So many women have been told to “do your Kegels.” They may do hundreds each day with no results. Talk about frustration! What they need to recognize is the importance and key role of their transversus abdominus (TA) muscle in relieving symptoms of pelvic floor dysfunction (including both prolapse and incontinence). This isn’t so much the fault of the women receiving the message but, rather, the fault of the health care provider giving this incomplete instruction.

Activating your TA muscle is a step beyond a simple Kegel, and will actually lift your pelvic floor. It will draw the muscles and the connective tissue of your entire pelvis to a higher, tighter position. To give you a clear visual of your TA muscle, you can simply place your hands on your hips, then slide your hands forward until your fingers touch. Your fingers from your thumbs down to your pinkies are the fibers of your TA muscle. They enclose the front of your pelvic cavity and encircle the soft tissue within your pelvis, attaching to the fascia of your spine in back. In order to engage or activate your TA muscle, you can focus on drawing your belly button “up and in.”

Engaging the co-contraction of your TA muscle and your pelvic floor muscles is the deepest contraction that offers stability to you lower lumbar spine, hips, and pelvis. Get to know these muscles. They are the root of your core! Stopping short and only contracting your pelvic floor leaves your spine, hips, and pelvis very vulnerable to dysfunction. We see evidence of this in the frustration so many women experience with “doing their Kegels.”

Learning the coordinated effort of the TA and pelvic floor is such an important lesson that we have made that the focus within the Hab It: Pelvic Floor DVD. The two 2-step Kegel contraction taught on our DVD will begin to re-train your body how to activate your deepest core muscles, setting you down the path to improved symptoms of pelvic floor dysfunction.

Published by Tasha

29 Comments

  1. Dear Tasha: thank you for sharing with us such life changing, life empowering information. I live in the middle east and recently ordered your dvd — I can’t wait until it arrives! I have a question to which I can’t seem to find the answer: is “once a prolapse, always a prolapse”? My OB diagnosed me with a mild cystocele at my 10 day postpartum check up. (I was flat on my back when she checked me and I have heard that this makes a difference on the actual diagnosis.) I realize that the severity of a prolapse can be reduced through proper exercise and care, but is it impossible for it to ever truly “disappear”? I would like to have more children in the future, God willing, but I dread continuous descent of my organs! 🙂 Thank you.

    Reply
  2. Hello again — I think I found part of the answer in your post “Do Our Bodies Have a Chance to Remodel?” Your wrote: “One of these benefits may be reversing or controlling the symptoms of prolapse[…]”

    And the actual prolapse? Getting rid of any symptoms is good enough; there is just something a bit disconcerting about knowing that you have a prolapse and that subsequent deliveries may worsen it!

    Here’s to health. 🙂

    Reply
  3. Dear Tasha, I am so grateful to have found a site that offers
    pragmatic advice as well as emotional support. I have purchased your DVD and it is wonderful. I have a uterine prolapse that has left me with an upper uterus that is no longer intact(my doctor compared it to a sock that is falling down from the inside) and the exercises you suggest give me a strong sense of being in control rather than allowing the prolapse to control me. However, I would greatly appreciate some clarification concerning one of the exercises on the video. I have been warned by some sites never to do a wide squat as it puts too much pressure on the pelvic floor. How does the samurai squat impact the prolapse? Oh, and Sorry if my info was on the graphic side, but sometimes I wonder if a uterine prolapse is more stubborn to treat.
    Thank you so much.

    Reply
  4. AJ,
    You have found the right answer. Once you have a prolapse, it can be assumed that there has been some level of damage to the connective tissue of your pelvic floor. Muscles that are simply stretched can recover quite quickly with appropriate exercises, however, fascial defects or tears of connective tissue, including muscle, will leave your pelvic support system forever changed.

    This is the reality, but don’t be overly discouraged as this happens throughout our lives as we injure a shoulder, knee, or back. Once we have torn ligaments, cartilage, discs, etc. that particular joint will forever be changed and we have to become aware of exercise and posture and sometimes activity modification to protect that joint. Our pelvic floor is no different…we have to perform the correct exercises to support it and hold the correct posture to protect it, allowing us to return to our prior level of activity with an increased awareness of our body!

