I’ve been talking pelvic floors (PFs) with Katie Marshall of My Body Balance, super physiotherapist particularly qualified in female health, mother of two young girls, and all round legend. She tells me 1 in 3 women have ‘urinary incontinence’, what you CAN do about it, and the risks of ignoring it – yes YOU: it’s not ok to wee when you sneeze or always need the loo during your work out!
What is the pelvic floor?
The PF is a group of muscles forming the base, or floor, of the pelvis. The muscles attach from the public bone in front of the coccyx (tailbone) at the back. If they are working well they should react automatically to help control the bladder and bowel. They also provide support to the vaginal wall and may help you feel more during sex. (from http://www.Squeezy.app.co.uk)
Is it normal to wee when I sneeze?
No! And it’s awful that so many people think that’s a normal part of life after having had kids or once you reach a certain age. It’s not: something can be done about it.
Is it possible to improve my PF control?
Yes! It’s definitely possible to improve through exercise. The bad news is it’s not a ‘quick fix’. Like all muscles, it takes 12 weeks of exercise to build the PF muscle. But it’s so worth it: PF exercises help about 70% of women – if you do them right. If they don’t work, there are devices and even surgical options, so never think that you have to just live with it.
Will my PF get stronger naturally with time?
Probably not. Muscle does have the ability to recover from trauma, but this often requires a tailored strengthening programme. Other factors can also cause weakening of a woman’s PF, including obesity, long distance running, or heavy lifting, including babies and children. And as we get older our hormone levels change which can further weaken the muscle. In other cases women can have an overactive PF which requires proper assessment, as it’s made worse by strength training.
So what should I do?
If you are having any symptoms, like leaking, feeling of bearing down through your PF or pain, it’s best to have a PF assessment with a specialist physio. Even if you aren’t having these symptoms, the best way forward is to see a physio and get proper instruction on how to do PF exercises so you avoid doing it wrong, making it worse, or not getting the full benefit.
Unfortunately it’s very common to do the exercises wrong: research suggests that of women who just do them with just verbal instruction, about 11% are doing it effectively, but about 14% are doing it ineffectively and up to 25% are ‘bearing down’, which can make the muscle weaker (Bump, 1991).
As well as making sure you are doing it right, working with an expert means you can do the right amount of exercises depending on how strong (or weak) you are to start with. There’s no point aiming for 10 fast 10 slow and 10 holds if that’s way beyond your current reach.
(Having said that – do check out ‘The right way to do pelvic floor exercises’ below!)
How much is this going to cost?
How many appointments you need totally depends on where you are. It could be one appointment to assess and learn the technique, and then you come back a few weeks later to check you are still doing correctly. If your PF is very weak you might need more help and a strengthening programme or access to a ‘feedback machine’ so you can visually see what’s happening internally when you are doing the exercises.
If people aren’t going to a physio should they just start doing PF exercises?
Yes – it’s definitely worth a try. But first I suggest they research to check how they should activate it correctly – for example pull up from back of the PF first and try not to let your bottom muscles or anything else activate at same time. (See below for a guide to doing it right!) Maybe buy a pelvic educator or cones – they are only about £15. And definitely check out the NHS Squeezy app.
How do I know if i’m doing it right?
You will know if you are doing it right if your symptoms start to improve.
How long do I need to do the exercises for?
You should do PF exercises three times a day. Your goal is to build up to doing 10 x 10 second holds, and 10 fast contractions each at the same strength. And you have to keep doing them: like any muscle it takes 12 weeks to strengthen and only 3 weeks to waste!
It’s a good idea to get into the habit of doing the exercises when brushing your teeth, waiting at traffic lights or answering your phone – something you do regularly throughout the day.
Can I go running if I think I have a weak PF?
I never like to stop people exercising, but if your PF is week it’s best to choose a lower impact type of exercise like cycling and swimming. And of course core strengthening like pilates is brilliant.
Running can worsen a weak PF it because its high impact. When your heel hits the ground the impact goes up through the PF and can further stretch and weaken the muscles and connective tissues.
If you are a runner and want to continue, my advice is to make sure you are doing PF exercises correctly, and then mix your running with some cycling, swimming and pilates. Change up your running surfaces and reduce stride length to reduce the impact, and consider reducing your speed and distances. Wear cushioned footwear and minimise downhill running. And take a break during your run to do PF exercises. If you are just starting or returning to running, begin with a run/walk programme to give your PF time to build up to the strain of running. And always complement your running with exercise that challenges your stomach and leg muscles, such as pilates.
You should also take care with lifting weights. Lifting heavy weights can increase intra abdominal pressure which can stretch and weaken the PF. Modify how often and how heavy you lift, do your your PF exercises, don’t bear down, and use your breath properly when lifting. Another one to watch out for is overworking your abdominal muscles without strengthening your deep core and PF muscles. Overly strong stomach muscles can make the PF worse.
What about prolapse? Do I have it or could I get it?
Pelvic organ prolapse is when one of your pelvic organs bulges into the vagina. The symptoms depend on what is prolapsing, so can range from problems urinating or leaking when you exercise, to recurrent UTIs to a feeling of pressure or dragging between your legs. It can be caused by a weak or damaged PF, or by excess oestrogen, ageing, heavy living or even chronic constipation. Treatment depends on the degree of prolapse. If you have any concerns visit a specialist physio as soon as possible to check what’s happening and how it can be treated.
For more information:
The right way to do PF exercises
First tighten (squeeze) the muscles around the back passage, as if you are trying to stop yourself passing wind. Whilst you hold this squeeze, tighten around the vagina and urethra, as if you are trying to stop yourself from passing urine. It should feel like a ‘squeeze and lift’ inside. After each ‘squeeze and lift’ make sure you fully relax your muscles by letting them rest back to their starting level.
You may feel some of your tummy muscles working gently but the muscles in your buttocks and thighs should be relaxed. Try not to hold your breathe while you are doing the exercises – breathe in and out as normally as you can. You need to practice both strong long holds and short squeezes. You should also try doing a strong ‘squeeze and lift’ just before any activity that causes a problem.
Katie adds: “When you pull up on pelvic floor, you shouldn’t be doing it as hard as you can, postural muscle, so it needs to trained at a low level so it builds endurance”.
The NHS Squeezy App has an ‘Exercise Plan’ section that asks you do to ten slow squeezes lasting ten seconds each with a four second rest between each one, then ten fast squeezes, one per second. You should do these three times a day. It’s difficult at first, so build up gradually.