Hey Hayley,

I've had a bit of a rough time with lady part issues this past year; large ovarian cysts, ruptures, endometriosis, fibroids, severe anemia. You get the icky picture. I had one surgery last spring and have another lined up next month. Chronic pelvic pain has put a damper on daily living for over a year now. It's really messed with any physical routine I had (not to mention bedroom routine with my husband). I thought I would be at the stage in my life of trying for a child by now, but all has been sidetracked.

My doctor suggested once I'm healed from this upcoming surgery, it is crucial to start building my lower back, pelvic/hip flexors and core strength. I should also focus on stress relief as this year has taken its toll. I've lost weight when I should not, am tired all the time and find myself anxious often. I want to start feeling some kind of normal again. Hoping you could provide me some lifestyle and exercise tips to kick start this hopefully pain free new chapter.

Downstairs Mix-up


I am sorry you are going through so much with your body. I agree with your doctor on the importance of strengthening your core and hip stabilizers as soon as he gives you the clearance, but I highly recommend you seek the advice of a professional. Start with searching out a physiotherapist that specializes in women’s health (ask your doctor who they might recommend). You want to find a specialist who does not work on a rotational system but will actually spend 45 minutes to an hour with you, educating you on how to reengage those deep pelvic floor muscles.

What can happen post injury and surgery is your body can lose its ability to connect to and recruit the muscles that are needing to be strengthened, causing the weak muscles to stay weak while the strong muscles remain strong. It is important to learn how to neurologically recruit these muscles again, which can take weeks to months to accomplish. You do not want to take this lightly, and you especially do not want to progress too quickly. This is going to take time, but you will get stronger as long as you stay consistent and seek out the help you need.

You are going to want to start with something as simple as learning how to breathe again, as your breath plays an important part in core activation. Start by having a seat in a chair with your feet planted firmly on the ground and sitting up tall on your sit bones (in doing this you should actually feel something start to fire deep inside your abdominal cavity). As you breathe in, your diaphragm will contract and draw down, which increases the volume of the lungs. In order to allow this to happen you need to create room for the expansion so place your hands on your belly and take a deep breathe in, allowing your belly to expand into your hands. As you exhale, allow the belly to retract. Your shoulders should remain still and relaxed as you breathe and focus sending your breath all the way to your pubic bone. Most of us do not even breathe properly so spend some time breaking bad habits.

Next, while staying seated, focus on your pelvic floor. Your pelvic floor works with your diaphragm in contraction and relaxation and it is responsible for holding all your “parts” up and in, which is especially important for you right now. Imagine a diamond shape between your pubic bone, tail bone and your two sit bones. As you breathe in, allow the diamond to open and expand while your belly expands into your hands. When you exhale, start to draw that diamond together, attempting to make it as small as you can and lift it up; however be careful here that you are not contracting your sphincter. All of the muscles that make up the pelvic floor have very important roles including pelvic stability, urine control and, for women, childbirth, which means this muscle should not be neglected especially if you want to rebuild your sexual health as well as start trying for a family.

Now move onto a mat, lying down with your knees bent and feet firmly planted on the floor. Place your hands on your lower abdomen and continue with the same breathing mechanics except this time, as you exhale, see if you can draw your abdominals down and away from your finger. This is one of the first steps to learning how to activate your transverse abdominals properly, muscles that act like a corset and play a major role in core stability. Until you are able to locate these muscles and learn how to activate them, you do not want to progress your workouts any further.

As you can see, it is quite complicated, so do not shy away from getting help. As I said earlier, a physiotherapist is highly recommended or look for a trained Pilates instructor who will be able to guide you through these steps and progress you forward. Your body has been through a lot and I do not recommend that you attempt this on your own.

Attached - Cameron Diaz heading to the gym yesterday in LA.