tag:theconversation.com,2011:/id/topics/pelvic-floor-exercises-8275/articlesPelvic floor exercises – The Conversation2023-09-05T12:56:59Ztag:theconversation.com,2011:article/2123052023-09-05T12:56:59Z2023-09-05T12:56:59ZHow to recover from childbirth – an expert guide<p>After all the physical changes during pregnancy and following childbirth, many women are left wondering <a href="https://theconversation.com/postpartum-exercise-can-have-many-benefits-heres-how-to-do-it-safely-200388">how to get active</a> again and where to begin. Of course, activity after childbirth is an individual journey with multiple things to consider – and one of the first considerations may not be what you expect: <a href="https://theconversation.com/pelvic-floor-training-in-pregnancy-could-help-prevent-the-need-for-barbaric-vaginal-mesh-surgery-76440">your pelvic floor</a>.</p>
<p>Your pelvic floor muscles sit at the base of the pelvis. The muscles form a hammock-like structure that supports the bladder, womb and bottom. As many as <a href="https://www.nice.org.uk/guidance/ng210">one in three women</a> experience unwanted bladder leaks or vaginal prolapse in their lifetime and many of these symptoms can start during pregnancy or following childbirth. This is because this small muscle group takes the weight of the baby for nine months and may be stretched during vaginal delivery. </p>
<p>Your pelvic floor supports the bladder and vaginal tissues, helping bladder and bowel control and vaginal position. Recovery of these muscles prevents unwanted leaks, improves internal comfort and allows women to confidently increase activity.</p>
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<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
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<p>So focusing on your pelvic floor around pregnancy and postnatally can help you to recover more easily after childbirth and will allow you to get ready to be more active when you feel up to it.</p>
<p>If you’ve just given birth (or are about to) and you’re wondering where to start, here’s what you need to know:</p>
<h2>1. Keep your poo soft</h2>
<p>Straining on the toilet can overstretch the <a href="https://www.uhd.nhs.uk/uploads/about/docs/our_publications/patient_information_leaflets/physiotherapy/013-22_opening_your_bowels_-_position.pdf">pelvic floor muscles</a> which makes it harder for them to work properly. To avoid this you can keep your poo soft by drinking lots of water and increasing the fibre in your diet, such as high-fibre cereals, brown pasta and nuts. </p>
<p>Also, consider your position on the toilet. The use of a stool underneath your feet can make it easier to poo without straining as it helps to straighten the end of the bowel.</p>
<h2>2. Get your pelvic floor moving</h2>
<p>Squeezing and relaxing the pelvic floor muscles daily can <a href="https://pubmed.ncbi.nlm.nih.gov/29271473/#:%7E:text=Authors'%20conclusions%3A%20Targeting%20continent%20antenatal,effectiveness%20of%20this%20is%20unknown.">improve blood flow</a> to the area and speed up recovery following childbirth. This is because <a href="https://thepogp.co.uk/_userfiles/pages/files/resources/20818_pogp_pelvicfloor_for_women_signed_off_1.pdf">pelvic floor activity</a> can improve the strength and function of the muscles to help bladder control and vaginal support.</p>
<p><a href="https://www.nice.org.uk/guidance/ng210">The evidence</a> shows that it usually takes a good three months of regular pelvic floor use to change symptoms – and every squeeze can make a difference. After a vaginal delivery and even after a c-section, the recovery time for the pelvic floor continues for up to one year.</p>
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<img alt="Woman lying on a bed with baby in the air." src="https://images.theconversation.com/files/545601/original/file-20230830-27-t25s3m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545601/original/file-20230830-27-t25s3m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545601/original/file-20230830-27-t25s3m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545601/original/file-20230830-27-t25s3m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545601/original/file-20230830-27-t25s3m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545601/original/file-20230830-27-t25s3m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545601/original/file-20230830-27-t25s3m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">You can do pelvic floor exercises anytime.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/mother-lying-on-the-bed-and-holding-her-baby-in-the-air-15855201/">pexels monica turlui</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>One of the biggest problems with pelvic floor training is that women aren’t sure they are doing the exercises correctly and regularly <a href="https://mhealth.jmir.org/2022/3/e28751/">forget to do the exercises</a>.</p>
<p>To engage your pelvic floor muscles imagine you are holding in wind and trying to close the vaginal opening at the same time. You may feel a lifting and tightening inside of you. Try to breathe normally and relax other muscles like your tummy and buttocks. </p>
<p>To check you are doing it correctly, you can use a mirror to look at the area between your front and back passage. This area (the perineum) will move slightly up and inwards with a correct contraction. After each contraction, let your pelvic floor muscles fully relax. Pelvic health physiotherapists recommend squeezing your pelvic floor for ten seconds before relaxing for ten repetitions, followed by ten short squeezes. And to do this three times a day.</p>
<h2>3. Let things settle and go gently</h2>
<p>The pelvis and abdominal muscles also need time to recover from carrying a baby. Many women have a normal stretch and separation of their tummy muscles, which in a lot of cases <a href="https://www.sciencedirect.com/science/article/abs/pii/S2468784720303652#:%7E:text=DRA%20presents%20with%20reduced%20quality,perceived%20as%20discomfort%20or%20bloating.">improves around eight weeks after delivery</a>, for others it can take six months. The tummy helps to support the pelvis so rushing back to activity too quickly can put unnecessary strain on these areas. </p>
<p>Opt instead for a <a href="https://www.activepregnancyfoundation.org/findyouractive">gentle increase in activity</a> to help the muscles and joints settle such as walking, yoga or pilates rather than starting higher impact activity, like running, too early.</p>
<h2>4. Check your mental health</h2>
<p>The pressures on women postnatally can feel overwhelming and combined with sleep deprivation things can take a toll mentally. <a href="https://www.gov.uk/government/publications/national-perinatal-mental-health-project-report">The National Perinatal Mental Health Project Report</a> focuses on improving mental health support for women after they have given birth by providing more support services. These services can be accessed by speaking to your GP, midwife, health visitor or pelvic health physiotherapist.</p>
<p>Although a good level of activity can improve mental health, <a href="https://absolute.physio/wp-content/uploads/2019/09/returning-to-running-postnatal-guidelines.pdf">over-training can have a negative effect</a> on the body, so take it steady and keep checking in with yourself to make sure you’re functioning at a pace that feels comfortable and that you’re not overdoing it. Listen to your body and avoid comparison as everybody and every pregnancy is different.</p>
<p>Above all else, remember to be kind to yourself, your body has just gone through a massive change. Looking after your mental health and concentrating on your pelvic floor are good starting points. Getting more active with the muscles around your pelvis, including your tummy, can all help during the natural recovery time frame. But listen to your body and <a href="https://couchtofitness.com/postnatal">take things at your own pace</a>.</p><img src="https://counter.theconversation.com/content/212305/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rosie Harper receives funding from the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) in Wessex, Bournemouth University and University Hospitals Dorset.</span></em></p><p class="fine-print"><em><span>Malika Felton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>How to improve your pelvic floor and get active after giving birth.Rosie C Harper, Clinical academic PhD candidate, Bournemouth UniversityMalika Felton, Senior Lecturer in Health and Exercise Physiology, Bournemouth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1930192022-11-22T19:05:09Z2022-11-22T19:05:09ZChoosing a caesarean birth to ‘protect’ your pelvic floor? Here’s why that won’t necessarily work<figure><img src="https://images.theconversation.com/files/494368/original/file-20221109-22-oxq0fy.jpg?ixlib=rb-1.1.0&rect=9%2C36%2C5997%2C3971&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-practicing-yoga-600w-1109877887.jpg">Shutterstock</a></span></figcaption></figure><p>It’s commonly understood that having a baby can be a primary cause of later pelvic floor problems, such as bladder leakage. While giving birth can be a very special and joyful time, it can sometimes be difficult returning to day-to-day activity postpartum. </p>
<p>About one in three women who have had a baby experience <a href="https://www.continence.org.au/information-incontinence-english/one-in-three-women-who-ever-had-a-baby-wet-themselves">urinary incontinence</a>. A similar proportion will have <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/vaginal-prolapse">prolapse symptoms</a> like vaginal heaviness or bulging.</p>
<p>You might guess that choosing a caesarean section – that is, a surgical birth via the abdomen – rather than a vaginal birth could be a sensible way to avoid such symptoms. You could assume doing so would avoid any direct stretching and trauma to the pelvic floor muscles. </p>
