Guest post: “Pelvic floor issues are still frequently ignored”

[MumsnetGuestPosts]

Why aren’t strong and well-functioning pelvic floor muscles really important to us all? Why is leaking when we sneeze OK, or standing on the doorstep, desperately trying to get the key in the door, and racing to the toilet before disaster strikes something that we put up with?

I’ve been a continence nurse for the last 25 years, currently working at The London Clinic on Harley Street. I’ve seen over 35,000 patients in that time and was recently described by the Times as ‘the Dr Dolittle of Vaginas’. I was inspired to write my new book, The Pelvic Floor Bible, when I heard the report from the recent Royal College of Midwives stating that a third of existing and expectant mothers don’t do pelvic floor exercises, despite their reported benefits. This statistic shocks me and has inspired me to start a pelvic floor revolution. We need to look after our pelvic floors in the same way we treat and exercise the rest of our body. Our pelvic floor is so important and when working well it helps keep us continent, is good for our sex lives, prevents prolapse and even enables us to poo better.

There is no reason that anyone has to put up with weak pelvic floor muscles. Yet we do. I wonder if it’s because it’s neatly tucked away, or it’s one of those things we say we’ll get round to, but never do. I imagine there’s a lot of pelvic floor leaflets in a box somewhere in your house that you took home from the maternity ward, gathering dust. I also think that while it is a very common condition, with over 200 million people affected by it worldwide, it’s still hugely under-reported and remains a taboo. While we’ve almost become comfortable discussing periods and tampons, pelvic floor issues are still frequently ignored, despite affecting one in three women in the UK. This absolutely has to change. I want to normalise discussions around this part of our body and make pelvic floor exercises part of our everyday routine.

I hope the next bit inspires you to make a plan. Pelvic floor exercises, when done correctly, take up just a few moments of your day. Regardless of whether you’ve suffered any problems thus far, it’s important to get into the habit and make it work for your lifestyle. That way, you are much more likely to do it. It’s all about making it doable for you.

Here are my quick tips for great pelvic floor muscles:
The two most important things of all are, are you using the right muscles and are you doing the exercises regularly.

Sit on the arm of a chair, or any hard surface with your feet flat on the floor. Lean slightly forward with your vulval area in contact with the 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.

Draw up all the muscles at the same time, squeeze, lift and hold for a count of five if you can, then try to build up to holding for ten seconds over time. Then, let go gently and count to five, repeat five times. Try to do the exercises at least twice a day; while cleaning your teeth is good time so that way you will never forget..

Once a day, you should try to also do ten short, sharp contractions. Done in a rhythmic pattern of squeeze, let go, squeeze, let go.

If this isn’t going to work for you, please don’t give up. You could try the Squeezy app, vaginal weights, or the Elvie trainer. If you are still not able to, seek help from a women’s health physiotherapist or a continence nurse specialist. Whatever you do, don’t suffer in silence anymore.

The Pelvic Floor Bible by Jane Simpson is published by Penguin Life, priced £9.99

MNHQ UPDATE: Jane Simpson will be returning to this post on 20 June to answer some user questions

@fairybeagle

Can you do pelvic floor exercises when you're pregnant?

Yes you can, One reason is it's important to have isolated your pelvic floor muscles before giving birth so that afterwards you are able to remember how they felt before your delivery or you will have nothing to compare it with. Another reason is it will help prevent stress incontinence before and after delivery. The Royal College of Midwives reports that a third of existing and expectant mothers don’t do pelvic floor exercises, despite their reported benefits. An online survey of 1,000 women in the UK revealed that 29.2 per cent who have had or are expecting a baby admitted to never practising the exercises. Much as I find it heartening that the other 70 per cent had at least done a few, it is concerning that nearly a third of women hadn’t. So I hope this has inspired you to do yours! To be honest it would benefit all of us what ever age we will live longer than our grannies and great grannies did and we are doing much more high impact sport that has an effect on the pelvic floor over time.

@Lb1984

Does it all depend on area and how your birth went? I had the physio come speak to me before i left hospital about pelvic floor exercises (3rd degree tear) and have already got an appointment for a 6 week check with the physio (they rang me to make it!) Feeling lucky that my nhs trust understands how important it is to strengthen your pelvic floor and prevent future issues.

That's really great to hear. After a third degree tear you really need to do your pelvic floor exercises. If you don't feel that you are not making progress you may benefit from some electrical stimulation. a third degree tear can cause damage to your anal muscles so even more important to make sure your muscles recover as much as possible You can ask the physio when you next see them if that would help.

@misssunshine86

Great post.... 99% of saving your pelvic floor is before you give birth. I would also add that a birthing ball is a great investment for these exercises (and is even if you don't exercise on it!)

I've youtubed a couple of pelvic floor birthing ball exercises (as i never ever remember to do them otherwise) and set aside 10 minutes in front of the TV every night to do them. It's really easy but if anyone is interested:

1. Sat on ball - circles both ways for 2 minutes (clenching in and out)
2. Sat on ball - figure of 8's (clencing in and out) 2 mins
3. Cat cow on ball front to back - 2 mins
4. Wall squat - don't need ball - clench in and out - 2 mins
5. Rotating arm right angle stretches (to stretch out back as my back always hurts now days) - 2 mins
6. childs pose with ball - finish

Thank you! I do recommend sitting on an exercise ball in my book. Sadly not enough room to mention it in my Mumsnet post. Thank you so much for saying it ,it's really helpful. However if you don't have one any hard surface or the arm of the chair will do.

