How to Tell the Difference Between a Tight and Weak Pelvic Floor with Emma Bromley: Podcast Episode #205

Kristin Revere chats with Emma Bromley of the Bromley Method about how to tell the difference between a tight and weak pelvic floor.  Emma is also the author of The Pelvic Floor: Everything You Needed To Know Sooner.

I’m so excited to chat with Emma Bromley.  She is the owner and creator of the Bromley Method.  Emma is a single mom, Pilates studio owner, diastasis expert, and co-author of The Pelvic Floor.  She helps busy moms heal from things like diastasis and leaking with simple but highly effective, strategic, core-healing workouts, both in person and with her online courses.  Welcome, Emma!  I’m so happy to have you here!

Thank you, and thank you for that great introduction!

I am very excited to chat about the pelvic floor.

It’s one of my favorite subjects!

Doula clients and listeners are often confused about the difference between Kegels and preparing in pregnancy and recovery in the postnatal time about what they can and cannot do with the pelvic floor, and what is normal and what is something to chat with your provider about and seek a pelvic floor therapist or physical therapist.  Let’s get into it!

So the first thing to note is that I’m not a huge fan of traditional Kegels in the traditional sense of the word, and the reason for that is – well, I don’t know if it’s a case of broken telephone that’s happened over time.  I don’t know how they were initially intended to be taught.  But what’s happened over time is that many women thinks it’s squeezing of their pelvic floor.  And what happens when you, over time, squeeze and squeeze with the pelvic floor is it can become very tight.  Tightness and weakness, first of all, go hand in hand.  They’re like best buds.  But secondly, tightness brings on a whole other set of symptoms and issue than a weak pelvic floor.  So what you’ve essentially done is you’ve got your weak pelvic floor, and you’ve done your Kegels and you’ve done squeeze squeeze, and now you’ve got a tight pelvic floor and you’ve got a whole other set of issues on top of that.

A common misconception is that a tight pelvic floor is a strong one, that tightness equals strength, and it doesn’t.  It’s actually completely the opposite.  A tight pelvic floor is actually a weak pelvic floor.  It’s not tightness we’re looking for with the pelvic floor; it’s strength.  So basically, in a nutshell, a tight muscle equals a weak muscle, and a weak muscle can’t do its job properly.  What we’re actually looking for is a strong muscle that can both fully contract and fully release, and that is essentially what many people’s idea of Kegels are.  We aren’t getting that full release as well as the full contraction.

That makes perfect sense.  As a birth doula, it’s all about relaxing.  If my client is tight and tense in any way – and sometimes athletes tend to have a hard time relaxing and releasing, so they might have a really tight pelvic floor.  To get them to open up in labor can be challenging.

I feel like I should say that I’m not a physical therapist.  I’m not a licensed physical therapist.  I never claim to be.  This kind of conversation is well known in the physical therapy community.  It’s not well known in the fitness community or the general public.  And my passion is to help to change that in the fitness community for that understanding that squeezing and tightening actually isn’t what we’re looking for.  There are telltale signs.  When I work with somebody in a private capacity, I usually ask them a bunch of questions in the beginning.  There are certain symptoms that go along with a weak pelvic floor and there are other symptoms that go along with a tight pelvic floor.  It’s very difficult to strengthen a muscle that is in a constant state of tension.  So it’s important for me to know if somebody’s got a tight pelvic floor before I start helping them try to strengthen their pelvic floor because if they’re very tight, we need to work on releasing before we can start to strengthen.  Probably the most common telltale sign is urge incontinence, and I’ll talk about the difference between urge incontinence and stress incontinence.  But urge incontinence is when you’re absolutely all of a sudden desperate for a pee and you’re kind of hopping up and down and you don’t know if you’re going to make it on time.  That is a very, very common sign of a tight pelvic floor.  If somebody is experiencing that, then I know we need to start working on release techniques first before we can strengthen.

The other really common one is painful penetration.  Penetration is not supposed to be painful, and sometimes people think, oh, well, I’ve had a baby, so that’s why it’s painful.  No.  It’s usually painful because the pelvic floor is too tight.  So I’ll use various different techniques to help them try to release their pelvic floor, and if I’m working with someone in a private capacity, I usually do that at the beginning of our first session.  I’ll do it at the beginning of maybe our first few sessions to try to help them get that release first before we can start to strengthen.

