Ok, so this may seem like a divergent post from what I normally write about. But really, I assure you it isn’t-it’s just another aspect of gut health. In my practice, I routinely help patients improve their core stability and movement patterns. In this post, I’m going to discuss:
-Associations between weightlifting, intra-abdominal pressure
-How weightbelts work, and how they increase intra-abdominal pressure (but save your spine!)
-How increased intra-abdominal pressure can cause urinary leakage in women, prolapse, and hemorrhoids
-One simple exercise to incorporate that prevents these problems and can make you stronger!
There are some things that people just don’t talk about and almost never share with friends. High on this list are taboo subjects like urinary leakage, bladder or uterine prolapse, and (more specific to guys) hemorrhoids. What do these have in common? You’re about to find out!
Weightlifting exercise, and CrossFit, are hugely popular sports around the world. And for good reason: studies show that these exercises don’t just make us stronger, but they also improve bone density and cardiovascular fitness as well as reducing stress. There is, however, a somewhat increased risk that the increased pressure in the abdomen (“intra-abdominal pressure…can we just call it IAP right now? Thanks!) can cause some of our insides to try to become outside, or at least injured. For women, that’s uterus, bladder, and hemorrhoids, resulting in everything from leakage incontinence to later challenges. For men, this is mostly about hemorrhoids. Preventing them, managing them, and being able to keep exercising. And, the best part is that there’s a simple exercise and muscle activation that can help prevent all of these problems!
Why do we use a weightbelt during movements like the front squat, back squat or deadlift? It makes your back feel stronger, right? So, imagine that your abdominal contents, intestines and everything, are basically like a semi-liquid. There is no muscle there that contributes to weightlifting. Your abdominal and oblique muscles hold all that stuff inside. When you properly contract your abdominal muscles (rectus abdominus, transverse abdominus, obliques) to activate your core, you’re taking that liquid-y insides, and containing it in a rigid cylinder made of muscle. That shifts some of the weightbearing off your spine, and onto this new cylinder. But…what forms the bottom of the cylinder? A group of often-weak muscles known as the pelvic floor! Now, women are often more knowledgeable about these muscles than men, as they’re taught something called a Kegel exercise, usually to strengthen these muscles after childbirth, to help prevent the problems described above. Men are not usually taught to do anything with pelvic floor muscles, though there is evidence that Kegel pelvic floor exercises can help with premature ejaculation and erectile dysfunction. Guys, if you’d like better function, then this is an added bonus to doing these exercises!
How do you do a Kegel? The easiest way to find the muscle group is to try to stop urinating during the stream of urine. That muscle you contract to stop is part of the pelvic floor musculature that is exercised during a Kegel (or Knack, see further down).
When we use a weightbelt, we boost the IAP created by core muscle activation, by adding a firmer exterior to the “cylinder”, in the form of the weightbelt. Without strengthening, and then activating, the pelvic floor muscles, there can be an increased risk of hemorrhoids or promoting prolapse. Obviously some individuals are more prone to these problems than others, but many just won’t experience the problems till later in life and then wished that they had learned how to prevent these issues.
You might think that established, strong athletes have already developed pelvic floor muscle strength and usage patterns compared to non-athletes (I thought that) but in fact researchers have found no difference in strength and activity between the two. This means that even though the athlete is much stronger, that athlete’s pelvic floor muscle is probably not…and that means that it’s a weak point that is vulnerable to injury.
There is a movement, called the “Knack Maneuver”, which involves tightening the pelvic floor muscles just before any IAP event such as a sneeze or cough. This has been found to reduce urinary leakage in susceptible women. However, the same concept can be applied to lifting weights, to provide support for the pelvic floor during the core activation and weight loading of the lift. Even if none of these health issues are a problem, it should be clear that this simply makes the core activation more effective as a bracing to provide stability during the lift.
Pre-contraction of the pelvic floor muscles, before initiating the lift, provides support to the pelvic and anal veins, and keeps the IAP from pushing your anal veins out of your anus, while also helping prevent pressure from closing off these veins-both factors that are part of how hemorrhoids happen.
I recommend exercising the pelvic floor muscles regularly, after you learn where they are. This can be done while sitting or standing, and nobody has to know you’re doing it! Exercises can start as simple contract/release cycles, and progress to “stairsteps” that involve contracting, holding, then contracting a bit harder, holding, and so forth. The number of contractions before you can’t make it any tighter is described as the number of stairs. For women with severe pelvic floor problems, there is a female physical therapist in my building, Melissa Hunt DPT, who specializes in teaching women how to rehab their pelvic floors (link below). All of us should be doing these exercises both to improve function and reduce the chances of injuries now or later.
So, when you address the bar, and take a breath while tightening your core before lifting…take a moment and remind your pelvic floor muscles to also tighten up before you initiate the lift!