Claire Brodie, Women’s Health Physiotherapist and owner of Spring Physio answers some common questions about pelvic health and exercise.
Why is it important that we raise the awareness of pelvic health?
The pelvic floor is an often neglected group of muscles, despite a staggering number of people having issues with them. 1 in 3 women suffer urinary incontinence, 1 in 2 women over 50 have a prolapse and 1 in 10 women experience fecal incontinence. Whilst the stats are lower for men, they have issues too! Historically, talk of problems such as prolapse and incontinence have been taboo and as a result of this women wait 7 years (on average) to seek help. The use of social media campaigns such as www.pelvicroar.org are doing a great job of raising awareness.
What does your pelvic floor do?
Your pelvic floor provides support to your pelvic organs and stops you leaking wee, poop and wind. It helps with sexual function; forms part of our core muscles and therefore has an important role in rehabilitation of back and pelvic problems
Aren’t symptoms like incontinence normal after childbirth?
Absolutely not! Just because something is common doesn’t make it normal. Having issues with incontinence can have lots of detrimental side effects – lowering self esteem, avoiding certain kind of exercise, fear of having an accident in public and the financial implications of regularly buying pads.
The great news is that for most women, conservative management will be effective at resolving their symptoms.
I’ve already tried to doing kegels at home and nothing has changed. Does that mean conservative management won’t help?
No! Kegels are just the beginning of the story. It is important that the pelvic floor is trained functionally and to the level that is required for each individual in everyday life. The amount of pelvic floor endurance required when comparing a sedentary person and a cross fitter is very different. Effective pelvic floor rehabilitation ensures the pelvic floor has been trained to tolerate the load required for each individual person.
I’m leaking when I exercise, should I stop exercising?
There are lots of ways to modify exercise to stop leaking in the short term. This may be altering the way you run or lift, changing the weight or reps; reducing impact. Pessaries can also be useful for running if you have a symptomatic prolapse. A women’s health Physiotherapist can guide you through this process and ensure you exercise at the right level.
In the long term the goal is to strengthen your pelvic floor enough to manage the pressure that’s being created during exercise so that your can return to your normal regime without fear of symptoms.
Should I buy a pelvic floor strengthening device to use at home?
Many of the gadgets on sale on line are expensive and are not always suitable. I would advise having an assessment with a women’s health Physiotherapist first to accurately assess your problem and provide direction on the best course of treatment. You can see your GP for referral on the NHS or see a Physiotherapist privately.
Diastasis is a much talked about issue post pregnancy and many women get very concerned during pregnancy when they detect a gap in their abdominals.
So what do we mean by diastasis? Diastasis refers to the gap that can occur at the middle of the abdominals. Think about your six pack muscles - the central line down the middle between those muscles is the linea alba. During pregnancy the gap at the linea alba between the rectus abdominals (six pack muscles) gets bigger to allow for the growing baby.
Post natally the gap should return to around 1cm with good tension but for some women this doesn't happen on its own. Where there is an ongoing gap, women often report weakness in the core and they often feel they continue to look pregnant even months after giving birth. They may also have other symptoms of a weak core such as back pain and stress incontinence.
It is important to note that it is not only women post pregnancy who get diastasis! Men can get it too. It can be caused by weight gain, muscle imbalance or medical history.
The things is, it's not just the gap that gives therapists an indication of what is going on with the core. When I assess the gap, I'm actually more interested in the tension that is present when the abdominals are activated than the width of the gap. A small gap with good tension can provide good core support in every function, but a small gap with weak tension is more likely to be problematic.
The goals of therapy are to regain good tension at the linea alba and more often than not, the gap will reduce too.
Check out this video on how to self check your abdominal gap. When you feel the in between the gap do you feel like your finger could just keep going? Or is there good resistance as you press down into the gap?
In other European countries (eg. France) it is a routine part of post natal care to have a course of Physiotherapy after birth.
Unfortunately, in the UK that is not the case. As a result, common post natal issues (eg. leaking with exercise, prolapse and diastasis) have been seen by the female population as a normal part of motherhood, something that just has to be put up with. Many women assume incontinence pads are the answer (thanks largely to a leading brand that have convinced women it is the only solution) and don't even consider that a course of pelvic floor strengthening will improve and in many cases cure the problem.
Even if you don't suffer any pelvic health issues, your pelvic floor will have been significantly stretched and weakened by childbirth. Look after your pelvic floor and core now and you are less likely to suffer problems after subsequent pregnancies or later in life. Check out this video to see how pregnancy affects your pelvic floor.
A Women's Health Physiotherapist has had specialist training to assess your pelvic floor muscles. They can detect whether your pelvic floor is tight or weak, whether pelvic floor muscles are contributing to other painful areas (such as the sacroiliac joint) and can also assess neighbouring muscle groups such as the gluts which have an impact on pelvic floor activity. They can also check you are recruiting your pelvic floor muscles correctly.
Once your baseline strength has been assessed an appropriate holistic strengthening programme can be prescribed. Improving your pelvic floor/core strength can improve many conditions including back pain, prolapse, posture, sacroiliac problems and incontinence. Your Physiotherapist can advise how to safely return to higher impact activities such as running and sport, ensuring your pelvic floor rehabilitation is focussed on your personal goals.