A weak pelvic floor often goes hand in hand with stress incontinence, which is more like if you’re jumping on a trampoline or you sneeze and you leak a little bit.  They’re two very different types of incontinence, both very related to the pelvic floor, but for slightly different reasons.

That makes sense.  Typically, the second is what women assume they’re going to have to live with after having a child or children.  It’s the idea that you can’t dance without leaking or sneeze, whatever it might be.

The crazy thing about that is that a weak pelvic floor actually has a very easy fix, and so many of us have just been led to believe, because it happens to all of our friends, we just think, oh, well, I’m a mom now.  It’s normal.  And it’s not.  It’s common, but it’s not normal, and it’s not supposed to be that way.

Exactly.  There’s so much education that’s needed.  But I feel like a lot has changed in the ten years that I’ve been a doula.  Providers are now talking in that postnatal visit, the six week appointment, about pelvic floor physical therapy and what is normal and what isn’t.  I feel like we’ve come a long way.  But there are still a lot of misconceptions out there related to, as you said, intimacy in the postpartum phase.  It’s not supposed to hurt.  You don’t have to leak.  You don’t have to be uncomfortable.  That urge is also not normal.

Right.  I think typically in the fitness industry, we’re told to go to our six week postpartum check, and the doctor says, right, you’re cleared for working out.  And what happens is, not knowing any better, we all go back to our regular routine of whatever workouts we were doing pre-birth, not realizing that actually the pelvic floor needs a bit of a rehab period before we can start doing those things again.  I’m a Pilates instructor, so particularly in the Pilates world, what happens is people are desperate to get back to their Pilates Reformers classes, and they go into their Pilates Reformer class.  They’re cleared at six weeks.  They go straight back into all of the things they were doing before.  They’re doing the 100s and the crunches and the sit-ups and their series of five, and they’re like, yes.  But what happens is those exercises – a lot of people don’t realize this, but those exercises are actually quite advanced core exercises.  And when you go straight back into doing advanced core exercises with a weak pelvic floor – I usually use the analogy of building a house on sand.  You’re basically asking for trouble.

That makes perfect sense.  I know that you work with women not only throughout pregnancy, but in the recovery time and have specific programs and exercises just for them during the recovery so they’re not going straight back to their old workouts, whether it’s Pilates or any sort of workout; whether they want to get back to running or swimming, whatever their sport is.

Right.  Here’s the other thing that happens with running.  When you go right back into running with a weak pelvic floor, it bounces.  It really bounces up and down.  And when there’s not much stability in the pelvic floor and it’s really bouncing, what can happen is – a lot of people will say, oh, I went back to running, but it feels like my vagina might fall out.  That’s actually a sign of a prolapse.  A prolapse can happen when the pelvic floor is not strong enough to hold up the internal organs and it all starts to kind of collapse a little bit inside.  And that’s another thing that – then people get disheartened and they say, oh, do you know what, I’m just not going to run anymore.  It just doesn’t feel good.  Not realizing that actually, if you strengthen your pelvic floor, it doesn’t feel like that anymore.

Right.  So starting out with a program to ready your body for physical activity is the first step versus going right back into your exercise program from pre-pregnancy.

Exactly.  And to be honest with you, I work with women who maybe they’re 20 years postpartum.  Maybe we’ve been working together for several years.  And I still don’t teach them the 100s.  I still don’t teach them the series of five.  I’ve got all the Pilates equipment, but I essentially now – because I believe that these low pressure essentially physical therapy ab exercises are so much more effective for anyone who’s ever had any kind of pelvic floor dysfunction, I continue teaching those exercises.  So I’m basically the Pilates instructor who teaches anti-Pilates because I’ve tossed out all of the traditional Pilates core exercises from my repertoire and essentially replaced it with variations of physical therapy core exercises because I find it to be so much more effective.  You can have great abs with those ab exercises.  Here’s the other misconception: a lot of people think, oh, if it’s not burning, if it doesn’t feel really hard, then it’s not doing anything, which actually isn’t true.

That makes sense.  And so you don’t feel like you’re getting a good workout unless you’re really hurting.

