Pelvic Floor Health 101

• Fast twitch (these are fewer) they work when a quick powerful contraction is needed (sneezing or coughing)
• Slow twitch - responsible for the tone of the floor - they help us continent or in control of our release
  The pelvic floor muscles form the base of the group of muscles commonly called the ‘core’. These muscles work with the deep abdominal and back muscles and the diaphragm to support the spine and control the pressure inside the abdomen.

Your pelvic floor muscles are pretty amazing but sadly they are some of the most neglected muscles in our body even when they are malfunctioning!

Like any muscle in the body, pelvic floor muscles can be trained with regular, targeted exercise. In almost all cases it’s possible to gain control over the pelvic floor muscles and to train them to do their job well.

Pelvic floor muscle exercises can help with:

• improving bladder and bowel control
• reducing the risk of prolapse
• better recovery from childbirth and surgery
• increased sexual sensation
• increased social confidence and quality of life

The first thing you need to do is find out which muscles you need to train. It is very important to correctly identify your pelvic floor muscles before moving into a regular pelvic floor muscle exercise program.

If there is a problem with bladder or bowel control, it is important to be properly assessed as weak pelvic floor muscles are just one of the many causes of incontinence.

PART 2 Pelvic Floor Rehabilitation
Pelvic Floor Rehabilitation dates back over 6,000 years ago starting with the Chinese Taoists. But it wasn't until the 1940's that American Gynecologist, Arnold Kegel, invented the Kegel perineometer, the first biofeedback machine, that it got a little more attention by women suffering weak pelvic floor muscles post childbirth. I’m sure you’ve all heard of the Kegel exercise - now you know where it stems from!! What a legacy, right??

The Kegel perineometer was a machine that would track a woman's progress of strengthening her pelvic floor - like a Fitbit for you lady parts! This process was a daily 20 minute activity, obviously not something busy women of the 21st century want to be spending their free time participating in.

Pelvic Floor Rehabilitation exercises that don’t require much time or equipment.

The most important thing about pelvic floor exercises is to isolate and use the right muscles, and then to make the exercises part of your daily routine.

Below are a few techniques to help develop an awareness of your pelvic floor muscles. At first you might find it hard not to just squeeze your bum or your legs together. It's also important to breathe normally, so try not to hold your breath.

• Sit on the arm of the chair, an exercise ball, or any hard surface with your feet flat on the floor.
• Lean slightly forward with your vulva area in contact with a hard surface. With your hands on your thighs try to lift the area around your vagina and anus away from whatever it is you are sitting on.
  If you are a tampon user, try inserting one, then pull gently on the string. At the same time contract your muscles around the tampon to stop it coming out, like a little tug of war. This is a good way of helping you to isolate and use the correct muscles.
• Sit up straight on the toilet with your knees apart. Using the restroom, try to stop the flow by contracting your muscles up and inward. Squeeze, lift, and hold for a moment and then let go. Don't worry if the flow did not stop all together, remember which set of muscles you use. This is just a test to figure out which muscles you are contracting. **Do NOT do this on a regular basis as it could be harmful to your bladder.
• When you are having sex try to squeeze your partner's penis or finger. This may help you isolate your pelvic floor muscles - ask for feedback, did they feel that little “hug?”
• Pretend you are about to pass gas, pull up the muscles around your anus, squeeze, lift, and hold.
  Those muscles you were tightening above are your pelvic floor muscles. They include the ones around your anus and the ones around your vagina. They form the cradle of muscles that support your rectum, vagina, and urethra. You should use all of these muscles together when performing the exercises.

>>> Still not sure that you have isolated the correct muscles, please seek help! Most health authorities have special continent nurses and women's health physiotherapists who can help you engage with the correct muscles.

How to perform your pelvic floor exercises:

• The best position is lying on the floor or on an exercise ball - standing up, though often talked about in women’s magazines, is not recommended due to gravity and those that have a prolapse.
• Draw up all the muscle at the same time, squeeze, lift, and hold for a count of five, if you can.
  Keep practicing and try to slowly build up until you can hold it for 10 seconds. This could take you a few weeks or even longer, you may have to start by contracting your muscles for just one second, and that is totally ok.
• Once you have held one for up to 10 seconds let go gently and count to five, this is the rest phase of the program. It is very important that you don’t overtire your muscles, particularly when you are just starting and your muscles are weak.
• You will need to repeat the same exercise - hold for 10 release for five, five times each day up to three times per day if you can.

It's likely to take several weeks before you start to see an improvement. Whatever you do, don't give up! And once you start to see that improvement, continue to do these exercises. Just like building muscle in your body this is an ongoing thing! Once you stop it will decrease in ability.

