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Why we should all be exercising our pelvic floor muscles every day

Pelvic mesh implants made life miserable for many women. The silver lining is it has helped to focus attention on why we should all look after our pelvic floor health.

By Professor Kerryn Phelps
The challenge posed by pelvic floor health problems has come into sharp focus in recent years, as women experienced life-changing side effects from pelvic mesh implants.
The mesh implants were used in surgical procedures to treat women with prolapse and urinary incontinence, but left many women with chronic debilitating pain or suffering from recurring infections.
They are no longer used in New Zealand and, since the mesh debacle, women are searching for more conservative and non-surgical but low risk, effective options for the treatment of pelvic organ prolapse (POP) and urinary incontinence.
WATCH: Pilates exercises for pelvic floor muscles. Story continues below...
One in two women have a degree of POP, where the "sling" of muscles and ligaments supporting the pelvic organs (bladder, bowel, uterus and cervix) drop down with age or vaginal childbirth.
It can vary from a minor inconvenience to severely limiting your lifestyle.
Symptoms include:
  • Tampons not feeling right.
  • Sensations of dragging or pressure in vagina or low back.
  • Slow urine stream.
  • Incomplete bladder emptying.
  • Incontinence with sneezing, coughing, jumping or straining.
  • Trouble emptying the bowel without using finger pressure.
Pelvic health physiotherapist Angela James treats many women with POP and other pelvic issues.
"We know that with pelvic floor training in pregnancy, there is a 50 per cent less chance of incontinence in the postnatal period. Women know they should be doing pelvic floor muscle exercises but they are not sure what to do," she says.
When it comes to treatment, according to Angela, there are plenty of options:
"Many women I see say they didn't realise there was something other than surgery that could help them. They need to know that there are really effective non-surgical options available, such as muscle training to support the pelvic organs, vaginal pessaries and lifestyle measures. It is not a downhill slide."
Surgery for POP is not inevitable. There are conservative measures you can take to maintain your pelvic health:
  • Seek advice from an experienced pelvic health physiotherapist.
  • Learn pelvic floor muscle training to do at home, from an expert practitioner.
  • Try a pessary (silicone device inserted into the vagina to hold the pelvic organs in place) that suits your anatomy and condition.
  • Maintain a healthy weight.
  • Avoid repetitive heavy lifting, including lifting children.
  • Take measures to avoid constipation by making sure you have a high fibre diet and drinking plenty of water.
  • Never strain to open your bowels. Instead, sit and relax with feet on a small stool.
  • Make sensible exercise choices. Trampolining may not be right for you right now!
By managing prolapse effectively with pelvic muscle exercises, pessaries and lifestyle techniques, you can reclaim your normal life and get back to doing the things you love.
We should all exercise our pelvic floor muscles once a day, though a few shorter sessions might be easier to begin with.
Start by sitting or lying down, eventually working up to standing.
The pelvic floor muscles are tricky to isolate (or switch on) so if in doubt please see a pelvic floor physiotherapist or continence nurse.
  • Tighten the pelvic muscles as if you're "holding on" and draw them up inside. Don't push down, hold your breath or squeeze your bottom or legs. Count slowly to three. Let your muscles go completely and count to six. Repeat up to 10 times.
  • Once you're comfortable with these, try tightening for a count of six to eight. Then try some shorter, harder squeezes, working up to 20 in a row.
  • Eventually you can try to weave these into your day when standing in queues, sitting at a desk, or whenever you can take a moment
    to focus.

The do's and don'ts of pelvic floor support

Whether we've had prolapse or not, we all need to take care of our bladders, says gynaecologist Dr Janine Manwaring.
That's because those occasional tiny leaks you may notice after childbirth tend to get worse.
Plus, the oestrogen drop that comes with menopause makes all women more susceptible to prolapse.
Do: hold on
Going before you really need to go can eventually weaken your bladder. That's because pre-emptive peeing (such as before leaving the house) conditions it to hold onto less and less urine.
Don't: sit tight
Your bladder relaxes better when you sit on the toilet rather than hovering over it. In public loos, put down paper or use a disposable seat cover.
Do: stop leaks
A few drops, even during a run, is not okay because it is likely to get worse. Consult a specialist physiotherapist to learn the activities to avoid and the exercises to support your pelvic floor.
For information on pelvic mesh visit medsafe.govt.nz; for resources to help with pelvic floor health visit continence.org.nz.

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