<p>However, it’s not that simple. It turns out pregnancy itself, <a href="https://www.sciencedirect.com/science/article/pii/S2590161321000181?via%3Dihub">regardless of the mode of delivery</a>, is a significant risk factor for pelvic floor dysfunction.</p>
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Read more:
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<h2>Under pressure</h2>
<p>During pregnancy, there is a rapid increase in pressure and strain on the pelvic floor from the growing baby and increasing fluid load. Add to this a <a href="https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.16559">high likelihood of constipation</a> during and after pregnancy causing straining that further weakens already stretched muscles. </p>
<p>A growing belly also stretches and weakens the <a href="https://www.thewomens.org.au/health-information/pregnancy-and-birth/a-healthy-pregnancy/the-abdominal-muscles#:%7E:text=This%20is%20called%20'core%20stability,uterus%20rests%20forward%20onto%20them.">muscles of the abdominal wall</a> and changes our posture, impacting core stability and the function of the trunk and pelvis. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S1028455914001697">Changes in hormones</a> during pregnancy soften our muscles, tendons and ligaments to allow the pelvis to widen during labour and delivery. This reduces the stability of the pelvic floor and supporting tissues. </p>
<p>So the risk for pelvic floor compromise is already there – well before any type of delivery. </p>
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<a href="https://images.theconversation.com/files/494372/original/file-20221109-20-mrjzfp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman hold newborn baby" src="https://images.theconversation.com/files/494372/original/file-20221109-20-mrjzfp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494372/original/file-20221109-20-mrjzfp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494372/original/file-20221109-20-mrjzfp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494372/original/file-20221109-20-mrjzfp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494372/original/file-20221109-20-mrjzfp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494372/original/file-20221109-20-mrjzfp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494372/original/file-20221109-20-mrjzfp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">After caesarean surgery you shouldn’t lift anything heavier than your baby until the six-week check.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-images-half-african-thai-600w-1922320169.jpg">Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/why-you-shouldnt-make-a-habit-of-doing-a-just-in-case-wee-and-dont-tell-your-kids-to-either-167628">Why you shouldn't make a habit of doing a 'just in case' wee — and don't tell your kids to either</a>
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<h2>Other risk factors</h2>
<p>Add to this other non pregnancy-related <a href="https://www.nature.com/articles/s41598-022-13501-w">risk factors</a> for pelvic floor weakness such as: </p>
<ul>
<li>being a woman (our widened pelvis and extra gap in the muscles for the vaginal canal compromise pelvic floor strength)</li>
<li>being overweight</li>
<li>previous pelvic surgery</li>
<li>advancing age</li>
<li>ethnicity and genetics</li>
<li>family history of incontinence, prolapse and connective tissue disorders</li>
<li>participation in repetitive high impact sports like dancing, CrossFit and running </li>
<li>repetitive heavy lifting (occupational or with sports like weightlifting)</li>
<li>a history of excessive coughing, sneezing or vomiting</li>
<li>constipation and straining. </li>
</ul>
<p>It’s a long list of contributing factors to pelvic floor dysfunction that don’t have anything to do with having a vaginal or caesarean delivery. </p>
<p>That said, a vaginal delivery (particularly a difficult one) does add risk factors. This is especially <a href="https://journals.sagepub.com/doi/full/10.2217/WHE.13.17">true if</a>:</p>
<ul>
<li>the baby is large (weighing more than 4 kilograms) on delivery</li>
<li>instrumental assistance is required, especially forceps</li>
<li>the second stage of labour (the pushing phase) is <a href="https://www.tandfonline.com/doi/abs/10.1080/00016340801899008">longer than an hour</a></li>
<li>muscle damage or high-grade perineal tearing (<a href="https://www.thewomens.org.au/images/uploads/fact-sheets/Perineal-tears-third-and-fourth-degree.pdf">damage</a> to the tissues between the vagina and the anal sphinter) occurs. </li>
</ul>
<p>A caesarean is certainly not the “easy way out” either. <a href="https://www.nhs.uk/conditions/caesarean-section/recovery/">Recovery from a C-section</a>, even a planned one, can be challenging as it is major abdominal surgery. It means avoiding lifting anything heavier than your baby for six weeks, not driving until medically cleared, reduced mobility, and incision pain. As with any surgery, it carries the risk of complications such as infection, reaction to the anaesthetic, surgical injury and blood clots. </p>
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<p>
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Read more:
<a href="https://theconversation.com/playing-games-with-your-pelvic-floor-could-be-a-useful-exercise-for-urinary-incontinence-182431">Playing games with your pelvic floor could be a useful exercise for urinary incontinence</a>
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<a href="https://images.theconversation.com/files/494370/original/file-20221109-23-mviuk5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="pregnant people on exercise mats" src="https://images.theconversation.com/files/494370/original/file-20221109-23-mviuk5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494370/original/file-20221109-23-mviuk5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494370/original/file-20221109-23-mviuk5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494370/original/file-20221109-23-mviuk5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494370/original/file-20221109-23-mviuk5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494370/original/file-20221109-23-mviuk5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494370/original/file-20221109-23-mviuk5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Exercise classes designed for pregnancy are a good idea.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-young-pregnant-women-lying-600w-1809776566.jpg">Shutterstock</a></span>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/7-ways-to-reduce-perineal-tearing-during-childbirth-176670">7 ways to reduce perineal tearing during childbirth</a>
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</em>
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<h2>Birth planning with your pelvic floor in mind</h2>
<p>There are pros and cons to <a href="https://www.nature.com/articles/s41598-020-78625-3">both modes of delivery</a> when considering potential long-term impacts on function. Individualised counselling with your medical provider during pregnancy is highly recommended, as everyone’s personal risk factors, circumstances and preferences are unique. </p>
<p>Using a <a href="https://www.ajog.org/article/S0002-9378(17)31205-X/fulltext">risk calculator tool</a> may be a useful starting point when discussing with your care team whether a vaginal or caesarean birth may be more suitable for you. </p>
<p>If you are planning a vaginal delivery, there are a few things <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8983111/">research shows</a> can reduce your risk of pelvic floor injury and dysfunction: </p>
<ul>
<li>maintain a healthy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406235/">body weight</a></li>
<li>practice <a href="https://www.pelvicfloorfirst.org.au/pages/pelvic-floor-muscle-exercises-for-women.html">pelvic floor exercises</a> during pregnancy, under the guidance of a suitably trained professional such as a pelvic floor physiotherapist </li>
<li>participate in supervised exercise classes specifically tailored for pregnancy and pelvic floor awareness</li>
<li>start <a href="https://www.qld.gov.au/health/children/pregnancy/antenatal-information/looking-after-yourself-and-your-baby/perineal-massage">perineal massage</a> from 35 weeks of pregnancy to improve muscle flexibility and blood flow</li>
<li>adopt <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002006.pub3/full">upright positions</a> for labour and delivery if it feels right and is safe and comfortable, which may allow for gravity assistance, more efficient contractions and a widened pelvic outlet</li>
<li>push when you <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8983111/">feel urges</a> rather than following “directed pushing” from others</li>
<li>use a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8983111/">warm compress</a> on the perineum during crowning to relax the muscles</li>
<li>a mediolateral <a href="https://theconversation.com/episiotomy-during-childbirth-not-just-a-little-snip-36062">episiotomy</a> (planned cut to the perineal muscles) with <a href="https://www.sciencedirect.com/science/article/pii/S030121151930332X">forceps-assisted deliveries</a> rather than allowing uncontrolled tearing towards the anal sphincter muscles. This is not the same as a <a href="https://theconversation.com/episiotomy-during-childbirth-not-just-a-little-snip-36062">midline episiotomy</a>, which carries <a href="https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/episiotomy/art-20047282#:%7E:text=A%20midline%20incision%20is%20easier,is%20more%20difficult%20to%20repair.">different risks</a>. </li>
</ul>
<p>Whether you choose to birth vaginally or via caesarean is a decision that is very personal and involves many factors. Due to unforeseen complications, sometimes this decision can be taken out of our hands so it is beneficial to be well-informed on both options. </p>
<p>Regardless of mode of delivery, it’s important to learn how to <a href="https://www.continence.org.au/who-it-affects/women/female-pelvic-floor-muscles">effectively exercise your pelvic floor muscles</a> for prevention and treatment of pelvic floor symptoms such as incontinence and prolapse. Today’s a great day to get started. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CYoldnCJztB","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/men-have-pelvic-floors-too-and-can-benefit-when-they-exercise-them-regularly-184451">Men have pelvic floors too – and can benefit when they exercise them regularly</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/193019/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mischa is the Founder and Principal Physiotherapist at Pelvic Fix Physiotherapy. She is affiliated with CQUniversity as a Sessional Lecturer, Curtin University as a Physiotherapy Clinical Supervisor, and Queensland Health as a Senior Women's Health Physiotherapist.</span></em></p>It turns out pregnancy itself, regardless of mode of delivery, is a significant risk factor for pelvic floor dysfunction. And there are other risks that have nothing to do with babies.Mischa Bongers, Sessional Lecturer, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1844512022-06-28T02:00:42Z2022-06-28T02:00:42ZMen have pelvic floors too – and can benefit when they exercise them regularly<figure><img src="https://images.theconversation.com/files/469907/original/file-20220621-22-zu5l9t.jpg?ixlib=rb-1.1.0&rect=13%2C41%2C4580%2C3021&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/sick-man-prostate-cancer-premature-600w-791204665.jpg">Shutterstock</a></span></figcaption></figure><p>“Kegels” and pelvic floor exercises are usually associated with “women’s business” – think pregnancy, childbirth, and menopause. But men have pelvic floors too. </p>
<p>Just like women, at various times in their lives men can benefit from training their pelvic floors to address a variety of health concerns. About 30% of men visiting the doctor have <a href="https://www.continence.org.au/incontinence/who-it-affects/men">urinary incontinence</a>, or bladder leakage, but a large majority don’t bring it up. Around 15% of men also experience faecal incontinence, or bowel leakage, and take longer to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4069320/">seek help</a> for it compared to women. </p>
<p>The pelvic floor muscles are also involved in sexual function. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1324914/">Erectile dysfunction</a> affects around 10% of healthy men, and up to almost 40% of men with chronic health conditions, and can be associated with pelvic floor issues.</p>
<p>People sometimes assume these problems are just a normal part of ageing; but common doesn’t mean inevitable. There is often much improvement to be had with some simple strategies – including pelvic floor rehabilitation. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1536587745195343872"}"></div></p>
<h2>Pelvic floor dysfunction in men is really common</h2>
<p>Though pelvic floor problems are <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2000.tb11669.x">more common in women</a>, one in eight men <a href="https://choose.physio/your-lifestage/adults/mens-health">have issues</a> with their pelvic floor, bladder or bowel. </p>
<p>The pelvic floor is a group of muscles lining the base of the pelvis. For men, this <a href="https://www.continence.org.au/who-it-affects/men/male-pelvic-floor-muscles">supports</a> the bladder, prostate gland and bowel. It is essential in maintaining core stability, bladder and bowel control, and for erectile function and sexual satisfaction. </p>
<p>Most men have little reason to think about their pelvic floor for the majority of their lives, until something goes wrong medically (in comparison to women, who tend to be introduced to pelvic floor exercises much younger, often in the context of pregnancy and childbirth). </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/469908/original/file-20220621-25-eny4r6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="couple look affectionate in bed" src="https://images.theconversation.com/files/469908/original/file-20220621-25-eny4r6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469908/original/file-20220621-25-eny4r6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469908/original/file-20220621-25-eny4r6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469908/original/file-20220621-25-eny4r6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469908/original/file-20220621-25-eny4r6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469908/original/file-20220621-25-eny4r6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469908/original/file-20220621-25-eny4r6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Working on your pelvic floor strength might even improve your sex life.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/happy-asian-senior-couple-having-600w-1684173169.jpg">Shutterstock</a></span>
</figcaption>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/playing-games-with-your-pelvic-floor-could-be-a-useful-exercise-for-urinary-incontinence-182431">Playing games with your pelvic floor could be a useful exercise for urinary incontinence</a>
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</p>
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<h2>Why it happens</h2>
<p><a href="https://www.continence.org.au/who-it-affects/men/male-pelvic-floor-muscles">Risk factors</a> for incontinence and pelvic floor problems in men include ageing, prostate issues, pelvic surgery, bowel issues including constipation, chronic coughing, frequent heavy lifting, and being overweight. </p>
<p>Prostate cancer affects up to 15% of men and is the <a href="https://www.wcrf.org/cancer-trends/worldwide-cancer-data/">second most common cancer</a> in men (and fourth most common cancer overall). </p>
<p>The largest source of pelvic floor physiotherapy referrals for men tends to be in the context of prostate surgery. This is because surgery on the prostate gland (which sits very close to the base of the bladder) causes trauma to the nearby structures and nerves that maintain bladder control and erectile function. </p>
<p>However, we know that training the pelvic floor early (starting pre-operatively) means post-operative side effects like incontinence <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7471070/">resolve more quickly</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/prostate-cancer-linked-to-bacteria-raising-hope-of-new-test-and-treatment-181542">Prostate cancer linked to bacteria, raising hope of new test and treatment</a>
</strong>
</em>
</p>
<hr>
<h2>How can men exercise their pelvic floors?</h2>
<p>To engage the pelvic floor, the sensation should feel like a squeeze, lift and relax of the muscles running between the pubic bone, tailbone, and sit bones. Some popular cues include visualising: </p>
<ul>
<li> stopping urine mid-flow (but <a href="https://www.wellandgood.com/im-a-pelvic-floor-therapist-and-this-is-why-you-shouldnt-stop-your-flow-mid-pee/">not actually doing this</a>)</li>
<li> holding in wind</li>
<li> retracting the penis/testicles</li>
<li> pulling the perineum (skin between the genitals and back passage) away from your underwear.</li>
</ul>
<p>It is important to ensure that the abdominal, gluteal (buttock) and thigh muscles stay relaxed, with breathing maintained throughout. </p>
<p>Exercises can be performed in any position, and if done right, should be able to be done inconspicuously (even when there are other people around!). But it’s quite common to find the exercises difficult to do without some coaching. </p>
<p>Working with a health professional such as a <a href="https://choose.physio/find-a-physio">pelvic floor physiotherapist</a> may be beneficial. Physiotherapists trained in men’s health and pelvic floor conditions will teach clients how to perform exercises correctly. Often they do this with biofeedback devices such as real-time ultrasound imaging that can help identify the right muscles to use and refine technique. </p>
<p>Not all pelvic floor problems require more strengthening. Optimal muscle function requires good strength, but also correct timing, co-ordination and relaxation. </p>
<p>A pelvic floor that is too tight can be problematic, for both men and women, and can contribute to symptoms of pelvic or genital pain, sexual dysfunction, urinary issues including overactive bladder, and bowel problems. </p>
<p>Your specific concerns will inform the way in which your physio might prescribe exercises, but good targets to aim for are to be able to: </p>
<ol>
<li>turn the pelvic floor on and off 10 times in 10 seconds</li>
<li>strongly hold 10 seconds, repeated 10 times</li>
<li>maintain an easy hold for 1 minute.</li>
</ol>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1537925051722309637"}"></div></p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/technology-for-incontinence-hasnt-developed-that-much-since-ancient-egyptian-times-98349">Technology for incontinence hasn't developed that much since ancient Egyptian times</a>
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<h2>If I don’t have pelvic floor problems, do I need to do exercises?</h2>
<p>Like a good gym program keeps you in optimal physical health and helps stave off injuries, it stands to reason that a regular pelvic floor training routine might serve to combat the likelihood of bladder, bowel and erectile dysfunction. However, the literature is scarce for preventative use in asymptomatic men.</p>
<p>Knowing where your pelvic floor is and how to exercise it properly can never be a bad thing – and training might even have some happy side effects, like <a href="https://link.springer.com/article/10.1007/s11934-013-0358-1">reduced waking in the night</a> with the need to urinate, reduced dribbling post-urination, better bowel emptying, and improved sexual satisfaction. </p>
