Out of sight, out of mind
Pelvic floor muscles are “hidden” muscles that we don’t tend to think about until something goes wrong.
Unfortunately, things do go wrong – more frequently than most people realise and as 70% of people with incontinence issues don't get help (Millard, 1998), there are a lot of you out there with unspoken issues that could be improved.
The most commonly quoted statistic is that 1 in 3 women post-childbirth will have some degree of incontinence. That's 33.3% of all mothers.
A less commonly known statistic is that 28% - 45% of elite athletes in high impact sports (running, gymnastics, sports involving jumping, trampolining) also suffer from incontinence whether or not they have had a baby (Caylet et al, 2006, Poswiata et al, 2014).
Moving up the age scale, 50% of 45-49yr old women have some degree of incontinence (Millard 1998) - this percentage worsens with advancing age and menopause.
Men fare better due to their lack of childbirth, however, there is still a 30% rate of incontinence in 70-84 year olds that increases to 50% in the over 85’s (Australian Institute of Health and Welfare, 2006).
77% of nursing home residents have incontinence (Steel & Fonda, 1995).
It's pretty clear from these statistics that there's a fairly high chance that either you or your partner will have continence issues at some point in your life.
Remember, NO AMOUNT OF URINARY LEAKAGE IS NORMAL.
As women, we tend to assume that a bit of urinary leakage - "light bladder leakage" - is normal and to be expected after childbirth. This is because it's really common, but it's not normal. Unfortunately this assumption is often reinforced by the medical community who pay little attention to the mention of mild incontinence or prolapse symptoms. This is not just from male medical practitioners either.
Pelvic floor muscle function
I have explained, in detail, the function of the pelvic floor muscles in previous blogs but in brief, the pelvic floor muscles form the sphincter of the bowel, support the bladder and urethra in good functional positions, give general support to all the organs of the pelvis, aid sexual function and form an integral part of your core stability.
Pelvic floor muscles can be damaged by trauma (childbirth, pelvic fractures, surgery), inhibited by pain (low back, pelvic, groin injuries) or nerve damage (childbirth, trauma, prostrate surgery), weakened (pregnancy, obesity, high impact exercise induced fatigue) or lengthened (childbirth, pregnancy, chronic straining, chronic coughing). This means that there are many reasons why you in particular, may have compromised pelvic floor muscle function. It is really common.
What effect will strengthening my pelvic floor muscles have?
Pelvic floor muscles are skeletal muscles like the ones we are more familiar with in our body - leg, arm and trunk muscles. They respond to exercise by getting stronger and increasing in bulk. You can also train them very specifically for endurance, speed, coordination, strength and bulk. They are the foundation for your deep core so if you suffer from any ongoing injury/pain (low back pain, groin problems, pelvic girdle pain etc) or want to increase your efficiency of movement, having a well functioning pelvic floor is essential.
Research shows that a well designed pelvic floor muscle retraining programme can "almost cure, or cure" 56% of women of stress incontinence (leakage caused by exercise, coughing, sneezing etc). This percentage increases to 92% when including those participants with some improvement. (Bo et al, 1999)
The same type of programme can also significantly reduce the symptoms of pelvic organ prolapse (Hagen et al, 2014)
Men who perform a well structured pelvic floor muscle retraining programme post-prostatectomy are much more likely to be dry at 6 months (94.6% compared to 65%) post-surgery (Filocamo et al, 2005).
This means that although pelvic floor exercises don't have a 100% guaranteed success rate, the majority of people will find that their symptoms significantly improve. This is the reason why it is accepted practice worldwide that pelvic floor exercises should be the first line in treatment of continence issues (Dumoulin and Hay -Smith, 2010) and only if they fail should you progress to surgical options.
So get started on the foundation level pelvic floor exercise programme as described in my previous blog and if you are not seeing a difference in 8-10 weeks, come and get a pelvic floor assessment done with a Pelvic Health Physio. This will determine if there is an underlying reason for the lack of improvement and if a more specifically tailored programme will be effective for you. It will also tell you whether you should progress to seeing a Specialist for a surgical opinion.
If you are getting improvement but your symptoms have plateaued, you may need a more tailored programme to achieve your goals - in the same way that you would seek the expertise of a Personal Trainer or a Coach for specific sporting goals, see a Pelvic Health Physio.
But I lack motivation to do them...
Never fear, there are always options!
The simplest way to know if you're doing them correctly is to get an assessment with a Pelvic Health Physio who can measure your strength, speed and endurance objectively using the neurotrac or peritron measurement systems. They will tailor a programme specifically to your needs to ensure you reach your goals in the most efficient way possible.