    You can do it! Read more of my blog and then move forward without fear into further pregnancies.

    Keep us informed of your progress as you move forward!

    -Tasha

    Reply
  5. I encourage everyone to use this method for doing kegals, and am dismayed that few medical practitioners are even aware of it, much less recommending it. Women are left doing dozens of kegels each day and actually causing potential harm. This two step approach is muh less time consuming and much more effective, training all those important muscles to work together to strengthen and protect the pelvic floor. Thank you, Tasha, for making this information available to us!

    Reply
  6. Hi Tasha! I am having trouble locating my TA muscles. I know the plank and leg lift exercises on the DVD are using the TA, but I am not sure about when I am standing, sitting, or just doing daily activity. I read the “Tupler technique” book which focuses on holding in the TA at all times, but all I can gather is that you should suck in your belly, which I know is incorrect. Are there ways to know that I am activating the TAs versus just sucking in?
    Thanks! Emily

    Reply
  7. Tasha –

    I am not sure if this is the right place to ask this, but you mentioned how we can return to our previous levels of activity while being aware of our bodies and what theyre doing. My questions relates to running.

    I’ve been running a long time and I dont want to give it up, my doctors actually said running would not make the prolapse (mild uterine prolapse) worse, just might make my symptoms more pronounced. How do you feel about this? Will learning how to contract the muscles while I run help me be more comfortable or is running just a big no no?

    I know theres probably bigger things to be concerned about but running is such a big part of my life that I hate to sacrifice it.

    Thanks

    Reply
  8. I’m glad the other Emily mentioned the plank exercise…I’ve been meaning to write in and ask if there’s a modification you could recommend for those of us with wrist problems who find the hands/knees position to be painful.

    Reply
  9. Emily,
    Technically, the “sucking in” maneuver is using your TA as long as you can still breathe. The TA muscle is cinching up your midsection below your ribs. You can hold this muscle in while still breathing because it doesn’t compromise your rib expansion, but it does limit your belly breathing.

    I like to coach you to pull your belly button “up and in”. This ensures the coordination of your pelvic floor along with your TA – and remember the combination of these muscles are the root of your core. Along with your multifidi, they are the deepest stabilizers of our body.

    I do caution you to recognize when you are bearing down. This means that you have recruited your Rectus Abdominus or RA vs. your TA. To give you another way to think about it…if someone were to threaten to punch you in the stomach, you would tighten up your RA. This tightens up your midsection, but it also bears down on your pelvic floor. On the other hand, if you were to wear a slim fitting dress, you would work to hold your belly in throughout the evening and hold good posture. This is using your TA. It is cinching up your midsection, drawing it up and in to a tighter position around your pelvis and spine, all while holding good extension of your spine…this means you don’t move your ribs closer to your pelvis.

    Does this help?

    Reply
  10. To answer the question on alternative to the plank position for TA strengthening. If your wrists bother you in the Hands and Knees position, you can bend your elbows and weight bear on your elbows on the first stair or a couple of stacked pillows. This should take care of your wrist pain and still allow you to pull your belly up against gravity.

    As you progress to plank position, you can again post on your elbows and knees or toes to relieve any wrist pressure.

    Tasha

    Reply
  11. Joanne,
    If you love running as much as I do, then you will work your way back to it! Being mindful of our bodies is important as we work our way back to our goals. I believe most of you have read through my personal story and I will re-state what I have said for the past 3 years…my symptoms are the best ever right at the peak of my triathlon season. Just as I am running longer, more intense, along with biking and swimming, my symptoms are really gone. This is an example of my body strengthening according to the stresses I place upon it.

    As I have gotten older, I am more aware of cycling on and off these high intensity training periods to allow our bodies some recovery. I finish my triathlon season and take some time for lower load workouts before coming back into a base building phase again. I am also aware of particular time (for me its when I am ovulating) where I just don’t feel good running and I don’t. I go non-impact at these times and come back to running when I feel better.

    So, do I think your symptoms will worsen? No, I actually think they will improve as your body strengthens to adapt to your activity level. That being said you need to do all the base building and strengthening and posture work to lead you to this training level.

