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How to Prevent Handstand Queefing: An Interview with Sarah Smith

Oct 10, 2020

Why Sarah Smith recommends more handstands & less kegels

Sarah Smith, personal trainer, level two Russian Kettlebell Instructor, postnatal fitness specialist and functional pelvic floor advocate

Sarah is a functional pelvic health educator and strength coach. After years working in exercise and strength Sarah saw the need for more information and education around the movement and functional side of pelvic floor health.

Sarah generously got on Zoom with me last week to help me understand how the pelvic floor muscles could impact handstands. What she shared with me was eye opening, I hope you like it.

Kirsty Grosart: I frequently get asked this question, "Every time I try and do a handstand, I queef." (For those who don't know, queefing is vaginal flatulence or fanny farting for the Brits!) So, I reached out to you to say, "Hey, Sarah, what's going on? Is this normal? Is this something that we should be worried about?"

Sarah Smith: I was so pumped that you thought of me, and I was like, "Yes!" And the fact of the matter is, that this actually is a very common occurrence. In our culture, just farting in general is not really socially acceptable, and so when it comes from your vagina, it's a little bit more horrifying. But it happens a lot, so it's incredibly common. You can experience it in intercourse, depending on what kinds of activities you're engaging in, just because of change of pressure in the vaginal canal and in the abdomen itself. But where a lot of people start to experience this, is in a yoga class or when they get into hand-balancing.

So, yes, it's common, and it's really interesting to me when people discover this, because it actually means they have an underlying issue that they need to address that's impacting the health of their whole body and the stability of their torso. And if they weren't getting upside down, they might never have discovered it. So it's actually a cool instance where a performance goal can actually inform you about some functional limitations that we can improve.

Kirsty Grosart: So, why does this happen? Because naively, from my perspective, I'm thinking that when going upside down, everything's going to move in the other direction and not out at the top!

Sarah Smith: So, it happens for two different reasons, depending on the body. For anyone that isn't really familiar with the pelvic floor, the pelvic floor is a network of muscles at the base of your torso. It attaches to your hip and to your tailbone and then at the front, to what's called the pubic synthesis. These muscles work together, and they move up and down, they recruit and relax all day long every day, or at least they're supposed to, automatically.

What we see is that some people, for a number of different reasons, they've lost connection to their pelvic floor. So the muscles, those muscles in the pelvic floor, they don't have a lot of tone. They're not engaged and they're not doing their job. So, they're a little more lax, and this can just make the vaginal canal a little bit more open.

Think about when you go camping and you have a tent, and there's the tent flaps. If the tent flaps aren't secure and they can just blow in the breeze, that's kind of what's happening. I know that can sound horrifying to people, they're like, "I don't want to think about my body as that." But the cool thing is that they are muscles, and so if we can utilize the right kinds of exercises, we can build tone again.

So, because they're lacking in tone, they're a little bit more open, and so it becomes easier for air to get in. Then, when you are in the process of going from upright to upside down, there's a change in pressure, you're breathing, you're moving, and air can get into the vaginal canal. Then either when you're going up or when you're coming down, the air escapes, and there's a noise. So, that is one side.

The interesting thing is that you can have a similar experience because the muscles of the pelvic floor, are too recruited. They're too tight. If that's the case, if the muscles of your pelvic floor are overworking, then they are lifted. And because they're lifted and tight, they act like a vacuum and they suck air into the body as you invert. And so, you'll have a slightly different kind of noise. It maybe a little bit more high pitched, a little bit more-

Kirsty Grosart: Toot tooty?

Sarah Smith: Yes, exactly. Right? Because there's a lot of tension in the muscles. So, you're sucking air in, as you invert, and then when you come out of the handstand or downward dog or whatever people are doing, and then as the air escapes, you can hear it. It's an audible sound.


Kirsty Grosart:
So, you can tell the difference by the tone?

Sarah Smith: I'm sure there are experts out there that can tell. They're just like, "Oh, yeah, I can tell by the sound." :)

It's a really important distinction to make. Because I think sometimes people know enough about queefing and symphonic vaginas to jump to the conclusion that, "I have a weak pelvic floor." Right? Or I need to tighten things up. And there's advice online where people say, "Well, put a tampon in or do a kegel when you do your handstand,".