However, I recognise that this isn't for everyone, whether it's due to financial, personal or time limitations, and that's fine. There are motivational options for you do to your exercises independently:
1. The first is a brilliantly simple phone app - "Squeezy". Designed in the UK for the NHS this great little app is the best on the market and at approximately $5- it's money well spent. You enter the programme that you want to do, how frequently you want to do it, set alarms to remind you to do it (you can even set a snooze feature), then start exercising. Once in exercise mode, there is a very simple yet super effective visual cue that you follow to complete your exercise routine. Once finished, you log your session so that you can keep track of how you are doing.
2. The next option is using weighted cones such as the Aquaflex Vaginal Cones (stocked in the website store). Again, very simple and effective to use. You use these for approximately 20mins 1-2x's/day. These are great for people who like to know they're doing something and can see objective progression, but don't like the conscious act of doing sets of exercises - once you've established your level, you can pop them in and carry on with your daily routine. Please read the blog on them to learn more about them.
3. The third option, and the newest on the market, is by far my favourite - purely because I'm competitive and rise to a challenge! This is the PeriCoach. For full information please read the blog, but in brief, it is a vaginal probe that links via Bluetooth to an App on your smart phone (both Android and Apple) that gives you audiovisual feedback as you perform your exercises. You perform a test contraction and the unit sets a programme that is suitable for you - enough to be a challenge, yet attainable. Once you complete this level 3 times successfully, it will automatically step you up to the next level to challenge you to work harder. As a bonus, you can link it with your Pelvic Health Professional via the Clinician Portal who can tailor a programme specifically to you. This unit is also available in the website store
At what age should I start doing pelvic floor exercises?
It is never too early or late to get acquainted with your pelvic floor muscles. Statistically, women get problems from their teenage years right through to their 90's and beyond. I see women in their 90's still getting fantastic results from their exercises. However I would love to get in to talk to year 11/12 girls to teach them and help them prevent issues later in life or at least know when and where to get help.
Men don't tend to get problems until later in life unless there has been an ongoing injury to the pelvis (groin strain, osteitis pubis, sportsman's hernia or surgery such as prostatectomy).
What if I'm not getting symptoms - should I do pelvic floor exercises?
If you have none of the risk factors as listed above, no symptoms of leakage, pain or prolapse, can quickly and easily stop your urine mid-flow and easily perform the foundation level of exercise (10x10sec maximal hold, x20 quick hold/relax contractions and perform a pre-emptive maximal hold before and during a sneeze/cough/lift) then you probably don't need to do pelvic floor exercises.
Also, if you get internal pelvic pain (vaginismus, endometriosis, bladder pain syndrome, dyspareunia - pain during intercourse) you should not do them as you may have the opposite problem of having muscles that are too tight. I will expand more on this in a later blog, but if this is you, I would recommend getting an assessment done by a Pelvic Health Physio as there are some very effective treatments to help you.
Thank you for taking the time to read this blog. I feel very passionate about educating and empowering people about their pelvic health and these basic foundations.
Pelvic floor exercises, whatever you think of them, are simple, cost effective and can be life changing. Incontinence has a massive effect on quality of life - embarrassment, shame, avoidance of exercise, avoidance of social situations with all the related health sequelae, yet it is so treatable in the majority of cases. So whether you currently have symptoms or are feeling invincible, take a moment or two to connect with your body and feel these hidden muscles working. It's much easier to feel them "this side" of having a problem.
Please share this information with your friends and family and increase the pelvic health conversation. You can also subscribe to the website to learn more about typical pelvic problems and keep up to date with the latest developments in pelvic health.
Please contact me if you have any questions or are unsure if you need to come in for an assessment.
Hagen A, Stark D, Glazener C, Dickson S, Barry S, Elders A, et al (2014) Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet 2014;383:796-806.
Dumoulin C, Hay-Smith J (2010) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews: CD005654.
Poswiata et al (2014) Prevalence of Stress Urinary Incontinence in Elite Female Endurance Athletes Journal of Human Kinetics volume 44/2014, 91-96
Caylet et al (2006) Can J Urol. Aug;13(4):3174-9.Prevalence and occurrence of stress urinary incontinence in elite women athletes.
Australian Institute of Health and Welfare (2006)
Steel & Fonda (1995)
Bo et al (1999)
Filocamo et al (2005) Eur Urol. Nov;48(5):734-8. Epub 2005 Jun 22.Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence