Sikh Women's Health Initiative

As Punjabi and Sikh women, our health is deeply connected to our cultural practices and beliefs. Today, let’s explore the crucial yet often overlooked aspect of women’s health: pelvic floor health. This is a very important topic for every woman, especially childbirth.

In our community, talking about issues like incontinence (and especially sexual function) may feel uncomfortable or even taboo. But, it is very important for your health to talk about these topics openly, because they can affect quality of life and be managed with the right knowledge and exercises.

What is the Pelvic Floor?

The pelvic floor is a group of muscles that make a supportive layer at the base of your pelvis. These muscles support your pelvic organs, like the bladder, uterus, and bowel. So, these muscles have an important part in controlling urination (peeing), bowel movements (pooping), and sexual function.

Why is Pelvic Floor Health Important?

The pelvic floor can become weaker for multiple reasons, including childbirth, aging, heavy lifting, and even chronic constipation.

Weak pelvic floor muscles can lead to issues including:

• Urinary incontinence (leaking urine)
  • This is one of the most common issues, especially leakage when coughing, sneezing, or exercise.
• Pelvic/lower back pain or discomfort during physical activities
  • This can happen during walking, bending down, praying, etc.
• Pelvic organ prolapse
  • This happens when the pelvic organs shift downwards into the vaginal area. Women might feel a heavy or dragging sensation in the pelvis.
• Sexual dysfunction/painful intercourse (dyspareunia)
  • Tightness in the pelvic floor muscles can cause discomfort during sexual activity.
• Fecal incontinence
  • Involuntary loss of control of your bowels/pooping

This is important for the physical health and quality of life for every woman, and it is especially important for women who have given birth – pregnancy and the process of childbirth can really strain those muscles.

Menopause can also affect pelvic floor health. Also, daily physical activities, diet, and cultural factors such as the demands of caring for family, can all affect pelvic health, which is why it is so important to talk about this topic that many young women do not know about.

Pelvic Floor Exercises

Kegel Exercises for Strength

Kegel exercises are simple but very effective making your pelvic floor muscles stronger. You can do them discreetly anytime and anywhere, even while sitting at home, working, standing in a line out in public. No one will know that you are doing this!

Here’s how to do them the right way:

1. Find the right muscles: The easiest way is to stop urination in the middle of your stream. The muscles you used to do this are your pelvic floor muscles. (Note: only do this to learn which muscles to use, don’t do this regularly while urinating).
2. Contract and hold: Squeeze and hold these muscles for 5 seconds, then relax for 5 seconds.
3. Repeat: Try to do this 10-15 times, 3 times a day.

Remember, it’s just as important to learn how to relax these muscles as it is to strengthen them. These exercises may feel very hard, or even impossible, at first when you start. This is normal, and will get easier with time as your muscles get stronger. Like any other exercise, it takes regular repetitions.

Squats

Squatting exercises can help strengthen the entire pelvic area, including hips, thighs, and glutes (bottom) muscles. The key is to use your pelvic floor muscles while you squat.

1. Stand with feet shoulder-width apart.
2. Keep your back straight, slowly lower your body as if you are sitting in a chair, and then stand up.
3. Do this regularly to help your core abdominal muscles and pelvic floor.

Bridge Pose

Also known as “Setu Bandhasana” in yoga, this exercise strengthens your glutes (bottom) and pelvic floor muscles. Yoga and stretching improve your flexibility and reduce tension in the pelvic area.

1. Lie on your back with your knees bent and feet flat on the floor.
2. Lift your hips off the ground, tighten your pelvic muscles, and hold for a few seconds before lowering back down.
3. Repeat 10-15 times, up to 3 times a day.

Core and Hip Exercises:

Strengthening your core muscles (such as your abdomen) and hip muscles supports the pelvic floor. Exercises like planks, lunges, and hip abductions (moving your legs sideways away from your body) all help. For more helpful guided videos, visit these YouTube links:

Comprehensive Management

While Kegel exercises are important, pelvic floor health involves much more. Here are important practices for everyone to improve their pelvic floor, especially new mothers after childbirth.

1. Diet/digestion:
   • Stay away from foods and drinks that irritate your bladder: caffeine (tea/chaa, coffee, energy drinks), and spicy foods. These make bladder sensitivity and irritation worse!
   • Constipation can worsen pelvic floor problems by putting extra pressure on the muscles. Continue to eat a high-fiber diet (daal, sabzi/vegetables, fruits, and grains) to prevent constipation.
2. Stay hydrated:
   • Many women reduce water intake to avoid urinating very frequently, especially if they’re busy working or caring for others.
   • But, this can really irritate the bladder and cause urine leakage, and also leads to constipation.
   • Drink plenty of water!
3. Healthy toileting habits:
   • Don’t rush or strain during bowel movements – take your time.
   • Use a squatting position or a small stool under your feet to have a better position.
   • Try to avoid “just in case” peeing, which can train your bladder and muscles to think they are full too early.
4. Healthy weight:
   • Extra weight can put more pressure on your pelvic floor.
   • Maintaining a healthy weight is very important.
5. Deep breathing techniques:
   • Deep breathing helps relax your pelvic floor muscles and prevent tightness and spasms, which can cause pain and discomfort, especially in high-stress moments.
   • Practice taking deep breaths into your belly, feel your belly rise, and then let it fall.
   • This is called “diaphragmatic breathing” (your stomach moves with each breath, instead of your chest).
   • You can also practice Naam Simran, the Sikh spiritual meditation practice, to help achieve deep breathing.
6. Posture:
   • Good posture keeps your spine and pelvic in a better position and reduces strain on your pelvic floor.
   • Be mindful of your posture during your daily activities, such as sitting on the floor, standing in a line, doing paath/prayers, or while eating.
   • Sit with your feet flat on the floor and your back supported.
7. Proper lifting techniques:
   • If you have a physical job or do a lot of house work, such as lifting heavy items, carrying children or groceries, or bending on your knees, it is important to have proper technique.
   • Always bend at the knees and use your leg muscles, not your back or pelvic floor.
   • Avoid heavy lifting right after childbirth – this can increase the risk of pelvic organ prolapse.

Cultural Considerations

Open dialogue/breaking the taboo: In our community, we may feel shy discussing issues that relate to our pelvic area, like incontinence and sexual dysfunction. Let’s break the silence and support each other in seeking help when needed.

Postpartum care: During the traditional 40-day rest period after childbirth (“sava mahina”), focus on gentle pelvic floor recovery exercises and proper rest.

Modesty: You can do Kegel exercises anytime, anywhere, without anyone knowing! Focus on establishing the mind-body connection and incorporate the exercises into your daily routine, perhaps during meditation or chores.

Posture: Sitting on the floor for langar or during prayers actually helps strengthen core and pelvic floor muscles. Just remember to sit up straight! Read the section above on posture for more tips.

When to Get Professional Help

While self-care and exercise can help, sometimes professional help is needed.

Talk to your doctor or a pelvic floor physical therapist if you have keep having symptoms even after following the general advice above, or if your symptoms are badly affecting your life, such as:

• Urinary or fecal incontinence
• Pelvic pain
• Feeling of heaviness or pressure in the pelvic area
• Pain during intercourse

These specialists can make a tailored plan to help bring back strength and function in your pelvic area. These may include specific physical therapy, bladder training exercises, physical exercise and weight management help, pessaries (devices that support the pelvic organs), or surgery in severe cases.

Remember, taking care of your pelvic floor health is part of honoring your body. Don’t wait to get professional help to advocate for your personal comfort if you’re having issues. While these problems are common, you do not have to suffer in silence.