<p>If you are unsure whether pelvic floor exercises are suitable for you or if you’re doing them properly, check in with a trusted health professional.</p><img src="https://counter.theconversation.com/content/184451/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mischa Bongers is the Founder and Principal Physiotherapist at Pelvic Fix Physiotherapy. She is affiliated with CQUniversity as a Sessional Lecturer, Curtin University as a Physiotherapy Clinical Supervisor, and Queensland Health as a Senior Women's Health Physiotherapist. </span></em></p>Knowing where your pelvic floor is and how to exercise it properly can help male incontinence – and might even have some happy side effects.Mischa Bongers, Sessional Lecturer, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1824312022-05-30T04:29:14Z2022-05-30T04:29:14ZPlaying games with your pelvic floor could be a useful exercise for urinary incontinence<figure><img src="https://images.theconversation.com/files/463238/original/file-20220516-12-amac5z.jpg?ixlib=rb-1.1.0&rect=32%2C49%2C5458%2C3598&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/girl-synchronizes-kegel-trainer-application-600w-1840517470.jpg">Shutterstock</a></span></figcaption></figure><p>Many of us have heard of “<a href="https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/kegel-exercises/art-20045283">Kegels</a>” or pelvic floor exercises, and probably have a vague sense we should be doing more of them. For many women, our social media news feeds are full of ads for the latest gizmos and gadgets for exercising our pelvic floors. There are brands with game-like apps including <a href="https://au.perifit.co/">Perifit</a> and <a href="https://www.elvie.com/shop/elvie-trainer">Elvie</a>, and there are <a href="https://www.health.com/condition/sexual-health/kegel-balls">Kegel balls</a> for sale too. </p>
<p>As technology advances and the need for pelvic floor rehabilitation after pregnancy, childbirth and menopause continues, the demand for innovation in these devices has increased. Then there is the global pandemic that has restricted access to face-to-face medical treatment – prompting many of us to take our health into our own hands.</p>
<p>But what exactly are these devices used for, and do they actually work? The short answer: pelvic floor strengthening; and, it depends.</p>
<h2>4 things the pelvic floor does and why it often fails</h2>
<p>The pelvic floor is a group of muscles that run from our pubic bone to tailbone, and between our sit-bones, lining the base of our pelvis. Contrary to popular belief, you don’t have to lie on the floor to exercise your pelvic floor. </p>
<p>The role of the pelvic floor muscles is to: </p>
<ol>
<li> keep all our organs (bladder, uterus, bowel) inside the pelvis</li>
<li> keep the sphincters to our bladder and bowel closed (until we’re ready to relax them on the toilet)</li>
<li> provide sexual sensation</li>
<li> work together with other deep core muscles to help with trunk stability. </li>
</ol>
<p>The pelvic floor doesn’t always work the way it’s meant to. Bladder leakage (also known as <a href="https://theconversation.com/urinary-incontinence-can-be-a-problem-for-women-of-all-ages-but-there-is-a-cure-49365">urinary incontinence</a>) and pelvic organ prolapse are common pelvic floor complaints for women of all ages. </p>
<p>About <a href="https://www.continence.org.au/incontinence/who-it-affects/women/pregnancy-and-childbirth">one in three women will experience urinary incontinence</a> at some point in our lives, especially if we’ve had a baby. Other risk factors include repetitive heavy lifting, straining due to constipation, carrying extra weight, pelvic surgery, and hormonal changes. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/463244/original/file-20220516-26-41ie2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="doctor points to muscles sitting within the human pelvic bones" src="https://images.theconversation.com/files/463244/original/file-20220516-26-41ie2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/463244/original/file-20220516-26-41ie2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/463244/original/file-20220516-26-41ie2i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/463244/original/file-20220516-26-41ie2i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/463244/original/file-20220516-26-41ie2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/463244/original/file-20220516-26-41ie2i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/463244/original/file-20220516-26-41ie2i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The pelvic floor helps hold organs inside the pelvis.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/doctor-gynecologist-showing-layout-female-600w-2122502321.jpg">Shutterstock</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-kegel-exercises-actually-good-for-you-111747">'Are Kegel exercises actually good for you?'</a>
</strong>
</em>
</p>
<hr>
<h2>Getting the pelvic floor into shape</h2>
<p>Pelvic floor muscle training is recommended as the first line of treatment for incontinence and prolapse, along with lifestyle changes such as healthy bladder and bowel habits, good general fitness, and weight management. </p>
<p><a href="https://choose.physio/find-a-physio">Pelvic floor physiotherapists</a> are health professionals specially trained to give you individualised advice for your pelvic floor symptoms based on an assessment and your circumstances. They will likely recommend daily exercises that may include rapid contractions of the pelvic floor muscles, coordination tasks and longer holds.</p>
<p>Those who have trouble sticking to the prescribed exercises, or who don’t have access to a suitable physio for geographical or financial reasons, may be interested in trying biofeedback devices. These devices and their associated apps are designed to give you more information on how and when to do your exercises, remind you to do them, and help you to stick with the program. </p>
<p>Maintaining motivation can be tough. Research shows it usually takes at least 6–12 weeks of regular pelvic floor training <a href="https://www.tandfonline.com/doi/abs/10.1080/j.0001-6349.2004.00559.x">to see results</a> (just like visiting the gym, we can’t build muscle overnight). </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/463235/original/file-20220516-12-vcls9f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="bright pink shapes with long handles" src="https://images.theconversation.com/files/463235/original/file-20220516-12-vcls9f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/463235/original/file-20220516-12-vcls9f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/463235/original/file-20220516-12-vcls9f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/463235/original/file-20220516-12-vcls9f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/463235/original/file-20220516-12-vcls9f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/463235/original/file-20220516-12-vcls9f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/463235/original/file-20220516-12-vcls9f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There are many types of pelvic floor trainers on the market.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/kegel-trainer-latex-vaginal-vibrator-600w-1800284818.jpg">Shutterstock</a></span>
</figcaption>
</figure>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/urinary-incontinence-can-be-a-problem-for-women-of-all-ages-but-there-is-a-cure-49365">Urinary incontinence can be a problem for women of all ages, but there is a cure</a>
</strong>
</em>
</p>
<hr>
<h2>Do pelvic floor biofeedback devices work?</h2>
<p>There’s some evidence to suggest pelvic floor <a href="https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-022-00812-6">reminder apps</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0031940610612643">biofeedback devices</a> can be helpful for improving pelvic floor function and bladder control. This might be <a href="https://www.sciencedirect.com/science/article/abs/pii/S0090429502021258">superior to pelvic floor exercises alone</a>. Then again, it <a href="https://www.sciencedirect.com/science/article/abs/pii/S0029784402021609">might not make a difference</a>. </p>
<p>Some women <a href="https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.665355">do not find the use of technology helpful</a> for pelvic floor training. Barriers can include connectivity or set-up issues, need for privacy, tech being distracting, and price. Insertable devices also require caution for use, as most are not appropriate during pregnancy, within the first six weeks after having a baby or pelvic surgery, or when there is unexplained bleeding, pain or active infection. If in doubt, it’s always best to consult your medical provider.</p>
<p>The benefits of pelvic floor trainers with game-like apps that sync with an inserted device include:</p>
<ul>
<li>giving real-time feedback on the screen for pelvic floor performance and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/nau.24439?fbclid=IwAR1XhK4xlsLgiYTbjkf3VnbGTfHKXNXYT5iBmxhmFL9IONGlWnvKzoD9n0U">correct technique</a> </li>
<li>allowing women to <a href="https://link.springer.com/article/10.1007/s00192-021-04981-x?fbclid=IwAR06JPIZ8SywUS-14Wmr_IfEJW56eea2m1eJuA14dHOKwironUEWmceNeU8">work with their physio remotely</a> </li>
<li>measuring and tracking strength, endurance and coordination improvements over time</li>
<li>providing reminder prompts via phone notifications to complete workouts</li>
<li>adjusting the workout difficulty of each session based on how the body is responding (this accounts for time-of-day fluctuations and fatigue) </li>
<li>entertaining the user with a variety of games and tasks, making them more likely to stick with their pelvic floor program!</li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/463240/original/file-20220516-20-9dz6w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman lying on exercise mats" src="https://images.theconversation.com/files/463240/original/file-20220516-20-9dz6w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/463240/original/file-20220516-20-9dz6w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/463240/original/file-20220516-20-9dz6w6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/463240/original/file-20220516-20-9dz6w6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/463240/original/file-20220516-20-9dz6w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/463240/original/file-20220516-20-9dz6w6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/463240/original/file-20220516-20-9dz6w6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You do not have to do pelvic floor exercises lying down – or with special equipment.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/group-young-pregnant-women-lying-600w-1809776566.jpg">Shutterstock</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-you-shouldnt-make-a-habit-of-doing-a-just-in-case-wee-and-dont-tell-your-kids-to-either-167628">Why you shouldn't make a habit of doing a 'just in case' wee — and don't tell your kids to either</a>
