Dr. Brianne Grogran prolapse expert wrote this guest post for Running on Balance readers. Check out the full bio of Dr. Brianne Grogan prolapse expert at the end of the post.

Kerry — yoga teacher, competitive soccer player, and mother of three — was a top-notch athlete; truly, you could bounce a quarter off her abs. She was also unaware that her workouts were slowly damaging her pelvic floor, and was shocked when she experienced COMPLETE pelvic organ prolapse during one of her daily ab blast routines. As Kerry says, “Nobody ever truly explained to me that if you do not do your pelvic floor exercises, your organs can fall out of your body. And that’s something I would have listened to!”

Kerry’s story is not unlike other women I hear from on a daily basis: healthy, fit women who are dumbfounded, scared, and angry when their bodies fail them, seemingly out of the blue. Kerry’s prolapse was rooted in the fact that she had never learned the importance of activating her pelvic floor while training. Her upper abs were super strong, but her pelvic floor couldn’t handle the pressure that was repeatedly forced down and out during intense core workouts.

It’s time to make women’s health education a priority.

After these women learn basic core and pelvic floor safety tips, I always hear the same thing: “If only I would have known this sooner. Why aren’t we taught this in school? Or at least from our OB/GYN?!”

I work in the field of women’s health and fitness, and it is my passion and personal mission to make pelvic health awareness (and pelvic floor safety) MORE of a hot-button issue. The topic might sound dry, or maybe even off-putting, but it is so important. Protect yourself NOW for a leak-free future with all of your organs in place!

Three Core-Safe Essentials

Here are some core and pelvic health basics to consider, whether you’re an athlete, a yoga enthusiast, a teen, a mother, or a grandmother… In other words, it’s never too early (or too late) to get started.

1) Your core is more than just your abs.

Many people think of a strong core as washboard abs, but it should be thought of as an entire “unit” consisting of your pelvic floor, the deep abdominal and back muscles that surround your trunk, and your breathing diaphragm. Your hip and gluteal muscles can also be considered part of your core. When you increase awareness of your deep core unit (including your pelvic floor) it becomes easier to flatten and tone your stomach, you’ll be able to lift and move things safely, and you’ll get a better workout each and every time you exercise. The icing on the cake is improved bladder control and increased satisfaction in the bedroom!

2) Start at the bottom and work your way up.

The pelvic floor is an integral part of your core unit; think of it as the “floor” of your core. Your pelvic floor muscles sit at the base of your pelvis like a hammock for your bladder, uterus, and bowels. When working correctly, your pelvic floor will relax and release to allow you to poop, pee, deliver babies, and have comfortable sex. On the flip side, it turns “extra on” when you have a full bladder, when you need to hold in gas, or when you’re laughing hysterically and don’t want to wet yourself.

It’s important to turn your pelvic floor “extra on” during isolated core training (i.e. ab workouts or anything that requires focused core control such as weightlifting). But here’s the key…When working your core, don’t just “suck in” your abs;  rather, engage your core starting at the pelvic floor in order to avoid the issues Kerry (above) had. The pelvic floor is your linchpin! Gently engage your core muscles from the bottom up for increased stability and control.

Try it:

Imagine you’re zipping up a pair of high-waisted jeans. Fasten the zipper at the bottom by gently engaging your pelvic floor muscles (think of holding in urine, or stopping gas). Next, pull the imaginary zipper upward as you gently draw your deep abdominals in and up. When fully “zipped,” you’ll be standing tall with your head over your hips over your heels. Check to be sure that you’re not thrusting your ribs forward. If you are, think of fastening the top button on your high waisted jeans.

You don’t need to be “zipped up” all day long. Relax and release when you’re done with your isolated core strengthening exercises, or after lifting a load or pushing/pulling/moving things.

3) Exhale with exertion.

Life requires lifting: kids, pets, groceries…Not to mention weights when you’re at the gym. Lifting increases in intra-abdominal pressure, which pushes your internal organs downward and outward. Repetitive lifting with improper breathing mechanics can result in a stubborn tummy pooch (often due to a condition called diastasis recti), bladder leakage, or pelvic organ prolapse.

The solution is simple. As you lift ANYTHING — including yourself against gravity (i.e. standing up from a squat) — EXHALE ON EXERTION! This breathing pattern is essential for managing intra-abdominal pressure. When you exhale, your breathing diaphragm rises, the pressure in your abdomen decreases, your pelvic floor naturally lifts, and your deep abs engage. Do it right now and see. As you exhale you should feel an automatic tensioning (activation) of your inner core muscles. Isn’t it fantastic how everything works together? It might take some retraining, but it’s well worth the effort. Practice “exhaling on exertion” (NEVER hold your breath!), and in time it will become automatic.

This is a great start!

These “core essentials” are a great place to start developing pelvic floor and core awareness. Always keep in mind that the entire core unit works together, and that managing pressure is key when it comes to keeping your workouts (and daily life in general) safe for your back, abs, and pelvic floor. Watch my toothpaste tube example for more details and an image you’ll never forget!

To learn more about gradually strengthening your pelvic floor, gaining awareness of the deep core muscles, and learning basic lifestyle techniques that will help prevent prolapse (or keep it from getting worse), Dr. Brianne Grogan prolapse expert offers a FREE “Lift” pelvic organ support series. 

With over three million views on YouTube and a 5-star reviewed book, Dr. Brianne Grogan, PT, DPT is a respected voice in the field of women’s health and wellness. She describes her YouTube channel as “the home of core + pelvic floor friendly fitness,” and is loved by her viewers for her down-to-earth, compassionate approach.