Hypopressive exercises in women with pelvic floor dysfunction and postnatal concerns

We have discussed what the benefits of hypopressive exercises are in the last article,  (Safely building your core: Hypopressives vs. traditional abdominal exercises), and how they differ from standard abdominal and core exercises. They can be especially therapeutic in a woman who suffers from pelvic floor dysfunction such as a prolapse, heaviness in the pelvis, pain with intercourse, incontinence or a diastasis recti.

Organs in the pelvic bowl for women include the bladder, the uterus and the rectum. The urethra is the exit pathway for the bladder and the vagina is the receptacle for sperm and the exit pathway from the uterus in childbirth. Too much pressure in the abdominal cavity can affect the organs as well as these pathway structures. We used to think that the organs of the pelvis “fell out” as a result of weakness in the pelvic floor muscles. The simple answer to this problem was to do a great number of Kegel exercises specifically for these weak pelvic floor muscles. The reality is that, for many women, these not only didn’t work to solve their problems, but in many cases, made them worse or made no change in their symptoms at all. What we now know is that the pelvic organs don’t “fall out”, but they are actually pushed out, by increased intra-abdominal pressure.
Standard “core” or abdominal exercises like crunches and sit ups increase the intra-abdominal pressure, effectively pushing the pelvic organs down or out. There will probably be some degree of weakness in the vaginal wall in the case of chronic constipation or vaginal deliveries. This loss of integrity of the vagina can allow for the alternating pressures in the bladder, rectum and uterus to cause a prolapse or hanging of vaginal tissue in or outside the vagina. Studies show that the greater number of vaginal deliveries there are, the more likely there will be symptoms of incontinence and organ prolapse. This is not all bad news if you are contemplating getting pregnant again because there is treatment.

Hypopressive exercise for increasing pelvic floor and core stability

Hypopressive exercise for increasing pelvic floor and core stability

Hypopressive exercises have been taught to post partum women and those with incontinence and organ prolapse in Europe, Mexico and Australia for more than 30 years with great success and with some compelling research compiled. Some of the things they found include an increase in base tone of the pelvic floor in 23% of older women with urinary incontinence in a hypopressive exercise group. In the cases where there were symptoms, an 87% decrease in those symptoms was found.3   Tamar Rial, a certified hypopressive practioner in Spain, has demonstrated a 25-50% (and at times even greater) increase in the strength of the pelvic floor muscles when hypopressive exercises were performed along with a Kegel as measured with biofeedback. Her testing can be seen on YouTube.

Hypopressive exercise for increasing pelvic floor and core stability

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These exercises are very effective for prolapsing tissues and organs. It is easy to feel the lift of the vaginal vault and pelvic organs with fingers inserted into the vagina while performing a hypopressive exercise once the exercise is performed adequately, With repetition of the exercises, changes in symptoms can be felt and seen in as quickly as 8 weeks. I have treated women who measure a grade 2 or 3 prolapse before starting the program and they resolve to a grade 1 or complete resolution with the program we use here at Hands On Therapy-Austin.

Pelvic pain and pain with intercourse may be more related to neurological involvement of the pudental nerve which can certainly be affected by abnormal tone in the pelvic floor or pressure from above the nerve pathway as that pathway courses along the wall of the pelvis. The appropriate exercises can help change the tone and pressure. An examination from a trained physical therapist is necessary to separate out the tone issues from the weakness and pressure issues and then apply the exercises and manual therapy treatment as needed.
In post natal events, hypopressive exercises can be applied as soon as 3-6 weeks post delivery depending on when the post delivery bleeding stops (there are varying studies on when the exercises can be applied). One of the goals here is to decrease the width of a diastasis recti, when it exists, which is a separation in the 2 halves of the rectus abdominus muscle in the center of the abdomen running from the rib cage to the pubic bone. Another goal is to increase core strength to protect the new mom, whose body is still somewhat compromised by the delivery process and hormones, while lifting and carrying her baby. It is a much gentler way to rehab all of the parts of the delivery anatomy pretty quickly without undue stress.
There are activities to avoid in the case of any of the symptoms of incontinence, pelvic heaviness or the feeling of organs or tissue “falling out”. Some of these precautions include jogging, high impact exercise, heavy weight lifting and abdominal exercises like crunches, sit ups or any others that encourage bulging of the belly muscles. With appropriate treatment and rehab, you may be able to return to some of these exercise modes if that is your personal goal. You may also decide that there is be no need or desire to go back to some of the more aggressive forms of exercise.
Although these exercises have great potential to help with the intra-abdominal pressure issues that are very common in all women, we must not assume that exercise alone is the answer. Once the kinds of symptoms described above present themselves, an examination by a skilled therapist is in order. At Hands On-Austin, we combine manual therapy for reducing tone or facilitating better contractions, which ultimately make the exercises more successful. We also help you determine when it is appropriate to start an exercise program. Sometimes starting an exercise program when the muscle tone is not balanced can lead to a worsening of sypmtoms.

Katrina Barton, PT
“Hypopresives Techniques”. Retrieved 4 October 2012.
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a b “metodo hipopresivo”. Retrieved 4 October 2012.
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a b c d e “Hypopresives techniquies: About”. Retrieved 4 October 2012.
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a b Resende, AP; Stüpp, L; Bernardes, BT; Oliveira, E; Castro, RA; Girão, MJ; Sartori, MG (January 2012). “Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse?”. Neurourology and urodynamics 31 (1): 121–5. doi:10.1002/nau.21149. PMID 22038880.
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^ Stüpp, L; Resende, AP; Petricelli, CD; Nakamura, MU; Alexandre, SM; Zanetti, MR (November 2011). “Pelvic floor muscle and transversus abdominis activation in abdominal hypopressive technique through surface electromyography.”. Neurourology and urodynamics 30 (8): 1518–21. doi:10.1002/nau.21151. PMID 21826719.
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^ Caufriez, M; Fernández-Domínguez, JC; Brynhildsvoll, N (Nov–Dec 2011). “[Preliminary study on the action of hypopressive gymnastics in the treatment of idiopathic scoliosis].”. Enfermeria clinica 21 (6): 354–8. doi:10.1016/j.enfcli.2011.06.003. PMID 22019528.
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^ Bernardes, Bruno Teixeira; Resende, Ana Paula Magalhães; Stüpp, Liliana; Oliveira, Emerson; Castro, Rodrigo Aquino; Jármy di Bella, Zsuzsanna Ilona Katalin; Girão, Manoel João Batista Castello; Sartori, Marair Gracio Ferreira (1 January 2012). “Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial”. Sao Paulo Medical Journal 130 (1): 5–9. doi:10.1590/S1516-31802012000100002. Cite uses deprecated parameter |coauthors= (help)

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