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<h2>The bottom line</h2>
<p>The evidence definitively supports pelvic floor exercises for incontinence and prolapse, and this is <a href="https://pubmed.ncbi.nlm.nih.gov/25233622/">best done</a> with the support of a suitably trained professional such as a pelvic floor physiotherapist. </p>
<p>While early research looks promising, the evidence for commercially marketed pelvic floor feedback devices has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852158/">not yet caught up</a> to their hype. But if you are keen to try a pelvic floor biofeedback device or app to improve pelvic floor tone for better bladder control, prolapse symptoms, or sexual function – then go for it (especially if your specialist physio agrees). </p>
<p>After all, the best kind of pelvic floor exercise regime is the one you’ll stick with. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1404967700686835714"}"></div></p><img src="https://counter.theconversation.com/content/182431/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span><a href="mailto:m.bongers@cqu.edu.au">m.bongers@cqu.edu.au</a> is the Founder and Principal Physiotherapist at Pelvic Fix Physiotherapy. She is affiliated with CQUniversity as a Sessional Lecturer, Curtin University as a Physiotherapy Clinical Supervisor, and Queensland Health as a Senior Women's Health Physiotherapist. </span></em></p>Social media is awash with ads for interactive games and devices to strengthen the pelvic floor. But do they work?Mischa Bongers, Sessional Lecturer, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/944032018-04-04T08:10:29Z2018-04-04T08:10:29ZNot all vaginal implants are a problem and treating them the same puts many women at risk<figure><img src="https://images.theconversation.com/files/213103/original/file-20180404-189830-7ufdlf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Around on in five women might need surgical treatment for prolapse or urinary incontinence.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Last week, a <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/MeshImplants">Senate Committee</a> investigating the impacts of “transvaginal mesh implants” on women in Australia handed down its report, with 13 recommendations. The implants are medical devices surgically inserted to prevent prolapse and urinary incontinence - conditions that affect many women over their lifetime, with around 20% <a href="https://www.ncbi.nlm.nih.gov/pubmed/24807341">requiring surgical</a> treatment.</p>
<p>The inquiry was the result of many <a href="http://www.abc.net.au/news/2017-05-31/more-women-mesh-implant-side-effects-than-thought-experts-say/8572840">women coming forward</a> reporting <a href="http://www.abc.net.au/news/2017-05-31/how-a-vaginal-mesh-implant-destroyed-maessens-life/8573878">serious side effects</a>, such as chronic pain and trouble walking, after vaginal mesh surgery. Recommendations included that these medical devices are to be used only “as a last resort”, that each mesh implant be registered, patient counselling and decision-making, surgeon training and better reporting of adverse events. </p>
<p>Proposals to improve outcomes for patients by implementing stricter standards in training, audit, research and monitoring of medical implants are welcome. However, the Senate has lumped together incontinence and prolapse devices, considering them all to be “transvaginal meshes”. </p>
<p>Only the prolapse devices are problematic, while those used for incontinence are safe and evidence-based procedures. Conflating the two confuses women and may lead them to seek snake-oil type treatments that have no evidence base, and can be risky.</p>
<h2>Different devices</h2>
<p>Prolapse is when pelvic organs – such as the bladder, bowel or uterus (womb) – fall through the vagina. Stress urinary incontinence is involuntary urine leakage with activity such as sport, coughing or even walking. Both conditions are types of pelvic floor dysfunction, but the surgery and medical devices used to treat them are different.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/urinary-incontinence-can-be-a-problem-for-women-of-all-ages-but-there-is-a-cure-49365">Urinary incontinence can be a problem for women of all ages, but there is a cure</a>
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</em>
</p>
<hr>
<p>Despite many <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/MeshImplants/Submissions">submissions to the inquiry</a> from clinical bodies, the Senate committee has been unable to distinguish between midurethral mesh slings (used for urinary incontinence) and transvaginal mesh (used for prolapse). The first is a mesh tape placed under the urethra like a sling for support. The second are sheets of mesh placed under the bladder, or in front of the bowel, to stop prolapse and prevent recurrence.</p>
<p>Midurethral slings in Australia have been associated with complaints in around equal numbers to mesh used for prolapse, but proportionately most problems have been seen with prolapse. This is because an estimated 120,000 sling operations have <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/MeshImplants">been performed</a>, compared to only around 30,000 prolapse mesh procedures.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/213106/original/file-20180404-189798-kzkowr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/213106/original/file-20180404-189798-kzkowr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/213106/original/file-20180404-189798-kzkowr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/213106/original/file-20180404-189798-kzkowr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/213106/original/file-20180404-189798-kzkowr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/213106/original/file-20180404-189798-kzkowr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/213106/original/file-20180404-189798-kzkowr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/213106/original/file-20180404-189798-kzkowr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many women who had mesh surgery for pelvic prolapse have experienced significant pain, bladder injury and incontinence.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>There is <a href="https://theconversation.com/common-surgery-for-vaginal-prolapse-can-lead-to-complications-review-shows-54559">still clinical uncertainty</a> and insufficient data on indications for use and best practice when it comes to the mesh used to treat vaginal prolapse. A <a href="http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD012079/abstract">review of several studies</a> found that the artificially grafted mesh had more problems than benefits, and the women who underwent the operation had high rates of needing repeat surgery due to mesh exposure, bladder injury and urinary incontinence.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/common-surgery-for-vaginal-prolapse-can-lead-to-complications-review-shows-54559">Common surgery for vaginal prolapse can lead to complications, review shows</a>
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</em>
</p>
<hr>
<p>Midurethral slings, however, have an <a href="https://www.ncbi.nlm.nih.gov/pubmed/26130017">excellent track record</a> and are the <a href="https://www.ncbi.nlm.nih.gov/pubmed/23563892">most researched incontinence procedure</a> in history. Midurethral slings have been recognised by every national and international medical or regulatory organisation as the treatment of choice for stress urinary incontinence in patients who have failed conservative management, such as pelvic floor exercises.</p>
<h2>There are riskier procedures</h2>
<p>The Senate also tasked the Australian Commission on Quality and Safety in Health Care with carrying out many of its recommendations. The commission recently <a href="https://www.safetyandquality.gov.au/our-work/transvaginal-mesh/status-of-commission-guidance-february-2018/">published guidelines</a> for hospital credentialing of surgeons to perform transvaginal mesh procedures for urinary incontinence and prolapse. </p>
<p>Along with many sensible recommendations on training and audit, the commission determined that surgeons needed to perform:</p>
<blockquote>
<p>a minimum of ten surgeries for stress urinary incontinence (either mesh or non-mesh) each year. </p>
</blockquote>
<p>This is not ten midurethral slings – the procedure for which the whole guideline was designed – but any surgery for stress incontinence.</p>
<p>There is no requirement from the commission that such procedures have proven efficacy and safety. This means that, in theory, a completely non evidence-based treatment such as vaginal laser could be claimed as a continence procedure. Vaginal laser is essentially a cosmetic laser treatment, for which there is absolutely no scientific data for any effect in patients with urinary incontinence.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaginal-mesh-controversy-shows-collective-failure-of-the-tga-and-australias-specialists-78605">Vaginal mesh controversy shows collective failure of the TGA and Australia's specialists</a>
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</em>
</p>
<hr>
