened to know a PT much closer to home, and I’m now on the waitlist for further treatment. Given the improvement I’ve already experienced, I’m optimistic that I’ll be able to avoid surgery. I was so inspired by my results that I asked Emilee to share her wisdom here in hopes that you may also be able to avoid what I believe to be a preventable medical issue for many women.

Q+A With Certified Pilates Instructor Emilee Wise 

Pelvic floor therapy with Certified Pilates Instructor Emilee Wise

What inspired you to start learning about and teaching Pilates for pelvic floor and diastasis recti?

I started taking Pilates after the birth of my first child and started teaching Pilates after the birth of my second.  I was pretty knowledgeable about the body, how it worked, and had been an endurance athlete for many years, so Pilates seemed to make sense to me as to what I needed after having children to get everything back together. When I got certified in Pilates there was a lot of talk about engaging the pelvic floor and I always instructed clients to do so. 

Just like many women, I had a series of injuries and health conditions that I feel strongly could have been avoided with the right education and care. I started teaching Pilates because it initially helped me and I wanted to bring Pilates into the “athlete” and mom world. When I learned to teach, Pilates was still very popular with dancers and older women, but not my friends.  As I worked more and more with clients, I would notice Moms would come in for sessions about 4-6 years after giving birth with low back pain, incontinence, neck pain, and wanting to get rid of the “baby pouch”.  The 4-6 years seemed to be when moms would have a chance to breathe as their child goes to preschool or kindergarten, at least for a few hours.  The more I worked, the more frustrated I got, not just with my ability to fully heal clients but with my own body as well. Pilates exercises were helping, but not “fixing” the problem.

Through my frustrations trying to get help for myself and what I intuitively knew needed to happen, I started the search for holistic help.  I discovered a pelvic physical therapist and found a regular physical therapist that had been trained in Pilates which allowed her to look at my body as a whole versus just looking at one injury spot. I began to really understand the pelvic floor, what was missing in my recovery and learned to walk and run again without pain.  At that point, I searched for further training and completed a 30-hour training with The Center Method.  I am now able to take the whole body into account and all the things I have learned through the past 20 years of being a teacher and a student of the human body and pay it forward.

What is the average age and stage of life of your clients? Are they young moms, older women trying to avoid surgery?

I have women of all ages, mostly moms, but certainly a variety of life stages. Some women were done having kids 10 years ago, others have newborns.  I have also worked with older women who have suffered from organ prolapse, a condition in which the pelvic floor muscles and tissues are not strong enough to hold up the organs and the organs press down into or out of the vagina.  This scares me as I worry this is going to be an increasing concern among women with the lack of education, increase in stress, HIIT works and this message to “get your body back” as soon as possible.  Our bodies are dynamic, always changing and we will not get our pre baby body back, as it will change, but it can still be beautiful just the same.

The pelvic floor is actually made up of several muscles working together.

The pelvic floor is actually made up of several muscles working together.

 Why don’t Kegels always work for incontinence?

When Kegels are described to women, they are described as the action to “squeeze as if you are trying to stop the flow of urine”.  There is a small muscle that does that, a sphincter muscle, while it is important, it leaves out major muscles of the pelvic floor. The pelvic floor comprises of several muscles that contract and relax as a diaphragm, much like the one we use for breathing.  It is more like a sling of muscles that support not just your bladder but other internal organs.  The entire set of muscles is weakened by carrying the weight of the baby for months.  It can also be weak from high intensity exercise, running, stress, improper exercise etc.  Therefore, without activating the entire set of muscles, you are not going to regain complete control of these muscles.  The pelvic floor muscles hold the body together from the inside. So often people just work on the muscles that are visible on the outside such as the glutes, hamstrings, etc. This creates an imbalance. Imbalance leads to injury.

 How is Pilates for pelvic floor different than doing Kegels?

The exercises we do teach you to engage the entire set of pelvic floor muscles and teaches you how to use them in tandem with other muscles in the body, not just in isolation. The body is dynamic and must flow and work together to function properly.  The exercises I teach also teach women how to relax the muscles of the pelvic floor as this is a vital function of a healthy muscle.  Constantly contracting a muscle without being able to relax it creates what we call a hypertonic pelvic floor.  We hold tension, stress and emotions in the pelvis and for some women, their pain is coming from that tension. We need to learn to release. It can be an emotional process.  The emotions don’t have to be from giving birth, they can be general stress or even emotions of past sexual experiences or trauma. Imagine all the tension we were never taught to release surrounding our first sexual experiences and maybe even those that may not have been by choice. It’s a lot and just even learning that is huge in my book. You better believe I will be talking to my girls (I already do) about the health of their pelvic floor well before they have kids! Because many of us didn’t go into pregnancy with a healthy pelvic floor to begin with!