    I have submitted some running blogs on our Hab It site so take a look at those and feel free to ask questions as you move forward.

    Tasha

    Reply
  12. Anne,
    The samauri squat is one of my favorites because it engages so many of the muscles that support our pelvic floor muscles. In that simple squat we engage our inner thighs (adductors), our hip external rotators, and our glutes. Plus at the top, drawing your TA in and squeezing tight along with your pelvic floor is a bonus.

    If you think about the samauri squat, you actually work your pelvic floor from its most lengthened, stretched position – at the base of your squat with good lift of your tailbone) and we are tightening, recruiting maximal muscle fibers as we return from our squat until we reach the point where our pelvic floor is at its shortest point. There are few exercises that I have come up with that work your pelvic floor, firing muscle fibers from their lengthened position, through their shortest position.

    Keep on squatting! If you have any trouble understanding my lingo above, please ask, because I want you to understand the benefit of this simple exercise.

    tasha

    Reply
  13. Dear Tasha, Thanks for your reply. I’m so pleased that I can continue doing squats and know that I’m helping not hurting my prolapse. Whenever you write about the pelvic floor needing to be challenged (in a sensible way) in order to adapt and grow stronger I feel motivated to continue exercising. I hope you release another video with more exercises as I will gladly purchase it. Thanks again.

    Reply
  14. I have been doing your DVD for several weeks now and feel much better about the prolapse and my health. It seems to me that my TA is much firmer but my abdomen protrudes more, is that normal?
    I still need to lose a little fat in that area so maybe it makes the fat more noticable. What is your opinion? Thanks for all your help.

    Reply
  15. Carole,
    There are so many times that I really wish I could be standing in a room with so many of you and watch your execution of each exercise and make minor adjustments to your posture. BUT, the challenge for us is to figure this out and make minor adjustments via email or this blog.

    So, to answer your question, I would not expect your belly to protrude more. Let’s go step by step through a couple of different scenarios. First, when you are finding your neutral spine position, standing so that you have a side view of your body in the mirror. Place your hands on your hips and rock your pelvis to stick your buns out in a gymnast position. This position will make your belly protrude more UNTIL you contract your TA. Draw your belly button up and in when you are in this position and you will see your belly draw in to a tighter position AND your pelvis will rock back slightly from this extreme gymnast posture to your neutral spine position.

    The second position to try is to simply get on your hands and knees and relax your belly, then simply draw your belly button up and in to see your belly cinch up from its relaxed position.

    Work all of the exercises on the Hab It dvd in front of a mirror to give you optimal feedback of your posture. Neutral spine posture is a dynamic position and the visual feedback from the mirror can be the difference between too much anterior or posterior pelvic tilt that makes a difference in your pelvic floor muscle activation.

    Give this a shot and let me know if you see the difference.

    -Tasha

    Reply
  16. Tasha – I have a very difficult time breathing while holding a Kegel and my TA. When I start to exhale I lose my Kegel immediately. Do you have any suggestions so that I can breathe during these?

    I have been doing the workouts 3 times a week for 5 weeks so far and have noticed drastic improvement. I did miss 4 days and started to notice my prolapse again so I will have to figure out a maintenance plan. This DVD amazing it has helped make me feel normal again. I also love being able to do PT in my own living room.
    Thanks Heather “breathless”

    Reply
  17. Tasha,

    I found out the hard way why my stomach was protruding. I had terrible pain and had to be rushed to the hospital and they found a tumor on my ovary that was bleeding. They removed the mass and ovaries. The Dr. said that my bladder prolapse was caused by the pressure from the tumor. That was 3 weeks ago today and I am healing very well and the Dr. has encouraged me to walk and slowly start exercising. I am doing some of the DVD and already the bladder is almost normal. The rectocele is still present but it never has been a real problem. I feel that now I can keep everything under control with your DVD exercises and really do appreciate this site for more info. Thanks so much!

    Reply
  18. Alright Heather,
    It is very important that you are able to hold your TA in while breathing. Concentrate on expanding your chest. You can elevate and expand your ribs while still contracting your TA. You may be a belly breather and have to re-train yourself to breath with your chest. Give it a try and let us know.