<p>Along with the Senate’s recommendation that mesh be used as a “last resort”, this suggests patients should be offered less effective procedures, such as an <a href="http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003881.pub4/abstract">injection therapy</a>, or <a href="http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD001755.pub2/abstract">big abdominal operations</a>, with <a href="https://www.ncbi.nlm.nih.gov/pubmed/28479203">more complications</a> and no better efficacy, simply because they don’t involve mesh.</p>
<p>We have already seen a <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/ajo.12445">reduction in continence surgery</a> over the last several years, which could be related to adverse mesh publicity. This has not been replaced by an increase in conservative management. Rather Australian women are now continuing to suffer with their incontinence. And there is a risk they will turn to expensive “snake oil” treatments, such as <a href="https://splinternews.com/vaginal-rejuvenation-stem-cell-therapy-is-probably-bogu-1793859971">vaginal rejuvenation therapy</a>.</p>
<p>We anticipate further patient anxiety and poor outcomes if the system doesn’t guarantee patients receive evidence-based care. We have the data on midurethral slings so we can’t compromise access to the safest and most effective surgical treatment for their stress incontinence.</p><img src="https://counter.theconversation.com/content/94403/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer King is the Chair of the UroGynaecological Society of Australasia.</span></em></p>Mesh surgery for urinary incontinence is effective and extensively studied, while the mesh used in pelvic prolapse is problematic. But the Senate has conflated the two, which will confuse women.Jennifer King, Honorary Clinical Lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/764402017-04-25T08:09:25Z2017-04-25T08:09:25ZPelvic floor training in pregnancy could help prevent the need for ‘barbaric’ vaginal mesh surgery<figure><img src="https://images.theconversation.com/files/166517/original/file-20170424-12629-b1cu81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exercises can help women's pelvic floor health during pregnancy and after birth.</span> <span class="attribution"><span class="source">COLLATERAL/www.shutterstock.com</span></span></figcaption></figure><p>For millions of women, childbirth is a somewhat daunting yet thoroughly rewarding process. In the western world, many years of medical research and professional experience mean that women have access to expert care before, during and after birth. However, there is still one matter that is not being addressed enough during pregnancy: pelvic floor health. Women often do not realise, and are not properly informed, that something can be done to reduce the risks of pelvic floor problems in pregnancy and after childbirth.</p>
<p>The pelvic floor muscles lie across the base of the pelvis, supporting and holding the bladder, uterus and bowel in position. They also help to control the bladder and bowel. Pregnancy and childbirth can cause problems such as weakness, overstretching and tears in the pelvic floor muscle, due to increased pressure. </p>
<p>Weakening or damage may result in inability to control <a href="http://www.nhs.uk/conditions/Incontinence-urinary/Pages/Introduction.aspx">bladder</a> or <a href="http://www.nhs.uk/conditions/incontinence-bowel/Pages/Introduction.aspx">bowel</a> movements, resulting in incontinence. Muscle weakness can also contribute to <a href="http://www.nhs.uk/conditions/Prolapse-of-the-uterus/Pages/Introduction.aspx">pelvic organ prolapse</a>, which is the bulging of one or more of the pelvic organs, such as the uterus, bowel and bladder, into the vagina.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/166536/original/file-20170424-25594-1nsx2hy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/166536/original/file-20170424-25594-1nsx2hy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/166536/original/file-20170424-25594-1nsx2hy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/166536/original/file-20170424-25594-1nsx2hy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/166536/original/file-20170424-25594-1nsx2hy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/166536/original/file-20170424-25594-1nsx2hy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/166536/original/file-20170424-25594-1nsx2hy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Weakening or damage to the pelvic floor can lead to incontinence or prolapse.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/female-pelvic-floor-labeled-157672304?src=inic3UbLdsbFHl5NKxTmkA-1-3">Alila Medical Media/www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Urinary incontinence is a common problem, affecting <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/595439/CMO_annual_report_2014.pdf">over 5m women</a> in the UK alone. Between <a href="http://www.icud.info/incontinence.html">30-50% of women</a> will experience some leaking of urine during or after pregnancy. And, according to one study, up to three out of four women still experience symptoms <a href="https://www.ncbi.nlm.nih.gov/pubmed/25846816">12 years after giving birth</a>.</p>
<p>Incontinence can make women feel <a href="https://www.ncbi.nlm.nih.gov/pubmed/22924517">shame and embarrassment</a>, which stops them from seeking help. It is normalised in UK society, with many women believing that incontinence is an unavoidable consequence of having children, further stopping them from accessing treatment. They are exposed to media images of female incontinence as normal and inevitable: young women are portrayed as accepting the condition in adverts for absorbent products, accompanied by tag lines such as “<a href="http://www.lightsbytena.co.uk/the-oooops-lounge/tv-advert/">Oops moments happen. C’est la vie</a>.”</p>
<h2>Prevention rather than treatment</h2>
<p>When women do seek help for pelvic floor problems they are offered treatment according to the severity of their symptoms. Pelvic floor muscle training (PFMT) is a first line treatment. <a href="http://pogp.csp.org.uk/">PFMT</a> involves pulling up the pelvic floor muscles by pretending to hold in wee or stopping passing wind. The muscles can be strengthened by regularly doing a series of long and short holds. For example, squeezing these muscles slowly ten times in a row, then doing ten fast squeezes and repeating this three times per day.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/LMiNq_ai1hU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>In more severe cases, surgery may be offered, which can include insertion of mesh through the vagina, to provide extra support when repairing weakened or damaged tissue. </p>
<p>However, vaginal mesh surgery has <a href="https://theconversation.com/common-surgery-for-vaginal-prolapse-can-lead-to-complications-review-shows-54559">more problems than benefits</a>. It has been called <a href="http://www.telegraph.co.uk/news/2017/04/18/800-sue-nhs-barbaric-mesh-implants-cause-agonising-pain/">“barbaric”</a> and recently led to <a href="http://www.bbc.co.uk/news/health-39567240">more than 800 women suing the NHS</a> over complications with it such as permanent pain, and an inability to walk, work or have sex.</p>
<p>So why aren’t we focusing more on women’s pelvic floor health in pregnancy, to try to avoid these conditions developing?</p>
<p>Evidence shows that PFMT can help prevent and treat incontinence in pregnant women or women who have recently given birth. In fact, research has found that women having their first baby who performed PFMT were about <a href="http://www.cochrane.org/CD007471/INCONT_pelvic-floor-muscle-training-for-prevention-and-treatment-of-urinary-and-faecal-incontinence-in-pregnant-women-and-women-who-have-recently-given-birth">30% less likely</a> to experience incontinence up to six months after delivery. There is also increasing <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32109-2/abstract">evidence</a> that PFMT may prevent symptoms of pelvic organ prolapse and could reduce the uptake of further treatment.</p>
<p><a href="https://www.nice.org.uk/guidance/cg62?unlid=6487027412017312201739">UK guidelines for antenatal care</a> recommend midwives offer information about pelvic floor exercises at a pregnant woman’s first appointment. However, for PFMT to be effective it needs to be delivered through a <a href="https://www.ncbi.nlm.nih.gov/pubmed/21820536">structured, supervised training programme</a>. Simply giving out information on its own is rarely enough to support people to carry on exercising long term. </p>
<p>Women have reported that the information they received about PFMT in pregnancy was <a href="https://www.ncbi.nlm.nih.gov/pubmed/17126457">insufficient</a>, and they weren’t told about the importance of pelvic floor health. They did not understand why they had to do the exercises or how to do them correctly. The information was not clearly linked to the role of the muscles in reducing the risk of incontinence or pelvic organ prolapse so many women did not think PFMT was worth doing.</p>
<p>Evidently, more <a href="https://www.rcm.org.uk/sites/default/files/CSP-000924_RCM.PDF">could and should be done</a> to improve the quality and delivery of PFMT information during the antenatal period. Incontinence and prolapse do not need to be taboo, but nor should they be normalised as part of the consequences of childbirth and pregnancy. </p>
<p>PFMT during pregnancy presents an opportunity to prevent long-term, debilitating pelvic health problems and may reduce the need for further medical or surgical intervention. But for this to happen, women need to understand the benefits, know how to do it and feel that PFMT is realistic and doable in their daily lives.</p><img src="https://counter.theconversation.com/content/76440/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Victoria Salmon is a member of the Chartered Society of Physiotherapy and the Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) professional network. Victoria receives funding from the UK National Institute for Health Research (NIHR). The views and opinions expressed in this article are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.