 To me, it’s fairly obvious that doctors should be suggesting some kind of pelvic floor rehab to every woman who has had children. Why do you think that’s not happening?

I think its lack of knowledge plus the mindset of our medical system to diagnose and treat. They are happy to recommend you to a surgeon if your condition get bad enough, but there is not preventative care.  Think about this: if you get shoulder surgery, you get 8 sessions with a physical therapist that is typically covered by insurance.  However, when you give birth, you get nothing. I think we all know, that the sooner you do the PT, the sooner and better your shoulder will heal.  But mothers deliver babies and are sent home within two days and a follow up checkup in six weeks.  The doctors are not knowledgeable about pelvic floor dysfunction and diastasis recti and the huge impacts these conditions can have on a women’s health.  It is our job to spread the word and get resources out to women.

What’s the difference between Pilates for pelvic floor and physical therapy?

In Pilates, I try to educate women on the pelvic floor muscles and generate a connection between the pelvic floor and the rest of the body as often women are extremely disconnected from this personal area.   I want women to know the various conditions of pelvic floor dysfunction so they can learn which exercises work best for them and know when to get help if needed.  With the 5-week introductory series, my goal is to start the conversation, give women the knowledge so they can take control of their own body, ask the doctor the right questions and to learn a core set of exercises the are safe for women to perform.  We also discuss the variety of exercises available and which ones to do vs which ones to stay away from.  We also learn how pelvic floor dysfunction and diastasis recti can be connected and learn how to make them work together.  

A Pelvic PT has the ability to go internal and has the ability to use tools to help give a detailed analysis of the status of a women’s pelvis, muscles, ligaments and tissues.  By having the doctor go internal, a woman can feel where the pelvic floor is and many times be hooked up to a biofeedback machine to know when and if they are contracting/relaxing the correct muscles.  

What are some common misconceptions you hear from your students about the pelvic floor and how it works?

Most women are curious and have an internal intuition that the doctor isn’t giving them all the information.  Many have a sense that exercises they are told to do “don’t feel right” so they come looking for answers, guidance and I love that. I have experienced many of the conditions that stem from pelvic floor dysfunction and therefore, I can relate to a majority of the women I work with. Some conditions are extreme and need more professional care and I advise the clients to see a PT.

One of the most interesting takeaways I got from your class was the connection between diastasis recti and the pelvic floor. Can you first explain what diastasis recti is?

Diastasis recti is a condition in which the rectus abdominis muscles (often referred to as the six pack muscles) separate during pregnancy or incorrect abdominal exercises.  These muscles hold in the internal organs and support the core and low back.  Their separation is often the cause of the “baby pouch” that moms can’t seem to get rid of.   What women, and doctors, don’t know is that is can be the cause of pelvic floor dysfunction, sacro illiac pain, low back issues, hip pain, incontinence, dysfunctional breathing patterns, shoulder tension and the list could go on.

 How do pelvic floor muscles play a role in diastasis recti?

The fascia that covers the pelvic floor muscles connects to the abdominal fascia. By releasing the fascia, we can start to realign and strengthen the abdominal muscles. 

 How can we check for diastasis recti?

Lay supine on the ground with your knees bent and feet flat on the floor. Place your fingers two inches above and below your belly button. Lift your head, pulling your chin to your chest. If you feel a separation or if your finger goes into your abdominals when you lift your head, you have diastasis recti.  Alternatively, you may notice a cone shape protrude from the midline of abdominals.  

Hernias are NOT diastasis and require medical care.

What are some basic exercises women can do at home to start addressing pelvic floor weakness and diastasis recti?

Learning to breathe to restore function and connection to the pelvic floor muscles is the first thing we start with in class.  It cannot be reinforced enough as to how important this is.  In general,  do exercises that stay in neutral position - like planking. Stay away from exercises that include weighted abdominal flexion, like crunches.

Where can women go for more information?

In person, I am currently running programs at Metta Yoga in Corte Madera. Please check the website for upcoming dates. 

I have a workshop coming in November that will include an introduction to the Pelvic floor and diastasis exercises as well as nutrition focused on women’s health.  Here is the link.

My website is www.emileewise.com, contact is bewell@emileewise.com

I am working on getting the exercises on video so that I can work with women remotely. I am finding many women have a hard time getting out of the house for self-care.  I love the in-person work and think it’s extremely valuable to have women working together, sharing stories and having conversations about this.  If you are interested in being on that wait list, please email me at bewell@emileewise.com 

Many of my readers unfortunately don’t live nearby. Is there a resource they can turn to for information on finding a Pilates practitioner with pelvic floor expertise near to them? 

Finding a pelvic PT in your area is the best place to start.  The Center for Women’s Fitness, where I did my training, has a directory of training practitioners as well.