Don't make me laugh!
"Don't make me laugh, because I need a wee!" is a phrase often heard from female friends, and for those friends who also run, the cry for "Please don't make me laugh when running" is called. Why? Because many ladies fear the curse of a weak pelvic floor.
Pelvic floor dysfunction is a common issue for many women (and more men than you may think) affecting the ability to control the activity of the bladder and bowel. The incidence is higher in women, and much more so in women who have undergone pregnancy and vaginal delivery.
The term pelvic floor disorder refers to a number of conditions, including overactive bladder, urinary stress and urgency incontinence, faecal incontinence and pelvic prolapse. Recent research suggests the incidence of urinary incontinence in women is 16-20% with this increasing to up to 50% in those over the age of 55.
How do i know if I have a problem?
In a word, if you experience any of the following symptoms then there is a dysfunction, or problem, with the pelvic floor ie it is not quite working right!
-leakage of urine when coughing, sneezing, jumping, running- being active in essence
-inability to hold or need to pass urine NOW, with little ability to hold
-leakage of faecal matter, or inability to hold until you reach a toilet
- change in sexual satisfaction
What is the pelvic floor?
The pelvic floor muscles are a group of muscles working together to form a sling support system. These muscles reach from the tail bone at the back to the pubic bone at the front of the body, and across the body side to side , much like a trampoline.
They have a dual role. Firstly they support and lift the internal organs ( bladder, bowel and uterus in women) whilst allowing the sphincters (think drawstring pulls) around the vagina, urethra and anus to tighten and hold everything where it should be. When these muscles then relax, the sphincters open (loosening the drawstring) and allows the passage of urine and faeces out of the body. They also help support the weight of a growing baby in pregnancy, and babies delivery!
The second role of the pelvic floor muscles is in sexual function. For men it is important for erectile function and coordinated and controlled ejaculation. For women contraction of the pelvic floor muscles contribute to sexual arousal and sensation.
The pelvic floor muscles also work with the muscles of the back and abdomen to help provide stability to the spinal and trunk movement control.
Why do I have a problem?
There are many reasons why somebody may have problems with muscles, causing them to be loose, the main ones are listed below
Pregnancy and childbirth, particularly vaginal and assisted vaginal delivery
chronic coughing
chronic constipation
heavy lifting
high impact sport especially long distance running
obesity
age
neurological conditions such as multiple sclerosis and spina bifida
health related conditions such as diabetes, prostate problems, respiratory problems
inactivity
The big but!
The great news is that for most people there is no reason why these muscles may not be strengthened and return to normal function! For those with health related problems there is often the ability to achieve a little more control too.
HOW???
Here is the answer, but, you need to be prepared to work at it.
The pelvic floor muscles are no different to any other skeletal muscles, they need to work hard to develop strength and control, and they need to work in bursts and over time (we have discussed fast and slow twitch muscles fibres in previous blogs).
The first question a lot of people will ask, is " how do i know which are my pelvic floor exercises?" Pause for a moment, imagine you really need a wee. You run up to the bathroom and just as you walk in, the doorbell rings, and you know it is the delivery you have been waiting for. You squeeze hold and run down stairs. the muscles you squeeze are the pelvic floor muscles. They are also the ones that stop you passing wind in polite company.
If you are still unsure about whether you are able to identify the muscles, imagine you have started to wee and need to stop suddenly...the doorbell is ringing again. Although it used to be recommended to stop mid flow of a wee, to test this, it is not advisable, however if you do struggle, you can try this once, but not the first wee of the day.
It is not advisable to practice stopping mid flow of an actual wee however.
Ladies please remain seated.
It is often easier to start these exercises laying down with your knees bent and slightly apart. Gently squeeze the muscles around your back passage and then imagine you are holding the need to wee. you should start to feel a slow, gentle drawing up of the muscles as they contract.
Hold for 2 seconds and then slowly release.
Whilst doing this be careful to not clench your buttocks or tighten your tummy muscles. Also don't hold your breath, keep breathing slow.
Gentleman , please stand a little closer.
As the ladies, try initially in lying, although some men find it easier to start in sitting.
Gently squeeze the muscles around the back passage, as though you are stopping yourself passing wind and stopping yourself passing urine at the same time. Using a mirror can also give a visual guide to men as to the lifting affect of contracting the muscles and maintaining the hold.
Try to hold for 2-3 seconds building up to 10 seconds, for 8-12 reps, complete 3 sets.
If 10 seconds seems far away, use it as your goal and build up to it ( see 3 sets of 10 blog). This is the way to start building endurance and hold over time in the muscles. Once you can comfortably do in lying, progress to sitting, then standing and then walking and activity.
Once you have achieved this control, then start to build on that fast control, with quick bust contractions. Aim to do 10 on/off, on/off contractions, again 3 sets of 10 as an aim.
The key to pelvic floor muscles is that they require frequency and commitment, and the expectation that it will take several weeks before you start to see results.
What else can I do to help?
Also be aware of the other risk factors mentioned and also address any of the issues that you can
avoid constipation
drink plenty of fluids limiting caffeine
lose weight.
engage the practice as you start activity
avoid too much strenuous exercise with high impact whilst you are re training your muscles
don't go " just in case". Aim to empty your bladder at intervals between 2-5 hours during the day.
The myths to ignore
I am too old to train mine, no skeletal muscle is unable to adapt and train due to age.
I did the damage at childbirth, so I cant, even following tears and instrumental births, training still works.
I need to practice stopping mid flow on the loo, don't! this can be linked to an increased incidence of urine infections, which in turn ca perpetuate the problem.
pelvic floor exercises are easy, just no! they take concentration and effort to gain the best, just like any muscle strengthening programme.
I don't have a problem so I don't need to do them, these exercises are not just great at rectifying a current problem, but are great at preventing future problems.
So what do I do now?
Go forth and squeeze, and if you find it a struggle to identify whether you are successfully doing, or see no change after doing for 8 weeks or more then contact your local physio, GP or continence adviser.
Note from the author:
I can personally attest to the effectiveness of this exercises. Following two pregnancies, with forceps delivery with episiotomy for one, I put down the quick recovery of my pelvic floor down to regular pelvic exercises throughout and after both pregnancies. I have continued these exercises, and can hand on heart say I run, trampoline and play footie with a full bladder, and can boast no leakage ever occurs They really do work!!!
If you would like to improve your pelvic floor muscles, or are interested in our Pilates program, please contact us or like and follow us on Facebook.