Other ways to improve your pelvic floor include improving your core strength. Our core is important for posture, stability, and for movement. Our core is made up from the pelvic floor muscles at the bottom, the abdominal and back muscles, and the respiratory diaphragm at the top. If you have a weak pelvic floor or know that you have diastasis recti you should be very careful not to do some specific core exercises like sit-ups or crunches.

It's important to make this a habit that you add somewhere in your daily routine. You brush your teeth every morning would it make sense for you to drop to the floor and knock out your pelvic floor exercises? Make sure you add it where it would make the most sense. Maybe when you're laying on the floor and watching your favorite show in the evening, or part of your stretching after your workout, or add it to your a.m. or p.m. stretching routine. FInd a strategy that works best for YOU that you can continue to do daily over the long haul.

PART 3 Tools and Gadgets:

• The Squeezy app for women is an app where you can follow a preset exercise program or tailor the app to a pelvic floor program designed specifically for YOU. The App will remind you to do your exercises, time your contractions and rest, and has a bladder diary setting which may give you an insight into what is happening with the fluid intake and urine output - information that will be very helpful if you are in need to see a specialist health care professional. It also has lots of helpful tips for bladder health.
• Vaginal Weights or cones help strengthen your floor by increasing in weight and size as your floor gets stronger. (this will most definitely be a product spotlight in the future) ** Please note this treatment is NOT for everyone, particularly women with prolapse. It’s a good option for those with mild stress incontinence to help improve your floor tone (again more to come on that one)
• Electrical Stimulation - This is something that is either performed in a clinic by a pelvic floor specialist, or using machines that are available to buy online or from Healthcare professionals. Something like this would be good for someone who has no awareness of their pelvic floor contracting. It's a great way to wake up your muscles.
• Elvie and similar devices - this small, intravaginal device connects to your smart phone and works with an app to give you biofeedback. It instantly tracks and provides information on how strong your contractions are. You can even set up competitions with your girlfriend on the app - like a Fitbit challenge for your vagina!
• Vaginal Pessaries (think sports bra for your lady parts). This is a removable device that is inserted into your vagina (usually by a doctor or women’s health specialist) made from silicon or soft plastic.
• Yoga and Pilates is also a great way to strengthen your pelvic floor health, especially those suffering from urinary incontinence. BUT don’t count on this as a cure, it’s just a great additional tool in your toolbelt.

>>>> It’s a lot I know - but remember this is going to benefit everything! From making your quality of life better (like not being afraid to sneeze at the grocery store) to your sex life and your fitness (jumping jacks here we come!!)

It is likely to take several weeks before you start to see an improvement. Whatever you do, don't give up!

You may find it more difficult to do the exercises in the evening, as your muscles tend to be more tired, much like the rest of your body. It's also possible that you noticed an aching sensation shortly after starting a pelvic floor exercise program, this is usually due to your muscles getting tired, as with any new fitness regimen. The aching in your pelvic floor muscles will subside as your muscles get stronger. If it continues, stop doing the exercises for a couple days for a little R&R.

As with anything health related (1) do your own research and (2) talk to a qualified health professional.

My goal is to open the dialogue, I am in no way, shape or form a substitute for a licensed professional. What I want is for you to know that there are treatment options - not all doctors are super knowledgeable about specific topics and may shut you down due to their inexperience, not your need for treatment. So never be afraid to get a second opinion and be an advocate for your health - just because it's common doesn’t mean you have to settle!!

The goal for treating pelvic floor dysfunction is to relax the pelvic floor muscles to make bowel movements easier and to provide more control.

It's important to understand that kegel exercises, or similar techniques that require you to contract your muscles, will not help this condition. While surgery is an option, there are less invasive treatment options available.

Other treatment options include:

• Medication. Your doctor may prescribe a muscle relaxant to help with pelvic floor dysfunction symptoms. The relaxants can prevent your muscles from contracting.
• Self-care. To reduce strain on your pelvic floor muscles, avoid pushing or straining when using the bathroom. Relaxation techniques such as yoga and stretching can also help to relax your pelvic floor muscles. Taking warm baths is another useful technique. Warm water improves blood circulation and relaxes the muscles.
• Surgery. If your pelvic floor dysfunction is the result of a rectal prolapse — a condition that causes the rectal tissue to fall into the anal opening — surgery will loosen the affected pelvic organs and cause them to relax.

I get it, it can be embarrassing to talk about, but living in pain or discomfort is not necessary - pelvic floor dysfunction is a highly treatable condition. Talk with your doctor about your symptoms to get a proper diagnosis. There are several home remedies you can try before resorting to medication or surgery for treatment.

Want to know about your Pelvic Floor Health? Check out The Pelvic Floor Bible by Jane Simpson, I found this book to be super informative!!

Also, if you haven’t already done so, make sure you are part of our women’s health community on Facebook The Midlife Athlete!!