AUTHOR: DELENA CAAGBAY, BOUNCEREHAB WOMEN’S HEALTH PHYSIOTHERAPIST & MATTHEW CRAIG PRINCIPAL PHYSIOTHERAPIST AT BOUNCEREHAB
Most women who have had a baby have heard about Kegel’s or pelvic floor muscle (PFM) exercises. Arnold Kegel first described ‘Kegel’ exercises in 1948 as a way of restoring function to the pelvic floor muscles after child birth (Kegel, 1948). While we may have heard of these elusive exercises it is difficult to know if you’re doing them the right way.
A recent study found that 1 out of 6 women incorrectly performed a PFM contraction with verbal instruction (Henderson et al., 2013).
Don’t feel bad if you’re having a hard time getting it right because performing PFM exercises correctly is actually quite tricky. Not only is it important to accurately contract the PFMs but to also know how to fully relax them is problematic in many cases.
WHAT ARE THE PELVIC FLOOR MUSCLES?
The PFMs sit in the base of the pelvis like a hammock. The muscles go from the pubic bone to the tailbone (front and back) and from both ‘sit-bones’ (side-to-side) (Bo et al., 2015). They are a group of muscles and soft tissue that work together to support the pelvic organs. These muscles give us voluntary control over the bladder and bowel so that we can decide when to empty them. When these muscles are weak, the closing pressure around the urethra and anus decreases leading to accidental flatulence and urinary/faecal incontinence.
Above: Side view of the pelvic floor (red hammock of muscle) containing the bladder, vagina, uterus and rectum. “The Boat Theory” gives an analogy of the pelvic floor muscles acting as a suspensory ‘elevating’ system.
If you’re an anatomy nerd, watch this:
WHO SHOULD DO REGULAR PFM EXERCISES?
• Pregnant women • Women who have had a baby • Women during menopause • Women who have a pelvic organ prolapse • High level athletes • Men and women over 60 years old • Men and women with urinary or faecal incontinence • Men with prostate issues • Men with erectile dysfunction
HOW TO START A PFME PROGRAM?
One of the hardest things about a PFM exercise program is remembering to actually do it! It is recommended that the exercises are performed three times a day. One way to remember to do them is to pick three things you do every day and pair them up. For example, brushing your teeth, putting the kettle on, watching the news or driving to work. Another way is to use a memory jogger; this could be a small circle sticker that is placed in a spot that you see every day. You could have a sticker on the fridge, bathroom mirror or bedside table to remind you about doing your exercises. In today’s modern age, setting an alert on your phone is a very easy option also.
There are three common descriptions that are used to visualise how to contract the pelvic floor muscles.
They are: 1. “Imagine trying to slow the flow of urine”, and/or 2. “Imagine trying to stop passing gas”, or 3. “Squeeze and lift your muscles inside your pelvis”.
When you squeeze your PFMs, the muscles are inside your pelvis and no one should be able to tell you are doing your exercises.
HERE’S A GREAT EXPLANATION OF HOW TO DO YOUR PFM EXERCISES:
COMMON MISTAKES DURING A PFME PROGRAM
Some common mistakes people make when doing their PFMEs: • Hold their breath • Tighten their stomach muscles • Squeeze their buttocks and thighs • Bear down or push down through the muscles • Don’t fully relax the muscles between contractions
The Continence Foundation of Australia has some great resources you can download for free. Pelvic floor muscle exercise for women: http://www.continence.org.au/pages/pelvic-floor-women.html Pelvic floor muscle exercise for men: http://www.continence.org.au/pages/pelvic-floor-men.html They also have a free national helpline you can call and speak to a Continence Nurse to ask for information and advice. Call: 1800 33 00 66
Here’s a good fact sheet on pelvic floor muscle exercise: http://www.bladderbowel.gov.au/assets/doc/Factsheets/English/06PelvicFloorWomenEnglish.pdf
WHEN TO SEEK HELP FROM A PHYSIOTHERAPIST
The biggest risk factor for pelvic floor disorders in women is childbirth.
It is a great idea for women who are pregnant to see a women’s health physiotherapist for a pelvic floor assessment and advice on prevention strategies (Morkved and Bo, 2014). For women who have had a baby, a physiotherapist can assess their pelvic floor function, pelvic alignment, abdominal separation (rectus diastasis), posture and give advice on how to safely return to your normal physical activity.
As we get older, both men and women can experience issues with their pelvic floor. There is normal age related muscle weakness that can reduce pelvic floor muscle control. Additionally, men may have problems with their prostate, leading to incontinence and sexual difficulties and women may start to experience symptoms of a pelvic organ prolapse or other pelvic pain conditions (Alves et al., 2015, Centemero et al., 2010).
If you experience any symptoms such as incontinence, feeling of a prolapse, a sense of urgency, incomplete emptying, or pelvic pain, it is best to have a session with a pelvic health practitioner. This could be a physiotherapist or continence nurse advisor. In their assessment they will ask questions about your medical history, lifestyle and symptoms.
They may also do a pelvic exam, use real time ultrasound or biofeedback to accurately assess your pelvic floor muscle function (Thompson et al., 2006).
At bounceREHAB our physiotherapists are experienced with use of Real Time Ultrasound for demonstrating with the greatest accuracy and visual feedback your ability or inability of isolating a pelvic floor muscle contraction.
It is important to have a thorough assessment to identify the key issues related to your symptoms. Contact BounceREHAB for more details or to book your assessment today.
PELVIC FLOOR MUSCLE TRAINING V’S NO TRAINING. WHAT DOES THE RESEARCH SAY…
A recent Cochrane Systematic review on this topic was completed: Dumoulin C, Hay-Smith EJC, Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2014, Issue 5.
Main results of the research: Twenty-one trials involving 1281 women (665 PFMT (Pelvic Floor Muscle Training, 616 controls) met the inclusion criteria; 18 trials (1051 women) contributed data to the forest plots. The trials were generally small to moderate sized, and many were at moderate risk of bias, based on the trial reports. There was considerable variation in the interventions used, study populations, and outcome measures. There were no studies of women with mixed or urgency urinary incontinence alone.Women with SUI (Stress Urinary Incontinence) who were in the PFMT groups were 8 times more likely than the controls to report that they were cured (46/82 (56.1%) versus 5/83 (6.0%), RR 8.38, 95% CI 3.68 to 19.07)
17 times more likely to report cure or improvement (32/58 (55%) versus 2/63 (3.2%), RR 17.33, 95% CI 4.31 to 69.64).Women with either SUI or any type of urinary incontinence were also more satisfied with the active treatment, while women in the control groups were more likely to seek further treatment.Women treated with PFMT leaked urine less often, lost smaller amounts on the short office-based pad test, and emptied their bladders less often during the day.
Their sexual outcomes were also better. Two trials (one small and one moderate size) reported some evidence of the benefit persisting for up to a year after treatment. Of the few adverse effects reported, none were serious.
Authors’ conclusions: The review provides support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress and any type of urinary incontinence.
If you have questions about your pelvic floor function, book an appointment with our pelvic floor physiotherapist at bounceREHAB today!