</span></em></p><p class="fine-print"><em><span>Rachel Jarvie receives funding from the UK National Institute for Health Research (NIHR). The views and opinions expressed in this article are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.</span></em></p>Women need to be given more information about pelvic floor health during and after pregnancy.Victoria Salmon, Research Fellow in Women's Health, University of ExeterRachel Jarvie, Research Fellow in Women's Health, University of ExeterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/493652016-02-11T19:01:30Z2016-02-11T19:01:30ZUrinary incontinence can be a problem for women of all ages, but there is a cure<figure><img src="https://images.theconversation.com/files/109586/original/image-20160129-27156-le0h63.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Urinary incontinence is often seen as a degrading condition and women can feel too ashamed to seek help.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>This article is part of our series examining women’s hidden health conditions. You can read about endometriosis, menopause and other pieces in the series <a href="https://theconversation.com/au/topics/womens-health-series">here</a>.</em></p>
<hr>
<p>Urinary incontinence is urine leakage from a loss of bladder control that mainly affects women after childbirth. But it can happen to anyone. Around <a href="http://www.continence.org.au/pages/key-statistics.html">37% of Australian women</a> have some form of the condition compared to 13% of Australian men.</p>
<p>Mild incontinence is <a href="http://onlinelibrary.wiley.com/doi/10.1002/(SICI)1520-6777(1999)18:6%3C567::AID-NAU7%3E3.0.CO;2-F/abstract">the most common form</a>, affecting about two out of three sufferers. This is where small amounts of urine leak out onto clothing a few times a week and require a light pad or pantyliner to catch the flow. </p>
<p>Moderate to severe incontinence is less common and affects about a third of sufferers. Women need to use a specific incontinence pad (with absorbent gel) and change it more than once or twice daily. This might not be enough though, and they may get accidental wetting through to their clothing even if using the pad.</p>
<p>Whatever form it takes, <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442455815">the impact of incontinence</a> can be debilitating and women are often too embarrassed to seek help from their doctor. This is unfortunate as there is more likelihood of a cure for those who receive treatment at an earlier point.</p>
<h2>Stress and urge incontinence</h2>
<p>There are <a href="http://www.medicalobserver.com.au/medical-news/female-urinary-incontinence">two main forms of urinary incontinence</a>: stress incontinence and urge incontinence. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/110551/original/image-20160208-18303-ygfcrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/110551/original/image-20160208-18303-ygfcrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=462&fit=crop&dpr=1 600w, https://images.theconversation.com/files/110551/original/image-20160208-18303-ygfcrw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=462&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/110551/original/image-20160208-18303-ygfcrw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=462&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/110551/original/image-20160208-18303-ygfcrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=581&fit=crop&dpr=1 754w, https://images.theconversation.com/files/110551/original/image-20160208-18303-ygfcrw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=581&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/110551/original/image-20160208-18303-ygfcrw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=581&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A urethra is like a hose.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/aboutamy/9393569695/in/photolist-fj5v1c-oP3Dyz-dFeJuJ-euAJrh-u1XZbc-87sDPW-87sDYY-ejHu9E-CyG8VV-brQmQ9-bQXhyT-4zD86w-3kDmhH-6sVPNv-6qsCeC-feetQ-6GiGDD-6qsCtY-8znEb9-6tfyr2-6zYu1t-6zYtEF-6qaaSK-AHq7JC-rJG7n4-3kDkup-7pSaM-7QVd9S-6gdkBM-Ha6vs-4xxAXw-om5m7i-87EWG3-7jE2oQ-b3cg3R-7YSN8X-c9aPVj-4SoZ7b-bL3xu4-dgMWHL-91RmJq-4Ftxuo-nC9ecZ-87m66u-tQo36f-84iNCt-bwfnjh-wxwyB8-bCMxkg-pQYPHR">Amy Stanley/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>In stress incontinence, urine leaks out during coughing, sneezing, laughing, or exercising. People with this condition have weak pelvic muscles around the urethra, which are overwhelmed during times of physical stress. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/8041527">About 28% of young women</a> who engage in high-impact sports - such as gymnastics, basketball and tennis - develop stress incontinence.</p>
<p>The second form, urge incontinence, is a desperate need to go to the toilet due to spasms in the bladder muscle. Sometimes this results in leaking. People often go to the toilet more than eight times a day, and get up to go more than once at night.</p>
<p>There’s another form called overflow incontinence, which is actually more common in men who have an enlarged prostate gland. It partly blocks the urethra so a pool of residual urine builds up in the bladder and leaks out when capacity overflows. </p>
<p>The problem is rare in women and happens when the bladder has <a href="https://jeanhailes.org.au/health-a-z/bladder-bowel/prolapse-bladder-weakness">prolapsed or dropped down</a> into the vagina. This can block off the urethra, leading to incomplete emptying with overflow leakage.</p>
<h2>Incontinence across the ages</h2>
<p>Women are more prone to incontinence because their urethra is very short (only 4 cm) while the male’s is quite long (11 cm). If you imagine a garden hose, the shorter it is, the more likely water from the tap is to leak out. In a longer hose, the tap water might stop flowing before it reaches the end.</p>
<p>About a third of women <a href="http://www.alswh.org.au/who-is-involved/students/9-who-is-involved/28-dr-pauline-chiarelli-s-studies">who have had children</a> suffer from incontinence at some point. Adolescent girls and older children also experience urine leakage, mainly in the case of bed wetting. This is due to an overactive bladder and <a href="http://www.ncbi.nlm.nih.gov/pubmed/8944518">affects about 4%</a> of children between five and 12.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/109584/original/image-20160129-27180-14khbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/109584/original/image-20160129-27180-14khbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/109584/original/image-20160129-27180-14khbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=441&fit=crop&dpr=1 600w, https://images.theconversation.com/files/109584/original/image-20160129-27180-14khbp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=441&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/109584/original/image-20160129-27180-14khbp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=441&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/109584/original/image-20160129-27180-14khbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=554&fit=crop&dpr=1 754w, https://images.theconversation.com/files/109584/original/image-20160129-27180-14khbp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=554&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/109584/original/image-20160129-27180-14khbp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=554&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Weak pelvic muscles around the urethra can lead to stress incontinence.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>Bed wetting gradually declines during adolescence, but urge and stress <a href="http://www.ncbi.nlm.nih.gov/pubmed/22704114">incontinence persist</a> in up to 10% of women. Incontinence then becomes more common after menopause as women <a href="https://jeanhailes.org.au/health-a-z/bladder-bowel/prolapse-bladder-weakness">produce less oestrogen</a> which weakens ligaments and pelvic floor muscles supporting the urethra. </p>
<p>Obesity <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866035/">increases the likelihood</a> of incontinence too, as abdominal fat puts pressure on pelvic floor muscles. Likewise, constipation and repeated straining to pass a bowel motion weakens these muscles, <a href="http://www.ncbi.nlm.nih.gov/pubmed/20346050">increasing the risk</a>. </p>
<p>Other factors influencing incontinence include urinary tract infection, which is <a href="http://www.ncbi.nlm.nih.gov/pubmed/18238968">known to worsen</a> its prevalence and severity. Anxiety also contributes to symptoms with studies showing 28% to 32% of women with <a href="http://www.ncbi.nlm.nih.gov/pubmed/22068320">urge incontinence</a>, and 22% with stress incontinence, suffer from anxiety.</p>
<h2>Treatment options</h2>
<p>Urinary incontinence implies lack of control which leads to feelings of shame and reluctance to seek help. As one <a href="http://www.ncbi.nlm.nih.gov/pubmed/15621220">study showed</a> 55% of women who wore pads for incontinence had not consulted a general practitioner in 12 months. </p>