@JohnnyMcGrathSaysFuckOff

In my area they have cut the 6w postnatal check for mums. It is just for babies now and they do not ask about mood, contraception or check stitches anymore.

As DTs were under NICU outreach team not HVs, I also had no HV input. So basically no support. Thankfully I could pay for a private women's health physio. If not there would have been literally no one at all to talk to post birth.

This is such a shame and could save lots of future problems. The other thing that is so important to have checked after giving birth is your tummy muscles to check for Diastasis recti or a division of the abdominal muscles It happens to most pregnant women but if it doesn't get better or go away after you have given birth you really do need to see a women's health physio.

@Welder

I've noticed my pelvic floor seems to have weakened since I started running. (Ashamed to say I stopped doing my exercises a few months back, since getting them back to a good place after childbirth). Would Jane advise stopping running, or could I work on my pelvic floor alongside running?

This is very personal, some people just need to run. I think if you have noticed a deteriorating in your pelvic floor since you started running, try to stop for a few weeks and work really hard on your pelvic floor exercises again. Then you can go back to running and keep doing your exercises. Try to run on the grass or a treadmill it's the high impact that is bad for the pelvic floor so pavements are not amazing for your poor PF muscles! Good luck!

@highlandcoo

Is it too late to start pelvic floor exercises many years after having children?

I've recently witnessed my MIL suffering miserably with incontinence after two failed prolapse ops and would love to avoid the same fate.

I'm probably like many women - I know what I should be doing, keep the exercises up for a week or two, get lazy and let them lapse. I do realise it's important though and can make a huge difference to your ability to remain active in later life.

It's absolutely never too late. I have treated women of all ages so don't let your MIL stop doing her exercises either although it sounds like she may need some professional help. I am a great fan of gadgets of various forms so if you are struggling to remember something like the squeezy app may help, if you try to associate your exercises to something like cleaning your teeth then you will never forget! I wish you and your mother in law strong pelvic floor muscles good luck

@glitterbiscuits

Is it true that the advice now is not to start/stop/ start when urinating?

Yes it is true you should not use this as a way of exercising your pelvic floor it's not good for your bladder. Instead try: to follow my quick tips from my post. You can try stopping and starting the flow of urine but just once to check if you are able to stop the flow if you can't that's a sure sign that your pelvic floor is weak it is a good way of trying to isolate the correct muscles but as I say just do it occasionally. Wishing you a perfect pelvic floor!

@higherforce

Great post. Do vaginal weights actually work? Are some better than others? What if they erm ... fall out?

I use ones called Aquaflex (there are various brands) They have two different sized cones so if your vagina is very weak following childbirth you can start with the bigger cone - it's less likely to fall out!! I did have a patient once who rather embarrassingly found that it was falling out when she was on the London Underground mercifully it was winter so a big coat and a hand in her pocket rescued the day! They are very useful if you have a busy life and keep forgetting to do your pelvic floor exercises they are very easy to use, I tell my patients to use them while they are in the shower so job done.

@londonloves

I would be really interested to know if pelvic floor exercises actually improve prolapse symptoms or can cure?

This largely depends on how bad your prolapse is. I do a lot of pelvic floor rehabilitation with women with prolapse. Surgery for prolapse is very much a last resort and particularly at the moment with all the controversy about the use of vaginal mesh. I think that prolapse can be very well managed with the use of pelvic floor rehabilitation and the possible use of vaginal pessaries which I discuss in great detail in my book. If you are post menopausal then you should ask about vaginal oestrogen as this may help you. Vaginal atrophy a bit like pelvic floor problems is still a hugely underreported problem and one I am passionate to raise awareness of. I wish you lots of luck and don't ever stop doing your exercises they will always be necessary. You will probably never get rid of your prolapse altogether so the aim is to live your life without it bothering you and after all my years of experience that is very possible

@moreismore

What do you think of hypopressives? Are they better than conventional exercises?

This is not my area of expertise, however there are a few studies from The British Journal of Sports Medicine that may shed some light on your question. Have a look at the work of Prof Kari Bo who is very eminent and is part of the Norwegian school of sports science. Sorry not to be of more help here.

@DrCristinaYang

I'm 19 and having bladder issues which aren't related to childbirth. I now have to wear inco pads daily and I lean if I cough or sneeze, sometimes even when I walk. On other occasions I get a sudden urge were I have to pee NOW and I wet myself (not a full bladder but a large enough amount). I have tried pelvic floors and stopping the stream once I start but it doesn't really work.

You need to seek the help of a continence nurse specialist/women's help physio or your doctor. What you describe could be a variety of things. Simple things to do is have a urine test (check for an infection) you may have something called overactive bladder and weak pelvic floor muscles but I definitely think that you should go and seek help. I sadly can't make a diagnosis here One thing is for sure you no not have to live with these problems. I really hope that you get them sorted out.