After growing and birthing two babies and working with hundreds of pregnant and post-partum mothers over the years, I wholeheartedly understand the importance of a strong and capable pelvic floor. Lifting and strengthening the pelvic floor is a vital part of any yoga practise but it never ceases to amaze me how many women have no idea what the pelvic floor is or how it works. However, a quick discussion about the side-effects of a weak pelvic floor - incontinence and prolapse - and those women are kegel exercise devotees for the rest of their life. As a yoga teacher I regularly share statistics to support my information and as recent studies have shown, 37 per cent of Australian women suffer from urinary incontinence after pregnancy and/or menopause - yes, it's a common problem but it can be rectified with correct treatment and exercise.
The pelvic floor is often described as a hammock or trampoline; a set of muscles that essentially form the floor or base of the bony pelvis. It wraps around the openings of the pelvic organs (bowel, bladder and vagina) to control and support them, relaxing and opening as required. Ultimately, the pelvic floor actively responds to increases in pressure within the pelvis and abdomen, supporting the pelvic organs, contributing to continence and forming a vital part of our core stability that supports the back.
Perhaps the most important thing to know about the pelvic floor is that it's just like any other voluntary muscle - it can be strengthened and thickened with exercise and thinned and weakened by disuse or injury.
Contrary to popular belief, it's not just the natural birthing process that weakens the pelvic floor. Imagine a towel, held taught at four corners. Now place a full term baby on there, a few kilograms of amniotic fluid, a placenta and about 10-20kg of body weight. The towels is dipping now, isn't it? That's exactly what your pelvic floor does in pregnancy, hence pregnancy plays a significant role in the stretching, thinning and weakening of the muscles (your hormones also contribute to this as they soften the connective tissue in the body).
For women, pregnancy, weight gain, the birthing process, continual heavy lifting, hormonal changes and menopause can all contribute to a weakened pelvic floor. For me, its been most profound in the weeks following birth when I would experience an internal dragging feeling if I had spent too long on my feet or had carried baby for longer than necessary. It's not a comfortable feeling whatsoever so in those instances I would always lie down and practise my pelvic floor exercises. Thankfully, years of yoga practise has increased my awareness of the pelvic floor - how it works, how it feels to use the muscles and what to do if I feel they need strengthening.
The Role of a Female Physiotherapist and PeriCoach
Chances are that someone you know has sought the advice and guidance of a female physiotherapist. If you experience a vaginal birth and subsequent 3rd or 4th degree tear you will automatically be referred to a female physiotherapist to ensure that your perineum heals and you're well aware of how to strengthen your weakened pelvic floor. However, female physiotherapists see women of all ages and their role is vital for the health and wellbeing of many. Most women will see a physiotherapist if they are experiencing the side effects of a weak pelvic floor (urinary incontinence is a major factor) and will be given an exercise program to take home with them.
One of the most common techniques used by a female physiotherapist to determine the strength of the pelvic floor and to highlight the muscles to the patient, is to use an internal training device that monitors the movement of the muscles. Launching in Australia in January, PeriCoach is a similar product designed to be used by women at home for a few minutes a day (and if you're wondering, no, it doesn't vibrate!). Essentially it's a sensor device that detects pelvic floor muscle activity and measures the strength of each muscle contraction, linked to a smartphone app via a wirless bluetooth connection (pelvic floor exercises just got high-tech!). The app collects and analyses the readings and gives the user and, potentially, their doctor, a picture of how they are going over time. Ultimately, it's reassuring for women to know that they are doing the exercises correctly, it helps them to stay motivated and, most importantly, helps them achieve positive results.
Designed by Australia's leading pelvic floor specialists (specialists in urogynaecology, gynacology and pelvic physiotherapy) and manufactured in Australian from BPA-free plastic, this product is most definitely a personal one, but offers women a positive step towards the health of their pelvic floor and bladder - for life.
Urinary incontinence is not something you should have to put up with, nor is it something to be embarrassed about (as mentioned above, one-third of Australian women suffer from it to some degree). If you would like to know more about how to improve your pelvic floor, visit PeriCoach for information and advice or follow their facebook page.
Five Ways to Strengthen Your Pelvic Floor
I chatted with Annette Innes, Principal Physiotherapist at Hahndorf & District Physiotherapy Service, about the role of the pelvic floor and asked her about the best ways to strengthen it. Her advice?
1. ensure that the exercise techniques you are using are optimal and correct. If you are unsure, see a Continence and Women's Health Physiotherapist (look here for a local specialist or ask your GP, Obstetrician or Midwife for a referral). A therapist will assess you and provide a series of personalised exercises.
2. try the "stop the flow" test - stop the flow of urine midstream but don't do it first thing in the morning when you have a full bladder and strong flow. Only practise once per wee and make sure you start the flow again to empty your bladder. This test should only be done once a week. Be mindful that this isn't an indication of your pelvic floor strength but it does help you to locate and understand how the muscles work,
3. set aside some time each day to do your exercises. You will need to focus to do a correct contraction at first so practising at the traffic lights may not be a good or safe idea. Some women practise after they have gone to the toilet and whilst washing their hands, before they go to sleep at night, whilst breastfeeding etc. The aim is to fit it into your daily life and with persistence, you will succeed.
4. don't try too hard! It's important to localise your exercise to the muscles around your vagina and urethra. Some women can automatically contract their neck and shoulders so remember - keep breathing!
5. visit the PeriCoach website and the "find a clinician" section - look for a trained therapist who can help with your program and monitor it online to support you. Also, opt for the reminder texts to help maintain your exercises.