Do you need to strengthen your pelvic floor? There are some amazing tools out there that you can use to help you do just that! Today’s blog post comes from Fiona a physiotherapist with 32 years experience who works solely in the area of pelvic floor and women’s health. Fiona works on the beautiful Sunshine Coast and also owns and runs, along with her husband and support team, the website Pelvic Floor Exercise. She is passionate about the promotion of pelvic health which we love here at Swim Ride Mum! So, lets get into it!
How do I strengthen my pelvic floor?
Exercise your pelvic floor they say….
Every day they say….
But I keep forgetting you say…..
I don’t know if I am doing it right you say….
And….It is boring you say …
Well you are correct! Unfortunately there is a lot of misinformation on the internet about the pelvic floor and how to exercise it.
How do you know you are doing it correctly?
If not correctly then are you doing damage? ( Bump et al 1991 showed that 25% of their subjects did a bearing down action when taught pelvic floor exercises from verbal instructions.)
The best option, if you are unsure, is to see a women’s health physio for an assessment. They will check your pelvic floor and teach you how to properly contract , strengthen and co-ordinate it . The pelvic floor is part of your core so needs to work in harmony with your diaphragm and deep abdominals in order to function correctly.
The pelvic floor does not act alone, although when it is very weak or injured , you may need to start with isolated pelvic floor before incorporating into functional activities and then your exercise program.
You don’t rehab your knee after an injury by just getting out there and running again – you isolate, strengthen and then co-ordinate via sport specific exercises.
What if I just ignore it?
You may have been bombarded on Facebook by ads for miracle cures for your pelvic floor, prolapse and incontinence, not the least of which are ads for pads.
Incontinence is also dismissively called LBL , or light bladder leakage , as if it is just a nuisance and not the actual problem that it is. Leakage is a sign that something is wrong within the continence mechanism – the finely tuned balance between abdominal pressure, urethral pressure and the supporting muscles and fascia of the pelvic floor.
You don’t ignore a toothache which is a sign of a problem so why do we continue to ignore leakage and laugh it off , as long as you don’t leak when you laugh. We have all heard the joke ‘ I laughed until the tears ran down my leg’
If you are reading the blog Swim Ride Mum then it is a fair guess that you like triathlon and enjoy running .
A number of studies have shown that BMI > 25 and weight >75kg is a risk factor for stress incontinence (SUI) .
It is the amount of weight gained that seems relevant , not the weight lost . ie if you put on 22kg in pregnancy but then lose it , your risk is not increased , but if you don’t lose the extra kilos then your risk for SUI increases.
The catch here is that if you are leaking when you are exercising you are less likely to exercise and hence less likely to reduce your risk factor for SUI – a vicious cycle.
So you need to exercise, but if you are symptomatic ie leaking, it needs to be in a manner that helps your fitness and weight control without compromising your pelvic floor. That is a topic for another blog but the fact remains BMI is a risk factor for SUI .
The other major symptom of pelvic floor weakness is prolapse. This is the herniation of one of your pelvic organs into the vagina. It can be your bladder, uterus or rectum. The pelvic floor muscles and fascial tissue are designed to support these organs , and when under load ( cough, sneeze lift a weight etc) to contract and close around the vagina to hold the organs up.
If your pelvic floor isn’t strong and bulky , it can’t close the gap around your vagina. The result is stretching of the support tissues and over time possible prolapse.
So what do I do?
You have heard about Kegels or pelvic floor exercises.
Kegels were named after Dr Arnold Kegel who did the original research on pelvic floor exercising , using a perineometer to measure muscle squeezes and to give women something to grip and work against whilst giving feedback as to how well they were doing them. This works on the physiological principle that a muscle will gain in strength in accordance with the amount of work demanded of it.
Encouragement via the use of a feedback device will improve compliance with a strength program. Whilst frequent repetition is required for establishing a new reflex pattern .
Today’s alternatives for this range from small tampon like devices that move a stick when you activate your pelvic floor correctly , to high tech Bluetooth™ devices that synch with an App on your phone and give you a customised program.
Types of biofeedback devices:
This is the most simple and cost effective tool.
A solid plastic device with a stick attached , inserts into the vagina like a tampon , with the stick externally. If you contract correctly the stick dips downwards ( indicating that the muscles are lifting internally) . If it moves up or out , then your technique is not correct!
Vaginal weights give feedback via the sense of the weight in the vagina.
Small balls or cones inserted into vagina which the pelvic floor has to grip in order to stop them from falling out. Some are progressive – adding in weights, increasing the number of balls.
These can be used as resisted exercise. Unfortunately most are sold as devices you can put in and forget . However you need to develop the neuromuscular control of the brain /muscle connection so you can voluntarily contract when required .
These weights can assist in helping you to identify which muscles to contract (or they fall out ) and when so you can use them functionally for example when emptying dishwasher, making the bed or doing a pilates class. You can even run with them in situ for short distances to help you retrain the piston like co-ordination of the pelvic floor and diaphragm ( for more on piston see Julie Wiebe’s blog)
No matter what you read elsewhere, you cannot put the weights in and sleep on it – waking up in the morning with a toned pelvic floor!
PERINEOMETER Measures pressure or force created by the pelvic floor muscles and tissues.
The PFX2 is similar to the device used by Dr Kegel. It measures the resting pressure and squeeze pressure created by the pelvic floor muscles. It feeds it back to you via a handpiece with a dial from 0-12. You can see the force created, how well you are holding it and monitor progress over time.
It also gives you the all -important resting pressure which is the pressure created by your pelvic floor at rest.
Why is this important? Because we only need maximal contraction of the pelvic floor for a very small percentage of the day – when you cough, sneeze or lift something heavy.
The rest of the time the muscles need to work only to the pressure demanded of them. For example standing up, holding a child, pushing a shopping trolley or carrying something at work. After contracting they will return to rest. We don’t hold them all day so the level of tone they hold when at rest is what stops the downward drag on the elastic support tissues.
There are a number of these on the market but very few that are based on research. The Elvie is the pick of the bunch here. Based on research by Crotty which showed that posterior cues gave better urethral support (read less likely to leak) This device has accelerometers that detect not only force generated but direction. If you get the squeeze and lift it detects it, if you don’t and you bear downwards it detects this and lets you know you need to see a women’s health physio for more individual guidance.
You may also be familiar with PeriCoach which is similar but doesn’t detect direction.
So you can see there are many choices to help you with your pelvic floor training. Fiona has heaps of valuable information on her website www.pelvicfloorexercise.com.au. Remember it is not normal to have leakage when you exercise. There is excellent evidence to support pelvic floor retraining to help with incontinence. Using any one of these systems could help you to regain your pelvic floor strength and confidence! If for you found this article helpful, I would love if you could share it! There are so many women who suffer from incontinence, especially when they run. If we could help any of them, we would feel super pumped!
©Fiona Rogers 2016
If you want to access some fantastic resources to help you on your fitness journey as a Mum and athlete, sign up to our mailing list today. Our online resource folder is full of workbooks, printables and guides designed just with you in mind. It’s completely FREE!