Right.  I was explaining this to someone the other day, and here’s the difference.  Any time you lift your head up from the ground – let’s say you’re doing the 100.  You’re doing the series of five.  You’re doing crunches or you’re doing sit-ups.  You’re using your rectus abdominals, your six pack abs.  What I teach with what I call low pressure abdominal exercises is we use more of the transverse abdominals.  And the transverse abdominals, those are the ones that wrap around your waist like a corset.  And I always use this analogy of tying your shoelaces tight.  If you want to tighten your waist, get rid of your bulging tummy, all of those things, the best way to do it is to work your transverse abdominals because it pulls your shoelaces tight.  It tightens your waist.  Whereas your six pack abs, your rectus abdominals, they don’t tighten your waist.

That makes sense.  So tell us about the Bromley method specifically.

Specifically, the Bromley method is essentially Pilates but with all of the core exercises taken out.  That’s essentially what the method is.  And I’m super passionate about it because when you take out all of those super advanced core exercises – those are the ones that tend to give people low back issues.  You’ll hear people say, oh, my doctor told me to go and do Pilates, so I’ve been doing Pilates classes, but then they keep throwing their back out.  And they keep throwing their back out because the core exercise are too advanced for their core in particular.  And what’s more effective is strengthening the pelvic floor, learning how to activate the transverse abdominals, strengthening the obliques.  So essentially I toss out all of those exercises and really, like, I could have been working with somebody for seven years, and I’m still not doing the 100s with them because – why?  What’s the purpose of it if you can get results elsewhere without them throwing their back out?

And you work with your clients in studio.  You of course have an online program.

I have a studio, as you can see in the back here.  I teach one to one only in the studio.  I don’t teach any group classes, and the reason for that is because people call me nitpicky, which I’m actually very proud of.  When somebody says, wow, you’re so nitpicky, I take it as a compliment.   To pull the exercises apart and pull it back together – we slow it down.  We’re not using momentum.  We’re not doing things really quickly.  Partly, it’s mind body connection as well.  A lot of people are so disconnected, their mind from their body, and a lot of times, what we feel like we’re doing in our body is not how it looks like to an onlooker.  And that’s what I look to change when I teach somebody privately.  Let’s reconnect those mind-body connections, and let’s actually really connect with your body because it translates into life.  It translates into – let’s say you’re on a plane, and you’re lifting a suitcase down.  Being aware of how you’re moving your body so that you’re not throwing your back out all the time.  So yeah, I teach privately in here, but I also teach privates on Zoom and on Facetime.  I have a six-week program, essentially, where they can go through and learn all of my techniques.  Some of those people have been doing it for several years.  They just keep going around the six-week program.  Some of them will occasionally check in with me and do a one-off private with me.  Maybe they’ve got a bunch of questions.  Maybe they want to do a trouble shooting session or whatever.  I also have a live program where I teach twice a week, and I just basically open up my Zoom room, and if they’re enrolled in the live program, they can come and join my own workout in the studio.

So many options.  And you can have clients all over the world that way, so it’s lovely.

Yeah, it’s great.  I love it.

You’re a co-author, as well, so tell us about your book.

Yes, I co-authored.  There were ten of us.  It was released in May of 2022.  It’s called The Pelvic Floor, and we basically are a bunch of pelvic floor experts from different fields.  So we’ve got a birthing coach.  We’ve got a doula.  We’ve got a physical therapist.  We’ve got myself, a Pilates instructor.  So we’ve got people from all different walks of life who consider it their specialty to be in the pelvic floor.  It’s super, super interesting because everybody’s written essentially a main chapter, and then we’ve all kind of chimed in on different topics.  It’s essentially a pelvic floor 101.  It’s a pelvic floor Bible, essentially.

I love it.  Where can our listeners find the book, outside of Amazon?

Yeah, they can find it on Amazon by searching for The Pelvic Floor Emma Bromley.

And you do have an excellent, comprehensive website with all of your different programs.  I know you’re also very active on social media.

Instagram is my happy place.  That’s where I like to essentially disrupt the Pilates community.  I like to think of myself as a disruptor.

We need more disruptors, for sure.  What other tips do you have for our listeners, Emma?

I think honestly my main tip is listen to your body.  Listen to your body because I think so many of us have become disconnected.  Listen to your body.  Listen to the symptoms.  Those symptoms are essentially warning signs from your body.  Your body is telling you something.  None of these are things that we just have to tolerate as moms.  Whether it’s diastasis, whether it’s prolapse, whether it’s leaking, whether it’s urge incontinence – whatever it is, those things are warning signs.  And it’s super important to address those warning signs.  I said this the other day on Instagram: if you want different for yourself, you have to move different.  And I think so many of us just follow along with what all our friends are doing or what we were doing pre-pregnancy.  And if it’s not working for you, do something different.

Yes.  Any advice for listeners who have had tearing and they’re trying to heal from that as far as wanting to work out and how to really deal with some issues with painful tearing and trying to even prep their body for baby number two or three after experiencing some tearing?

Yeah.  I think with tearing, I’m not a huge expert on tearing, but I think go easy on your body.  I think so many of us want to rush back into the workouts.  I was messaging with somebody the other day who was feeling frustrated with her body because she was four months postpartum and she wasn’t happy with the way her belly looked.  And I was like, four months postpartum is really early.

It is.

It’s really early to be feeling frustrated with your body.

There’s so much pressure.

Yeah.  Obviously, there’s tons of things that you could be doing, but don’t rush it.  There’s no rush.

And for prepping your body for future babies?

A question I get asked a lot is: I’m planning on having another baby.  Shouldn’t I just wait until after I’m done having babies to begin working on my pelvic floor?  And my answer is always definitely not because a stitch in time saves nine.  It’s wild to me that people would think, oh, I’ll just wait until afterwards because these issues get worse with each pregnancy, right?  And we can do so much work on fixing these symptoms before we go into another pregnancy, and then you’re essentially starting with a fresh slate again.  It’s a no brainer.  Definitely work on your pelvic floor; rehab your core.  That’s not to say put off having another baby.  I’m just saying, don’t put off your pelvic floor rehab until after you’re done having kids.  Do it now.

Exactly, and that can impact your length of labor, your labor experience. 

The other great thing is that a strong pelvic floor actually typically makes for a smoother and less complicated delivery.  It’s very often particularly a tight pelvic floor that can make delivery more complicated.  Again, I’m not an expert in delivery.  That’s a conversation for somebody else.  But like I said at the beginning, a strong pelvic floor, a strong muscle, is one that can both fully contract and fully release.  Right?  So a strong pelvic floor has that ability to get a really good release.

That’s very helpful.  As far as pregnancy, any tips in preparation during pregnancy that would be helpful?

Strengthen your pelvic floor.  Strengthen your pelvic floor during pregnancy.

Obviously, join your program.

Strengthen your pelvic floor.  So my program is a specific postpartum program.  It’s not tailored towards specifically people who are pregnant.  However, I’ve had so many women go through the program and then get pregnant with another child and say which of these sequences can I do during pregnancy that I ended up pulling out all of the sequences that can be safely done during pregnancy and that are also super helpful to do during pregnancy, and I’ve put a prenatal workout library together.  Basically, if you go through the program and get pregnant again, here are all the workouts that you can do during pregnancy and are super helpful.  So yeah, I’ve had this conversation a lot with people who are pregnant who literally think that because we don’t do crunches during pregnancy, they take that to mean don’t train your core during pregnancy.  Your rectus abdominals are just one part of your core, and so that’s the important thing to note during pregnancy.  We don’t train the rectus abdominals during pregnancy because the rectus abdominals are the abdominals that get affected when we have diastasis because they move apart during pregnancy.  It’s a natural part of pregnancy that they should move apart to make space for baby.  What we do want to be doing during pregnancy, however, number one, strengthening the pelvic floor.  Number two, strengthening the transverse abdominals, which are your corset abs and give a huge amount of support for baby.  And number three, strengthening the obliques, your side abs.  So four different parts of your core, but a lot of people have this misconception that if they’re not doing crunches, that they shouldn’t be doing any core work at all, which is not true.

Excellent advice.  Well, thank you for sharing all of your wisdom and resources!  I will definitely chat with you in the future.  We have so many topics we could discuss.

Definitely, yeah.  I could talk all day about the pelvic floor.  I eat, sleep, and dream it.

We definitely need more education, so thanks for the important work you’re doing, Emma!

IMPORTANT LINKS:

Emma Bromley and the Bromley Method

The Pelvic Floor book

Becoming A Mother – a course from Gold Coast Doulas for all things pregnancy

Freebies from Emma: Pelvic Floor 101 , Too Tight