    -Tasha

    Reply
  19. Wow Carole,
    I am so glad that you discovered the source of your problem. Sounds like you are on the road to recovery!

    -Tasha

    Reply
  20. Thank GOD for you, Tasha. I have your DVD and I’m about 3 weeks into working steadily on the strengthening exercises. I have a uterine prolapse and like yourself (and a previous commenter) am an avid runner who truly does NOT want to give it up.

    I was devastated when a doctor flippantly told me “well you’re done with that”. 😮

    I’m staying with the program. All tests have come back negative – no disease and no other issues – so I trust that my body will strengthen and recover.

    Here’s something to consider – I’ve been taking supplemental magnesium for years. Started years ago for migraines, then bronchials, then sleep problems – yes magnesium helps all of those things (even constipation) so I have taken more on a regular basis every day. What I didn’t realize is how many smooth muscles is really affects. I believe the ultra – relaxing (plus active running) has contributed to my prolapse. I stopped the extra magnesium and started your program and have seen positive results in only a few weeks.

    Just something to consider. We really do have to be our own doctors – at least our own ‘experts’ on our bodies.

    On my first visit I was told I needed a total hysterectomy “immediately”. No other options. For a fit, healthy, non diseased person. It was terrifying until I got online and spent days on end researching. Thank you for your DVD and all of the help you give online. Your sincerity just shines through – you truly want to help and you are thorough and knowledgeable and it really shows. I so appreciate what you’re doing!

    Reply
  21. Thank you Tasha for this fabulous, informative website and the DVD. I have been persevering with your DVD working my way slowly through the exercises (not at level 4 yet but am confident I will get there!)
    I was diagnosed with a cystocele (grade 2) Sept 2010 (two children aged 13 & 9, one vaginal delivery, last one C-section, I’m now 38 but feel 98 due to my symptoms). Was referred for physiotherapy with minimal benefit. Your DVD (combined with my weight loss to a health BMI) has helped so much more and my TA is much stronger. However, my cystocele causes incontinence daily and I still have to wear pads every day. I have to use a sponge pessary when I exercise (VERY COSTLY!!!). I am absolutely determined not to have TVT tape which my surgeon suggests. Is there a possibility that I am going to be the only person who can’t live a normal life despite your DVD? I have so many ‘accidents’ – perhaps my fascia has become damaged beyond repair?

    I am a very positive person by nature but after 12 weeks of doing your DVD three times per week (and daily 8 second kegel holds) I was hoping my symptoms might have improved. I don’t want to give up and wonder if you can offer any encouragement or positive news?
    Thank you for response I get

    Reply
  22. Update – I have been using your DVD faithfully for a month and a half now and today ran a 5k! First time out for that long of a run since the ‘big news’ from the doctors that I would never run again! 😉

    I think I read somewhere that you said Give it 3 months… and I had set that amount of time in my head to give to the exercises before deciding if it was helping or not, but it’s definitely helping.

    I’m trying to teach my 20 something daughters to do these exercises too. Hopefully they’ll never have to deal with a problem if they do them. I wish someone had told me about this when I was younger.

    Thank you again!

    Reply
  23. Linda,
    Congrats on the 5K! What a great message to send out to so many women that are wondering if they will get back to competing again. I am proud of you and strongly encourage you to keep it up, but don’t forget to cross train to give your body time to recover. Biking, swimming, in line skating, and many more non impact activities are great ways to stay in shape and decrease the pounding on days off from running.

    On your very important note of “If I would have only known then what I know now!” I am 100% with you on that one. That is why I have created this website, this blog, and continue to try to give more information every month so that we eventually will have this information available within prenatal classes and more. Thank you for all you do to help get the information out there. Is Dr. Oz listening!!!

    -Tasha

    Reply
  24. Cally,
    I hear your frustration. I would definitely have expected you to see great progress at this point. I have 3 suggestions:

    1. Pay particular attention to your posture throughout your day. Are you sitting and standing in a supportive position, allowing your pelvic floor to contract effectively and efficiently?