But if you already have a very recruited, almost tight lifted pelvic floor, tightening it and lifting it and squeezing will not solve the problem, because that's why you're having the situation in the first place. You're just making a tighter vacuum, more likely for air to come in. You're going to start to give yourself tailbone pain and other kinds of discomfort and prevent the pelvic floor from doing its job. We don't want to do that. So, it's best to identify which one you are.

Is it that my pelvic floor doesn't have a lot of tone and it's just relaxed and a little open? Or is it that I have over recruitment issues and everything's too tight and I'm sucking the air in like a vacuum?

Kirsty Grosart:
So, what are some ways people can tell which one they might be experiencing?

Sarah Smith: If you want to get answers really quickly, go to a pelvic floor physical therapist, because this is what they do. They look at your muscles, they palpate them, they touch them, they can tell you if they're relaxing or recruiting properly.

What I tend to see, and this is a generalization, is people that have a strong history in gymnastics, a lot of performance sports really, develop strong cores and have a lot of tension in the body. Maybe they have six pack abs and everything, and they don't know that they've been over recruiting the pelvic floor and carrying more tension in their body than they need to.

What's really neat is a pelvic floor physical therapist can put their hands on your muscles, in your pelvic floor, and do a manual release. Just like someone can manually release muscles in your back or your neck and you feel some release and relief, they can do that, too. They can help you to get a better sense of what your baseline is. They can help you to see like, "Oh wow, I have been using too much muscle", because the pelvic floor needs to relax. It's like any other muscle in the body. If you want to be able to use those muscles, they need to fully relax so that we can fully recruit them. If they never really relax, then we never really have access to them, and so we're not as strong as we could be.

So, whether you're doing hand-balancing or whatever, you want your torso to be strong and stable. You want your core to be stable. Well, a lifted, tight pelvic floor that doesn't move like it's supposed to, is just not going to provide you with that. So, a pelvic floor PT will be able to look at you, and they'll release the tension and a good one will teach you how to do it yourself. From there, you can work with someone like myself and learn how to move in a manner that stops you overly relying on your pelvic floor's tension and build strength around it.

Sarah Smith: Then the other side is if you are lacking in tone and you can't really access the pelvic floor, having a pelvic floor physical therapist put their hands inside your vaginal canal and touch your pelvic floor can give you a sense and feedback. You're like, "Oh, that's what that is. Okay." So, they can help you, they can give you a little bit of feedback so that you can feel like, "What does a real adequate pelvic floor contraction feel like?" So, that's the first step for most people. If you have access to physiotherapy, that's what I would do.

Kirsty Grosart: Excellent! That's really great advice. So, once people have seen a PT, and then they come to you, what are the key areas that you would focus on with people for helping them with their handstand? Is it just these pelvic floor exercises, or is it more than that?

Sarah Smith: Yeah. That's actually what I get really excited about because the pelvic floor, like everything in the body, is connected to everything else, and so while pelvic floor PTs are awesome for helping us with the specific pelvic floor exercises, if you want to be in athletics and you really want your body to be functioning well, communicating as a whole, we have to zoom out from there. You want to know how it impacts your performance and how you need to think about it in terms of hand-balancing.

Generally, the first thing that everyone really needs to do, whether they have over recruitment or under recruitment, is work on their breath. Breathing with the diaphragm and moving your diaphragm through its full range of motion is really important because your thoracic diaphragm at the base of your lungs is stacked directly over your pelvic diaphragm, which is your pelvic floor, in your torso. They move up and down together all day long, and they help you to manage pressure. The better you breathe, the more you breathe with the diaphragm, the more you're exercising the pelvic floor, the more you're teaching it to relax and teaching it to recruit. And that dance with the diaphragm at the top, if you can picture a diaphragm at the top of a canister and the pelvic floor at the bottom, and they're moving up and down together as you breathe, they help you manage pressure.

