Updated: May 3
In today's post, I wanted to address the topic of the core. Oftentimes, I will get really strong moms that come to me with the issue of stress urinary incontinence during exercise. These ladies are doing high-level activities at the gym like CrossFit or Barre, which I am super proud of them for, but they find that they have this issue with incontinence. It's important that we focus on training the missing link to their core - the transverse abdominus muscle - to help them perform high-level activities without peeing their pants.
So what is the missing link?
When I start training somebody on their core, we begin with the transverse abdominus muscle (TA for short). If you don’t know what this is, the TA is the deepest layer of core muscle attached to your ribs, diaphragm, pelvis, and pelvic floor muscles. I sometimes refer to this as the “corset muscle” because it helps with the visual of what this muscle looks like and its role in the core.
First, let’s use a bit of a visual. Take a balloon, for example, that is blown up to represent the TA muscle. It is placed between the diaphragm and pelvic floor (the diaphragm is an umbrella-like muscle that sits directly beneath your ribs). So from top to bottom, it is the diaphragm, TA, and pelvic floor: the TA connecting the diaphragm and pelvic floor together. These three muscles have a significant relationship and work together collectively to form this sort of “canister” during movements of the body, especially during inspiration and expiration.
Within this canister, there is a certain amount of pressure that is held within. If the TA (my balloon) gets engaged, it disperses the pressure and the pressure has to go somewhere. Depending on the individual’s mechanics and depending on how one activates their TA, that pressure is dispersed either well or not so well. For example, if you are in the gym practicing your deadlift or jumping rope, and you don’t engage your TA properly, this could result in a downward force of the pressure toward the pelvic floor leading to…you guessed it: stress urinary incontinence.
This improper downward dispersion of pressure can also occur during other activities including coughing, sneezing, running, and jumping resulting in urinary leakage. If any of these examples sound like you, check out my free ebook "6 Steps to Stop Accidental Urinary Leakage" for a free downloadable resource.
Downward pressure is not the only issue that you can experience if you do not learn to engage your TA properly. Say you have some weakness in the muscle bellies of the rectus abdominus (or your 6-pack abs), and you don’t engage the TA well, the pressure is going to find the weakest link in the tissue and disperse anteriorly potentially resulting in what’s called diastasis recti.
The key is in the details
There are a lot of little details that go into the proper engagement of the TA, but I am hoping to help set the stage and improve your confidence in activating this “key” muscle group. We want to be able to properly activate this muscle without overrecruiting the superficial abdominal muscles as well, such as the internal obliques, external obliques, and rectus abdominus. By properly engaging the TA, it will allow you to participate in higher levels of physical activity without worrying about things such as stress urinary incontinence or diastasis recti.
"High level" is different for everyone
What are higher levels of physical activity you say? Well, the obvious intense workouts including CrossFit, Bar, Pilates, etc. But sometimes “higher level” physical activity can be something as simple as lifting a car seat, especially for a new mom who recently had a baby. I have seen a lot of moms that have returned to everyday activities such as lifting a car seat, getting out of bed, stepping into/out of the shower, or going up and down stairs that need a lot of help learning to properly engage the TA. More often than not, with these women, I will see a lack of muscle endurance specifically with the TA muscle. These moms may be doing pretty well at 8 o’clock in the morning, but by the time 3, 4, or 5 o’clock in the afternoon comes the TA muscle is worn out and the result is improper pressure dispersion. What we want to do with these ladies is create appropriate muscle recruitment of the TA and use these muscles for what they are designed to be used for → stability.
The transverse abdominus muscle provides the primary stability of the core. Think about the abdominal space for a second: there is a certain amount of abdominal space that is completely “free floating.” What I mean by this is that there is a certain amount of abdominal tissue that is not encased by any type of bony structure. So with this in mind, we have to create an environment where we are able to stabilize the pelvis onto the spine. This is where the TA comes in: connecting and stabilizing the space between the pelvic floor and diaphragm so you can move, jump, and lift without compromising your lower back or other vulnerable parts of your body like the pelvic floor.
Two things I want you to take away front this post regarding the transverse abdominis are that first, it’s an “automatic” muscle and the shoulder be communicating with the brain within split seconds once we start moving. Unfortunately, this communication doesn’t quite happen right and this automatic piece gets turned off or becomes less efficient. I’ve seen this a lot with postpartum women and with individuals who have dealt with any sort of physical or emotional trauma. These stability muscles “shut off” and don’t starting working “automatically.” Today we’re going to focus on retraining the brain and TA to work together.
The second thing I want you to know about this muscle is that it is an expiratory muscle, meaning it’s connected to the breath on expiration. When you exhale, the TA muscle is engaged. There are two types of exhalation: one for example is while you are sleeping (or passive exhale) - you’re inhaling/exhaling without consciously thinking about it. As you take a breath in the diaphragm moves down and as you exhale it recoils back up to its original spot. With this type of passive exhale, there is not a lot of core muscle involvement at all. The second type of exhale is the one where we can start to train the TA and get much more core muscle involvement. We are doing what’s called an active exhale where we are forcefully pushing the air out. In order for this to happen, the TA has to be engaged. We can utilize this practice of active exhale as a movement or action to get the most engagement out of the TA.
Let's get to work
Now we are going to talk about engaging the TA appropriately. First, we want to engage the TA from the bottom up versus the top down. If you think about it, trying to engage the TA from the top down is going to result in pressure downward toward the pelvic floor and that doesn’t allow us to have reasonable control over things resulting in: incontinence. Engaging the TA from the bottom up allows for the pressure to disperse in an upward motion, allowing you to achieve really good control as you exhale.
I usually try to start my clients with a very simple TA exercise. You want to utilize the exhale you learned during the diaphragmatic breathing video to engage the TA. Remember, if you are forcefully exhaling, the TA has to be engaged. This is one way you can start to safely retrain the TA. From this kind of activity the brain starts to catch on and starts to build the motor pathways needed that allow it to kick on “automatically” with movement.
Once you master the breathwork that comes with diaphragmatic breathing, you are ready to move on to training the TA to engage from the bottom up during forceful exhalation. So let’s try it: laying flat on your back take a nice and big inhale, expanding the ribs laterally. As you exhale, visualize the air leaving from the bottom of your core moving upward and feel that “corset” cinch up or stabilize the core. Once you master this technique and feel in control of engaging the TA, you can move into a different position to also practice engaging it.
From here you can start to strengthen the TA by increasing the load placed on it with some resistance or increasing the amount of time that we hold the activation of it. We can practice holding the contraction while talking, making it a little more complex of an activity. These are all great places to start before engaging the TA with any kind of transitional movement like getting up off the floor, getting in/out of your car, rolling over in bed, etc. This can be critical especially for new moms to practice before lifting their baby, loading a car seat, or getting out of the bathtub to eliminate the risk of things like urinary incontinence, diastasis recti, hernia, or pelvic prolapse.
Working on engaging your TA from the bottom up is going to take so much pressure off of your pelvic floor and is going to make you feel more secure with transitional movements lowering your risk of peeing your pants. I hope this information is helpful and gives a good place to start if you are struggling with things like peeing your pants during exercise or everyday activities. If you’re interested in learning more about this topic or have questions, feel free to reach out to us at 502-939-8564 or request a consultation here.