Prevent Incontinence: Don't Do Sit-Ups!
By Marianne Ryan, PT, OCS
Appeared in the October 2013 issue of Quality Care®


For most of us, abdominal crunches are on life’s list of things we know we really should do, but are not really that much fun - like flossing our teeth or sprinkling flax seeds on everything we eat.  Well, maybe what I am going to tell you will be good news – ABDOMINAL CRUNCHES CAN BE BAD FOR YOU!

The problem is not so much what these types of exercises are doing to your six-pack abdominal muscles, but the effect they are having on your pelvic floor and deep abdominal muscles. These two muscle groups work together to help keep the lower part of your body stable so you can move more efficiently and prevent incontinence.

Your pelvic floor is shaped like a hammock connecting the back, front, and sides of the pelvis; and it is meant to act like a trampoline. It is composed of a group of muscles whose job it is to support our abdominal organs, maintain bladder and bowel control and support healthy sexual function. When the pelvic floor muscles contract your deep abdominals should contract at the same time, forming the base and front part of your core muscles.

When you do a sit up or, an abdominal crunch, the pressure in your abdomen rises and places downward pressure on your pelvic floor. Your pelvic floor muscles should contract strongly and automatically, like a trampoline, to match the increasing pressure.  If you have weakness in your pelvic floor, the increased pressure will hone in on that area, and can worsen the weakness and cause serious problems, including problems with bladder and bowel control, pelvic organ prolapse and pain in the pelvis and lower back.

Also, performing sit-ups or crunches can cause your upper abdominals to become over trained and much stronger than your lower abdominal and pelvic floor muscles. This can result in muscle imbalances. If this happens, each time you perform a sit up, the upper abdominal wall tightens and causes funnel pressure, which presses down on the lower tummy and pelvic floor muscles. So, you run the risk of developing a little potbelly and a droopy pelvic floor (which can lead to incontinence).

The pelvic floor and your deep abdominal muscles are not normally trained to withstand the prolonged pressure created by repetitive crunches. It's an endurance issue. Pelvic floor muscles can fatigue easily and lose their "trampoline like" effect of matching the downward pressure placed on it by the internal organs.

Take a toothpaste tube; make sure it’s fairly full. Now make it do a crunch – go right ahead and bend it in half! The cap represents a strong pelvic floor. Okay, now imagine doing several sit-ups in a row, which will fatigue the pelvic floor muscles. Take the cap off of the tube and “do a crunch”. Get the picture?

This doesn’t mean you get out of exercising your abdominal muscles altogether!

So, how can we work out our abdominals safely?

The thing to keep in mind is that we have a few different layers of abdominal muscles. It is best to avoid over strengthening the outer layer of muscles to avoid downward pressure on your pelvic floor. This is the ‘six-pack’ group of muscles.
The deepest inner layer of abdominal muscle, the transverse abdominis, has a special connection to the pelvic floor muscles. When working properly, these deep muscles will help flatten your tummy and prevent incontinence. The best type of exercises you can do to flatten your tummy will also strengthen your pelvic floor. Here are some exercises that will help you strengthen from the inside out.

(Note: Please read disclaimer prior to performing exercises)


  • Lie comfortably on your back on a firm surface. Keep your head relaxed. You may use a pillow or two under your pelvis if you like.
  • Bend your knees and hips, keeping your feet flat on the ground, hip width apart.
  • Place two fingers of each hand on the top part of your panty line, just inside your pelvis.
  • Now, gently EXHALE and perform a pelvic floor contraction, as if you are trying to stop the flow of 1 or 2 drops of urine. Try to hold this contraction for 3 seconds. (Try slowly counting out loud, “O-n-e Mississippi, T-w-o Mississippi, T-h-r-e-e Mississippi”)
  • Relax. Then perform 3 quick contractions, where you gently contract then relax your pelvic floor, remember to gently exhale with each contraction. (Try counting out loud, “One – Relax, Two – Relax, Three – Relax”)
  • Now relax for 6 seconds.
  • Do each set 10 times in a row, 3 times per day.

Make sure to feel as if your abdomen is gently drawing in towards your spine, not bulging outwards as you contract your pelvic floor muscles.

Got it? Once you feel confident about doing these exercises correctly, try doing them in different positions while sitting, standing and even walking. Then try to fit them in during normal daily activities; such as while you cook a meal, wait at a traffic light or while checking your Facebook page.

You can gradually build up to holding the long contraction for 5 seconds, then do 5 quick contractions and relax for 10 seconds in between each set.

Remember to be gentle! Less is more. If you try too hard you will be working out your outer layer of abdominals not your deeper core muscles.


THE HEEL SLIDER – "The Hovercraft”

  • Lie comfortably on your back with your knees and hips bent, keeping your feet flat on the ground, hip width apart. (Use a thin pillow to support your head)
  • Place one hand under the small of your back, to monitor excessive movement while you perform this exercise.
  • First contract your deep abdominal muscles by doing the "pelvic-core starter" exercise (above).
  • Keeping that contraction (and counting out loud), lift the heel of one foot ¼ inch above the floor.
    Slowly slide that heel just above the ground, like a hovercraft, as you straighten your leg. And then return to the start position by slowly gliding your heel, like a hovercraft, towards your buttocks.
  • Make sure you don't wiggle your pelvis and maintain the normal curve in your lower back!
  • Repeat with the other leg.
  • Do this 10 times on each leg and work up to 3 sets of 10.

Don’t forget to continue gently exhaling or counting out loud while you do the heel slide in both directions.



  • Lie on your back with a thin pillow to support your head. Your head and arms should be relaxed with your knees and hips bent. Put your weight on the heels of your feet and point your feet up towards the ceiling.

  • Next, EXHALE and lift your bottom off the floor, aiming for a straight line from your shoulders to your knees.
  • Hold for a count of 3, if you can. Then slowly lower your body to the start position.
  • Work up to holding the bridge position for 10 counts, then repeat 10 times.

Note: the images are the property of BabyBod® and are protected by copyright.

About the Author:
Marianne Ryan PT, OCS
Owner/Clinical Director MRPT Physical Therapy
Spokesperson American Physical Therapy Association Media Corps
Marianne Ryan has been practicing for more than 30 years and is a board-certified orthopedic clinical specialist specializing in the treatment of the spine, pelvis and jaw. She has developed a hands-on patient-centered approach to treatment techniques with strong attention to individualized needs.
She has extensive experience in Women’s Health, especially treating prenatal and postpartum patients with particular emphasis in helping women to restore their stomachs with core exercises. Her experience as an educator includes Columbia University School of Nursing– Nurse Midwifery Program, where she taught physical therapy treatment and exercises for prenatal and postpartum women, and New York University Dental School where she taught in the TMJ clinic.
She also serves on APTA’s panel of experts for high-risk pregnancies, authored an upcoming book, “BabyBod®” and has an active social media presence; and can be followed on Twitter @MarianneRyanPT or Facebook
Marianne is frequently interviewed by publications including Red Book, FitnessMagazine, Shape Magazine, numerous internet based magazines, radio shows and has been featured in a film documentary. She is available for lectures, workshops and interviews in print, radio and TV on several topics including Women's Health, Pelvic Physical Therapy, Physical Therapy Treatment for pregnant and postpartum clients, TMJ and Headaches, Back and Neck pain.
Contact Marianne Ryan at, 212-661-2933 or E mail at