Guest Blog by Taryn Watson
We all know that we have a pelvic floor, we know that it’s important to keep it in tip-top shape to prevent embarrassing little mishaps, and we know that in order to keep it working we need to do some exercises called ‘Kegels’, right? Well, here are five facts about the pelvic floor muscles that Women’s Health & Continence Physiotherapists want you to know about…
- Pelvic Floor Muscle exercises cannot be learnt from an information brochure
Often women are told by a midwife, a GP, a friend or the internet that they need to do pelvic floor muscle exercises (AKA ‘Kegel’ exercises, named after Mr Kegel who wrote articles about the benefits of exercising the pelvic floor muscles back in the 1950’s). This is a great starting point, but unfortunately we know from studying women performing pelvic floor contractions that many are actually doing the wrong action if they only receive verbal instruction. In fact, in one study 50% of women were incorrectly activating the muscle when checked on ultrasound, and in another study of women with pelvic floor muscle dysfunction (incontinence, prolapse of the pelvic organs) less than 40% were doing it correctly, and another 40% were activating the muscles in a way that was bearing down and could worsen problems.
So, in summary, it’s really essential to get an individual assessment of your pelvic floor before doing these exercises, especially if you already have any bladder leakage or vaginal prolapse. Make an appointment with a Women’s Health Physiotherapist who can do either an abdominal ultrasound, a vaginal examination, or both, and tell you exactly what type of exercise program you should be doing.
- It’s not all about the squeeze
Pelvic Floor Muscle exercises do involve squeezing around the urethra, the vagina and the anus. However, exercising this muscle is not just about maximally squeezing these sphincters. It’s really important to also feel an upward, forward lift of the area between your sit bones, it’s really important to be able to hold on and breathe at the same time, and it’s really important to be able to let go. It’s also essential that the muscle can be activated in a variety of postures and movements, and that it can automatically come on when a pressure goes through the abdomen like a cough, a sneeze, or a jump.
All of these things can be assessed by a specialist physiotherapist and can be integrated into an exercise program designed especially for you.
- Being able to hold on a long time between toilet visits is not necessarily a sign of a strong pelvic floor
This is something that I hear a lot of women say – “I know that I have a good pelvic floor because I can hold on for ages between going to the toilet!”. Ummm… nope. Sure, having well-functioning pelvic floor muscles can help you to get to the toilet without leaking on the way there, but going for long periods between urinating is a sign of a large bladder capacity, or not drinking enough fluid, or both.
It’s healthy to drink 1.5-2L of fluid per day, mainly water with limited caffeine, and to go to the toilet to urinate 4-7 times per day (approximately 2-3 hourly) and 0-1 times overnight. If you find yourself only needing to go to the toilet a couple of times in a 24 hour period, but you’re drinking a good amount of fluid, you should probably mention this to your GP, and work out why your bladder isn’t giving you appropriate signals to empty sooner.
- A pelvic floor can’t be ‘Too Strong’ but it can definitely be ‘Too Tight’.
I’ve heard women say that their obstetrician told them that they tore during childbirth, or they had trouble stretching the pelvic floor muscles as the baby’s head was crowning, because their pelvic floor muscles were ‘too strong’ and perhaps they shouldn’t have been exercising these muscles during pregnancy. This is worrying because it may turn pregnant women off doing these very important exercises – it’s just that they need to be done correctly.
If your pelvic floor muscles are tense and not able to stretch easily, you might experience pain or difficulty with sex, tampons and vaginal examinations. Tight muscles like this anywhere in the body are not usually very strong – they are weak because they are overworked and exhausted. This is why for this group of women, learning to exercise these muscle correctly is ESPECIALLY important.
A physiotherapist who does vaginal examinations can tell you if your muscles are able to relax on cue or not. If it turns out the you have tight or painful pelvic floor muscles and you are not able to fully relax, it is very important that you don’t do the ‘recipe’ pelvic floor muscle exercise program involving lots of quick lifts and long holds. Instead, the physiotherapist will give you a ‘down-training’ exercise program to teach you how to fully relax the muscles with a variety of techniques like breathing, mindfulness and feedback. Then when you have achieved this, you may then be given strength and endurance exercises to do, but these exercises should never be done without complete relaxation in between repetitions.
- Keeping generally fit is fantastic for your pelvic floor muscles, but there are certain types of exercises that might actually worsen pelvic floor issues if done incorrectly.
Regular exercise that challenges your muscles and gets your heart rate up is very important for all women – it can prevent heart disease, osteoporosis, diabetes and many other chronic health issues. However, research has shown that certain activities have a higher rate of pelvic floor muscle dysfunction in the form of stress urinary incontinence and vaginal prolapse. These include exercise that involve heavy loads, running and jumping, like basketball, gymnastics, and many group fitness classes.
That doesn’t mean that you shouldn’t participate in these forms of exercise if you have had a baby or you have some form of pelvic floor dysfunction. But it is highly recommended that if you’re a woman and you choose to do a form of exercise that is high impact or high load, you should have a pelvic floor assessment with a specialist physiotherapist to see what’s happening in your nether-regions while you’re exercising!
It’s not about the type of exercise, it how you do the exercise that matters. If you are doing yoga or pilates exercises in a way that pushes down into the pelvis, that can cause more problems than lifting very heavy weights with good technique. Individual assessment is the key, but the bottom line is (pardon the pun) that no leakage or prolapse symptoms should be experienced with any form of exercise. Don’t ‘pad up and play on’, see a specialist physiotherapist sooner rather than later – research has shown that if these issues are caught early, more than 80% of women are cured with an individualised program from a Women’s Health Physiotherapist.
So how do you get in touch with a Physiotherapist that specialises in Women’s Health and Continence? It’s easy – no referral is needed if you’re happy to see someone privately, just do some research into physiotherapy practices in your local area and ask the receptionist if they have any practitioners who have done extra training in Women’s Health & Continence. If you’d like to see someone in the public system, ask your GP to refer you. Ideally it would be good to see a physiotherapist who does internal vaginal examinations as this will give you a much larger amount of information than an external assessment.
Taryn Watson is a Women’s Health & Continence Physiotherapist from Perth, Australia. She runs a pregnancy and postnatal exercise class business called FitRight. If you’re pregnant or have recently had a baby, check out her recently launched online video series called ‘Postnatal Rehab: The First Six Weeks’ – you can learn all about early rehabilitation exercises and advice for the pelvic floor muscles, the abdominal muscles and more.
Taryn consults from Southcare Physiotherapy in Murdoch and can see patients for pelvic floor muscle assessments there – call 9332 2132 for appointments.