<p>This is unfortunate as treatment options have advanced enormously in the last 20 years. If a patient seeks treatment when leakage is mild, it’s much more likely <a href="http://www.ncbi.nlm.nih.gov/pubmed/12955342">to be successful</a>. The more severe the incontinence, the more difficult and expensive it is to treat.</p>
<p>First-line therapy for stress incontinence is pelvic floor muscle training by a specialist continence physiotherapist, which doesn’t require a doctor’s referral. This has a 65% likelihood of cure for mild, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/12842055">35% for moderate, incontinence</a> with no side effects or risk.</p>
<p>If this doesn’t work, there are two kinds of <a href="http://link.springer.com/article/10.1007/s00192-007-0519-1">vaginal ring pessaries</a> available to support the urethra. These are particularly useful for women who only leak with active sports or gym classes.</p>
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<p>The final option is to have an operation. The most widely performed is one where a mesh tape is placed under the urethra like a sling for support. About 93% of women <a href="http://www.ncbi.nlm.nih.gov/pubmed/10426241">are found to be</a> cured three years after having the surgery and it shows good long-term results.</p>
<p>For urge incontinence, first-line therapy is training to increase bladder capacity. <a href="http://www.australianprescriber.com/magazine/29/1/22/4">A tablet or patch</a> that reduces bladder spasms is prescribed alongside training for at least three to six months.</p>
<p>Urge incontinence after menopause is treated with vaginal oestrogen cream that helps <a href="http://www.ncbi.nlm.nih.gov/pubmed/23076892">strengthen the urethra</a> and enhance bladder capacity. </p>
<p>About 40% of women who don’t respond to these are found to <a href="http://www.ncbi.nlm.nih.gov/pubmed/24844724">have a low grade infection</a> of the bladder, known as cystitis. More treatment options are being developed for this. For instance, a <a href="http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=12613000285752&isBasic=True">randomised trial is currently underway</a> exploring bladder-specific antibiotics together with a muscle spasm reduction tablet for urinary incontinence. </p>
<p>No woman should have to suffer urinary incontinence in silence or shame. The above treatments are not difficult, but they require a professional to steadily work through the options to find the right cure for each woman.</p>
<p><em>Specialist continence physiotherapists can be found at the <a href="https://www.physiotherapy.asn.au">Australian Physiotherapy Association’s</a> website and at the <a href="http://www.continence.org.au">Continence Foundation of Australia’s</a> website.</em></p><img src="https://counter.theconversation.com/content/49365/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Moore receives funding from the NHMRC, the Bupa Research Foundation and the Australian Bladder Foundation.</span></em></p>Women with urinary incontinence are often too embarrassed to seek help from their doctor. But there is more likelihood of a cure for those who receive treatment at an earlier point.Kate Moore, Professor, Obstetrics and Gynaecology and Head of Department of Urogynaecology, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/209772013-12-09T14:39:25Z2013-12-09T14:39:25ZRegular pelvic floor exercises help a very common problem<figure><img src="https://images.theconversation.com/files/37148/original/s8rbkpjt-1386339721.jpg?ixlib=rb-1.1.0&rect=1%2C3%2C1022%2C680&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">And hold.</span> <span class="attribution"><span class="source">Relaxing Music</span></span></figcaption></figure><p>Women who have had children are often advised to do exercises to tighten their pelvic floor muscles. The <a href="http://www.nhs.uk/chq/Pages/1063.aspx?CategoryID=52&SubCategoryID=146#close">muscles run</a> from the pubic bone at the front of your body towards the back and help support your bladder and control when you urinate.</p>
<p>As you get older, these muscles can also weaken, and pelvic organ prolapse is a common disorder. This is when the bladder, womb or bowel moves downwards from its normal position because the muscles or ligaments aren’t supporting it as they should. It can lead to pain, discomfort and less enjoyment in life. Problems with the bladder – both difficulty passing urine or incontinence – the bowel and having sex can be embarrassing and debilitating. Prolapse and bladder problems often co-exist but they aren’t always related.</p>
<p>We don’t know the exact number of women with prolapse. This is because women don’t always come forward because they are embarrassed, but also because studies measure prolapse in different ways – some record symptoms, others actually measure how far your anatomy has dropped from its normal position but which may not always be accompanied by symptoms. </p>
<p>According to <a href="http://www.ncbi.nlm.nih.gov/pubmed/12066091">one large study</a> about 40% of women older than 50 had some degree of prolapse when examined. About 11% of women undergo surgery for urinary incontinence or prolapse in their lifetime, <a href="http://www.ncbi.nlm.nih.gov/pubmed/9083302">and 7%</a> for prolapse alone. In England, <a href="http://www.hscic.gov.uk/hes">about 29,000</a> prolapse repairs were done between 2010 and 2011, at a cost of around £60m.</p>
<p>All of this suggests that the problem is common – but there are things that can be done to help. Pelvic floor exercises have been recommended but evidence of their effectiveness has been limited. But a study we carried out with 447 women suggested that women reported fewer symptoms at six and 12 months if they had been involved in a personalised programme of pelvic floor muscle training than if they had been in the control group.</p>
<h2>Pelvic floor muscles exercises</h2>
<p>You can pull in your pelvic floor muscles by pretending to hold in your wee or stop yourself passing wind. Once located, the muscles can be trained by regularly doing a series of long and short holds. For example, you might squeeze these muscles slowly ten times in a row, then do ten fast squeezes.</p>
<p>The exercises can be built up over time, and in our study we aimed for women to achieve ten long muscle holds for ten seconds, and up to 50 fast contractions three times per day. It does take some time to start to see the effect, but after a couple of months they did start to feel a difference.</p>
<p>Consulting a professional, such as a pelvic floor physiotherapist, as well as giving you the correct exercises, can also help you understand more about the anatomy and function of pelvic floor muscles and the types of prolapse, and offer support. They will perform an internal assessment of the muscles to ensure correct exercise technique and provide an individualised exercise programme.</p>
<h2>Risky business</h2>
<p>There are a number of reasons why women develop a pelvic organ prolapse. The main one is childbirth, which is associated with a higher risk of prolapse in later life. The more children you deliver, the greater the risk. Other obstetric factors could also play a part. Caesarean sections, for example, might be protective compared to vaginal delivery, while the use of instruments such as forceps during the delivery may increase risk. </p>
<p>Women can also have a genetic predisposition to prolapse, and heavy lifting or a physically strenuous occupation can contribute.</p>
<p>Treatments for prolapse include surgery and conservative (non-surgical) management, which includes the pelvic floor exercises, lifestyle changes (such as weight loss), and vaginal pessaries (a support device worn inside the vagina to push the prolapse up to restore normal anatomy).</p>
<p>Choice of treatment depends on the severity of the prolapse and its symptoms, and the woman’s general health and preferences. Conservative treatment is generally considered for women with a mild degree of prolapse, those who wish to have more children, the frail or those unwilling to undergo surgery. These therapies are less expensive, carry lower risk and don’t stop you having further treatment such as surgery later on. It is also the main form of management used to help women with this condition. </p>
<p>While we reported better results for women who’d done exercises in a follow up after a year, we still don’t know whether in the longer term it prevents women from having to go on to surgical procedures. What we do know is how common prolapse is and what could help. It really is nothing to be embarrassed about. </p><img src="https://counter.theconversation.com/content/20977/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Suzanne Hagen receives funding from the Chief Scientist Office, Scottish Government Health Directorates.</span></em></p>Women who have had children are often advised to do exercises to tighten their pelvic floor muscles. The muscles run from the pubic bone at the front of your body towards the back and help support your…Suzanne Hagen, Programme Director in Nursing and Midwifery, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.