The interesting thing about breathing is that if you want to get good at breathing, you have to get into a really good neutral alignment. You have to be able to stack the diaphragm directly over the pelvic floor. So, when people get into hand-balancing, they don't necessarily know that they have some overhead mobility issues, right? Some compensations. And I know you talk about this in Handstand Building Blocks a lot, you have to have good overhead mobility. If not, people start to flare their ribs. As the ribs starts to flare, you can imagine your ribs are coming out. The diaphragm is no longer directly over the pelvic floor, so they're not going to talk as well together. So, your ability to recruit and relax your pelvic floor and control the air and the sounds, it's not going to be as great.

So, working on your breath and then doing all the things you need to do to address overhead mobility so that you can get into that neutral stack position is going to help you better to manage pressure and to move the diaphragm and the pelvic floor together, as much as your body needs to.

Kirsty Grosart: That's so cool because so much of what you need to develop to get that good handstand line, the good overhead mobility, being able to pull your ribs down when you're upside down, being able to keep that neutral alignment, I mean, that's what we talk about so much with a good handstand line. And that seems like that's part of the solution to fixing this problem.

Sarah Smith: I know. I really wish that people were getting prescribed hand-balancing more than kegels, because I think it would do more for the body. Everything that's going on upstream and your head position, your rib position, your shoulders, it impacts how well you breathe. If you're not breathing well, you're not going to be good at anything in the gym, no matter what, but definitely not hand-balancing. People need to breathe when they're upside down, too. Right?

You can do kegels and some recruitment, too. A PT will teach you about that. I talk about that in my (Connect Your Core and Pelvic Floor) course. But it doesn't matter if you don't synchronize it with the breath.

Another thing that's really helpful for people to do is to practice breathing in an inverted position. Try and get into as good alignment as they can. And nobody's perfect. In my handstand, I am not perfectly straight, but I can feel, when my alignment is better, that I can feel better control over the pelvic floor. I've had my fair share of vaginal farting with handstands. I'm not going to lie. And I have seen how it really improves, not just in me, but some of the people that I've worked with, too, as you start to focus more on the breathing and the alignment, and it makes you better at hand-balancing.

Kirsty Grosart: That's fantastic! Breathing is so important upside down firstly because you need the oxygen, but also for core stability and core strength. If you're doing a handstand and you are loose in the midsection, you're not going to be up there for very long.

Sarah Smith: That's so, so true. A lot of people do not realize that they're breathing into their chest and into their shoulders and that they're leaving strength and core stability on the table by not breathing down and moving their diaphragm down. Because as the diaphragm moves down with the pelvic floor, there's this increase in pressure, the abdomen, it's like there's this positive pressure that happens. It makes you stable. And so, as you are better able to control your breath and have really good inhales and exhales, you are going to be stronger in everything, but especially upside down.

Kirsty Grosart: So much wonderful information there. I'm just wondering if people want to get started on this, do you have anywhere they can go for more information or more exercises from you?

Sarah Smith: Yes! I have a breathing course, it's called Better Than Kegels. And it's totally free. It's a digital course. It will teach you a lot about what you need. You can do it in one sitting, it's not complicated, but it will give you the tools you need to start breathing better. And you can take that into your hand-balancing practice.

And if for some reason you are not in a situation where you can get to a pelvic floor PT, I created an online digital course called Connect Your Core and Pelvic Floor, and that really stands in the gap between PT and the athletic world to give people the tools that they need to come back. Maybe you've had some kids and you have a lax pelvic floor, you'd like to get it back online, or maybe you have a history of over recruiting the pelvic floor and you have tailbone pain and stiff hips, and you think you're supposed to have a strong core but it doesn't feel strong, this is a good option for you. And you can find both of those, at sarahsmithstrength.com.

Kirsty Grosart: Fantastic! Thank you so much. Is there anything else that you would like to add?

Sarah Smith: I love always to emphasize that this doesn't mean that you're broken. This is not a bad thing. You should pat yourself on the back for exploring movement, because it's only when we explore movement and we try new things that these sort of issues become revealed and then we know that we need to work on them. Because, quite frankly, we don't want to fart when we are doing hand-balancing, but a pelvic floor that isn't functioning well, and isn't relaxing and recruiting, will eventually lead to other issues like hip replacement and lower back pain. You can have disc issues. You can have chronic incontinence issues and even knee, ankle and shoulder pain can be linked to it. So, it's not bad you've discovered it. So now go and do something about it!

 
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