    2. You may choose to go back to a women’s health physical therapist for some hands on guidance and to ensure that your muscles are all firing.

    3. Your other option is to look into a Kegel 8 electric stim machine. So many women have had great success supplementing the dvd with this “at home” electric stim device that helps to maximize their muscle activation. There is alot of chatter about this device on http://www.prolapsehealth.com

    -Tasha

    Reply
  25. Linda, I really appreciate your Magnesium comment. It highlights the importance of vitamins/supplements we use to keep our bodies in a healthy balance. With your permission I would like to post your comment as a blog entry so it is out there for all the women visiting this site to read.

    -Tasha

    Reply
  26. Hi Tasha
    Thank you so, so much for your reply! I truly appreciate your input. I am still seeing the women’s health specialist who assures me my muscle tone is excellent. In fact, she cannot understand my symptoms considering the strength of my muscle tone! Which I suppose is reassuring in one way, but very frustrating in the other!
    I looked at the website you suggested. Thank you. In fact – probably like lots of other women who suffer the ’embarrassment factor’ when suffering from incontinence, I did lots and lots of investigating before I referred myself to my doctor. I actually bought the Athena Fem (a wireless device) which is a similar device to the Kegel8. I wonder if you would be so kind as to look at this and give me your very much valued opinion. I used it absolutely religiously before being referred to my physician and everyone (but me!) thinks my muscle tone is great! I was just wondering, as my cystocele is at the entrance of my vagina, I was thinking I might have better results from the Kegel8 than with the Athena Fem because, as you will notice, the electrical contacts on the Athena are much higher up on the probe than the Kegel8……therefore, toning much higher up in the vagina? Its lower down (ie, the entrance of my vaginal opening) where my problem is.
    I’m sorry to be perhaps too graphic – but I 100% have faith in your opinion and I value it very much – because you have actually been through the problem yourself (unlike my childless women’s health therapist and the the male physician who is suggesting TVT).
    Thank you as always for any reply

    Reply
  27. Cally,
    Although I do feel that there are different trigger points at different locations within your vaginal canal, I don’t know if the Kegel 8 purchase is required at this point. If everyone is telling you that you have good muscle tone, then it may be an issue of firing pattern for you. I have a specific blog that I want you to read through and begin working on immediately. Let me know your progress in 2 weeks.

    http://hab-it.com/blog/?p=238

    Also, I’m sure you have already done this, but go to the category of “Incontinence and Exercise” and read through all of the blogs in this section to reinforce your focus on firing pattern.

    With good muscle tone, focusing on firing your transversus abdominus and your multifidi before every reach, every lift, etc. WILL make a difference.

    It is this same training that I talk about in my blog
    http://hab-it.com/blog/?p=219

    Focus on this for 2 weeks and give us an update!

    -Tasha

    Reply
  28. Tasha, you have my permission to post anything I send here. I have been desperately researching this whole problem, not getting anything but “surgery” from 2 doctors who have seen me, and am so thankful for your work!

    I’ve been a big supplement person in the past but I’ve seen negative effects from overdoing it. We read so many articles about this supplement helping and this one fixing things and this one preventing cancers, etc. I think it’s time for articles to be written pointing out that supplements DO work on things, but it’s because they are potent and they can easily become TOO potent or overused in our bodies and cause problems.

    I developed high blood pressure (even though I’m a runner) and no matter what I did it kept getting worse. My doctor put me on a drug and it wasn’t even working (but it had side effects). After discovering that magnesium relaxes the circulatory system as well, I stopped magnesium supplementation, within a couple of weeks my blood pressure has gone back to normal (I am off the drugs).

    It’s mind boggling to me that I was causing such a negative effect throughout my body when I was doing something I perceived as harmless, natural, and healthy!

    Keep up the great work – I’m so happy you do what you do and that you share it with us.

    Reply
  29. PS

    I submitted your blog and DVD information to Dr. Oz 🙂

    Anyone who has been helped can do the same, go to http://www.doctoroz.com/ and look at the bottom for “contact us” and submit this. He had a decent segment on Pelvic Floor problems a few weeks ago but could take it further.

    Reply

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