We all know how stressful coughing can be to the pelvic floor and pelvic organs, let alone the mental stress of knowing what’s happening ‘down there’ and feeling helpless in protecting against it. At Made for Women Workouts, we want to reduce that stress both physically and mentally and arm you with as many tools and tips that we have up our sleeves to help you feel more empowered about coughing and prolapse.
As you saw from the infographic, sharp coughing produces intra-abdominal (IAP) pressure levels that are among the highest compared to other activities (1). The sharp rise in IAP pushes downwards into the abdomen and pelvis, affecting the exact structures that we don’t want stretched.
Thankfully, we have a system built into our bodies that allows us to manage these high levels of IAP so that, in ordinary circumstances, it doesn’t do too much harm. That system is our deep core. As you may be aware, the deep core comprises of the pelvic floor, transverse abdominis (TA), diaphragm, and multifidus. Studies have shown that the TA, specifically, is the abdominal muscle that is most closely related to changes in IAP (2). Hence, we want the TA to be fully utilized during a cough!
However, what often happens is that the lower ribs get pulled inwards by the external obliques (EO) in an effort to produce a more forceful cough. These strong EO contractions, if done repetitively, often leaves you with “chest gripping” habit and you become a “chest gripper.” This is a term coined by
Dianne Lee (3) to indicate overactive EO muscles which looks like this.
These pictures are from Dianne Lee’s website: http://dianelee.ca/article-butt-grippers.php and http://ipphysio.com/images/sept11day2rotated.jpg
Why is this important for Prolapse?
An overactive EO alters your body’s ability to manage pressures since the TA, the muscle that is designed to manage IAP, stays in the back seat while the EO takes over. This is often why you see a “pressure belly” (3) as demonstrated in the pictures above. Hence, a chest gripping habit lingering from your cold, can leave you with a stubborn motor pattern that seems to activate with every small thing, including talking and breathing at rest.
Implications for Prolapse and Exercise
As the name implies, a pressure belly contains pressure that would normally be dispersed throughout the abdominal canister, but is now more concentrated in the lower abdomen and can further strain the tissue holding up your pelvic organs. This mean that if you have a pressure belly, your pelvic floor and pelvic organs would likely be experiencing even more downwards pressure during exercise which could affect the status of your prolapse.
How to Fix It
If you have a cold, do everything you can to manage the symptoms ie cough suppressants, lozenges, sleeping with your head slightly elevated, and drinking plenty of water!
Pay attention to how you are coughing.
Ideally you want the pelvic floor to turn on and the lower abs to pull inwards during a cough.
During a coughing spell, someone with prolapse may find it beneficial to:
Cough in a supported position – i.e try to sit down
Cough in a supported position while being in a neutral posture. The deep core muscles have been shown to recruit better when the pelvis is in neutral
Contract your pelvic floor right before the cough and hold on to it
Place your hand on the lower abdomen during the cough to encourage the lower abdomen to pull inwards to activate the TA
Here is a video that covers this in more detail. Apologies for the poor quality! https://www.madeforwomenworkouts.com/single-post/How-to-Protect-your-Pelvic-Organs-and-Pelvic-Floor-During-Cold-and-Flu-Season
After coughing, do you notice that your upper abs are still pulling inwards?
If so, we need to work on restoring the function of the deep core system, since chest gripping and over-active external obliques appear to raise resting IAP levels, when in fact, we are trying to lower the IAP profile in prolapse.
Improve the Chest Gripping Situation: Exercises to Do
******Made for Women Workouts tip: It might be a good idea to do these exercises right after a bout of coughing******
1. Stretch out and release the tight, pulled-in lower rib cage
1a) Take a few minutes every day to practice breathing into the front of the upper abdomen, to stretch the area that is cinching inwards. As you exhale, and let everything fall back down naturally without using your abs to help, which often happens after you’ve had a cold.
1b) Also practice breathing into the sides of the lower rib cage help them expand with breathing.
1c) Rib stretch. This is a great stretch that opens up the space between the ribs and loosens the grip of the EO. You can hold for 15 seconds each side while breathing into the lower ribs.
2. Train the right muscles, namely, the pelvic floor and the transverse abdominis
2a) Perform 1a and 1b, and then at the end of your exhale, try to turn on your pelvic floor to see if the lower abdomen pulls in. If it does, that’s great because the TA is coming on and we are our way to restoring the deep core. Practice a few minutes a day
2b) If it doesn’t, see if you can feel it TRYING to contract, and then add on to that contraction.
2c) If the TA is not activating at all, try practicing the contraction separately by using the cue: bring your two front hip bones together.
Summary for Prolapse Safe Exercise
Ultimately, the goal of doing these exercises is to help your body re-familiarize itself with its own built in mechanism to manages IAP. We need to down-train the external obliques which tend to increase IAP and can therefore raise pressure levels during exercise. We then need to re-train the deep core, especially the TA and pelvic floor, to help the body manage the pressure better.
Cresswell, A.G. et al. (1992). Observations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man. Acta Physiol Scand. 144(4):409-18.
O'Dell K. et al. (2007). Vaginal pressure during lifting, floor exercises, jogging, and use of hydraulic exercise machines. Int Urogynecol J Pelvic Floor Dysfunct. 18(12):1481-9.