My pelvic floor muscles – or in medical speak, levator ani – and I have had a troubled relationship ever since, as a teenager consumed by a fit of giggles, I lost control of my bladder. By the time I’d given birth to my second baby the doctor warned, ‘You’ll be incontinent by 50 if you don’t do your pelvic floor exercises.’ Sure enough, since the menopause, those ‘ooops’ moments have become embarrassingly familiar.
I’m not alone. A third of us – and 25-45 per cent by menopause – experience problems, according to a study of 28,000 women. ‘Problems range from leaking urine when you run, jump, laugh, cough or sneeze to prolapse (when the uterus, bowel and/or bladder sag and bulge into the vagina),’ says pelvic floor physiotherapist, Katie Mann.
‘Your genes can affect your collagen, the ‘glue’ that holds tissues together and is responsible for their strength and elasticity. Pregnancy and birth (forceps, episiotomy and a baby weighing more than 8lb all up the risk), being overweight, constipation, and smoking can all affect the strength of your pelvic floor too,’ explains Katie. And, unless you take preventive measures, things get worse at menopause when with loss of oestrogen, collagen production diminishes weakening the vaginal muscles and supporting tissues.
We all know that the secret to a strong, resilient pelvic floor is to practise those pelvic floor exercises – aka Kegels (below). ‘All women should do them three times daily throughout life and six times if they have symptoms,’ advises women’s health physiotherapist Myra Robson. Yet many of us don’t unless, or until, we develop problems.
The great news is that new scanning techniques such as MRI and CT have led to better understanding of the pelvic floor and new ways to fix problems and coax those muscles back into shape. ‘These days there is plenty of help out there so no woman should put up with symptoms or be too embarrassed to go to the doctor,’ says Katie Mann.
As for me after years of shameful neglect, I’ve renewed my relationship with my pelvic floor and am once again doing my exercises. I’m hoping that, with time, the only ‘ooops’ moments will be when I accidentally spill a glass of wine.
What is the pelvic floor?
A group of muscles, ligaments and tissue stretching from your pubic bone at the front of your body to your tailbone. ‘We used to describe it as a supportive sling but we now know it is extremely dynamic and active, more like a trampoline’ explains Myra.
In fact, the pelvic floor is actually the lowermost part of a ‘cylinder of control’ that extends up to your diaphragm (the dome-shaped tissue at the bottom of your ribs), which is essential for core stability. Both Pilates and yoga can help you tone this interconnected cylinder of muscles.
Is it ever too late to shape up?
‘No,’ says women’s health physiotherapist Lisa Few emphatically. ‘Whatever your age, and even if you have long-standing problems, a prolapse, or have had pelvic floor surgery you can benefit.’ If at first you don’t succeed, keep at it. ‘Although you should notice a difference in the first few weeks, it can take 12 to 16 weeks for long-term recovery,’ adds Katie Mann.
Take a tutorial
One in two women do pelvic floor exercises incorrectly,’ says Lisa Few. ‘The secret is to lift and tighten and then relax.’
• Tighten the muscles around your back passage as if trying to stop yourself passing wind.
• Holding this, tighten around the vagina and urethra as if trying to stop yourself from passing urine. Squeeze and lift. Don’t do this when you’re actually passing urine as it can harm the bladder.
• Practise both long, slow holds and short pulses. After each set fully relax the muscles. Slow squeeze for ten seconds, relax for four, repeat ten times. Follow with ten fast squeezes, completely relaxing after each one – aim for one squeeze per second.
• Repeat six times a day if you have symptoms or otherwise three times a day.
• Do a strong squeeze and lift before any activity that causes problems, i.e. if you’re about to sneeze or doing star jumps at the gym.
• If you don’t see an improvement your GP can refer you to a physiotherapist for a thorough pelvic floor assessment. This lasts around 45 minutes and you’ll be asked about symptoms and your previous medical, obstetric and gynaecological history. You’ll also have a vaginal examination to assess the pelvic floor muscles and related structures.
Gadgets worth trying
Apps that do everything from charting how soundly you sleep to counting the calories when you run are the norm. But powering up your pelvic floor strength? Well, now there’s an app (or two) for that or you can buy an online consultation with a physiotherapist.
1. Squeezy. This NHS-approved app features a customisable exercise plan, reminders, audio-visual guide and exercise record. Designed by Myra Robson, from Propagator. Our tester gave it a good rating. £2.99 from the App store/Google Play. squeezyapp.co.uk
2. Elvie. Dubbed ‘your most personal trainer’ this sleek Tiffany green, silicon ‘pebble’ is inserted into the vagina where motion sensors detect muscle movement. The device is linked by Bluetooth to your mobile or tablet, you’re given a range of exercises to do and your phone displays your results so you can monitor progress. Two testers trialled it for us with one rating it as good and the other saying it wasn’t for them. £149, elvie.com
3. Online physiotherapy. Not a gadget but a live consultation via Skype with women’s health physiotherapist Jane Appleyard. She sets you a personalised plan, including links to video tutorials and you check back in after six weeks. £89 from stressfreewoman.com
4. Kegel8 Pelvic Toners. Not an app but a device using neuromuscular electrical stimulation (NMES) – electrical signalling – to stimulate your pelvic floor to contract and relax via a probe placed in the vagina. £79.99 from kegel8.co.uk.
5. AquaFlex® Weighted Vaginal Cones. A totally non-tech idea that has been around for a while uses mini weights inserted like a tampon. The effort of holding them in causes the muscles to contract. £29.99 from aquaflex-cones.co.uk.
6. The Peritone. A training feedback device which assesses your progress – each time you contract your pelvic floor you’ll see LEDS light up on screen. £164.99 from neenpelvichealth.com. The Peritone is currently being used in a study of 600 women called OPAL – Optimizing Pelvic Floor Muscle Exercises to Achieve Long-term benefits – funded by the National Institute for Health Research. Half of the women will use the Peritone and half will do the usual pelvic floor exercises. ‘Results, expected in November 2018, will tell us if women will benefit from using this technology,’ says Professor Suzanne Hagen, the trial’s chief investigator.
Note: Some devices may be unsuitable for some women. Check with your doctor or physiotherapist if you don’t get on.
• Physiotherapy. There are 500+ women’s health physiotherapists specialising in the pelvic floor in NHS and private hospitals. Ask your GP for a referral or visit pogp.csp.org.uk
• Medication. Local oestrogen (as a cream or pessaries) can restore vaginal health and many doctors recommend them from menopause onwards. Because they are topical low-dose they don’t carry the same risks as other forms of HRT.
• Surgery. The most common op, TVT (tension-free vaginal tape), involves inserting a synthetic tape through the vagina to support the urethra and bladder neck. NICE recommends it if physiotherapy fails to bring an improvement.
It’s easy to forget those Kegels so here’s how to jog your memory.
• Hitch them on to other regular routines such as cleaning your teeth or making a cup of coffee.
• Stick post-it notes around the house – by the kettle, microwave, TV, bathroom scales.
• Put a reminder in your diary or set an alarm on your mobile or other tracking device.