Pelvic floor exercises

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hello everyone and welcome to this uh nzdf health week presentation
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um my name is narissa chapman and i am a physiotherapist by trade
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and i have uh recently completed uh some further study into
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pelvic health physio today i am going to be talking about the
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floor to your core and why the pelvic floor is so important
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so looking at this slide here there might be some of you out there that do uh
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sympathize with this uh lady here so sometimes i laugh so hard that tears run
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down my legs so we're actually going to be covering this because what what's likely happening here is that this poor
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um woman is suffering from something called stress urinary incontinence which we
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will talk about a little further on so what we're going to cover in this
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presentation is just uh understanding a little bit about what the pelvic floor is
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what are some risk factors out there for developing pelvic floor dysfunction
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what types of pelvic floor dysfunction are out there what can we do to actually identify if
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we've got a well-functioning pelvic floor or do we perhaps have some dysfunction there
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i'll then go through some education with you all followed by uh
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understanding how we can strengthen it well how most people can strengthen their pelvic floor and where do we go
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from there so first of all what is the pelvic floor
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so the pelvic floor is a group of muscles ligaments and fascia that form the base of your core
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it sits low in your pelvis and it acts like a hammock to support to correction to support your bladder
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bowel and obviously in females the uterus
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it has both a superficial and a deep layer so the superficial layers
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are down by your perineum and the deep layers are roughly two centimeters
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above that so it works synergistically with other muscles in your core so they work they
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work together so the other muscles that it works with is your diaphragm which is obviously at
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the top of your abdomen and the most important muscle for breathing
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it works with your transverse abdominis muscle which acts like a big corset all
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the way around your abdomen and also with your back musculature in
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particular a really a small muscle called the multifidus the multifidus
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muscle is deep in beside your vertebral column and these muscles along with the pelvic
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floor they act to provide core and pelvic stability which is obviously
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really important when we are moving they support your pelvic organs and they
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also contribute to managing the intra-abdominal pressure
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the pelvic floor muscles are really really important for maintaining both urinary and anal continence and control
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so that's things like uh being able to
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go to the bathroom both for peeing and for pooping
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as well as being really important in sexual function so things like your pelvic floor muscles
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if you have a penis they work to
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help you get and maintain an erection they are also important
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in orgasm both for males and for females
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and that moves on to our next thing so both males and females have have a pelvic floor a lot of guys out there
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might be thinking this lecture is not relevant for me but actually males have
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a pelvic floor as well however dysfunction is significantly
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more common in females than it is in males
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so this slide just shows a few pictures of what i was talking about before so
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this picture up here on the left as we look at the screen this
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just talks about that kind of the pelvic floor being that floor to your core so
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we've got our multifidus at the back we've got our transverse abdominis which wraps around our abdomen and we've got
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our diaphragm up here and you may hear people talk about the kind of can theory of core stability so
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if you think about a can when it's got its top and it's bottom
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on it's really really hard to crush that can isn't it and you can pretty much stand on it
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and it'll support your weight the same kind of thing works here and that the diaphragm and the pelvic floor as we uh
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kinda breathe in the diaphragm drops down to allow that oxygen to go into our
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lungs our pelvic floor also drops down a little bit and our transverse abdominals
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they expand a little bit and then as we exhale everything kind of moves up and
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in forcing that air out of our body this picture down here is a female
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pelvic floor as you can see it's got the three holes so that is the rectum for the vagina and
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at the front here that is the opening where the urethra passes through and as
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you can see it's like a hammock right down the bottom of our pelvic girdle so
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these are our hip bones or our iliums coming down with our pubic bone at the
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front and deep down in here is a bone called the ischium or the sit bones that you can feel when you're sitting down on
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a chair and coming up here this is just a side view of the pelvic floor and obviously
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in men they just and males they just have two openings so a little opening here to the um front which is where the
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urethra comes through and obviously to the back where uh the rectum passes
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through on females we have an additional uh
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hole in our pelvic floor and that is where the vagina passes through
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so a couple of important anatomical structures here at the back we've obviously got the bowel or the rectum
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coming down to uh the anus we've got the uterus
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down into the vagina and bladder and urethra here on male and
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female uh just interest uh important to note that the urethra on females is obviously
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a lot shorter than on males which can obviously be a varying varying lengths
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cool so i'll get you guys just to um pause the video here and if you click on the
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link it'll take you to an interesting uh video that i'll get you to watch
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while this video is quite old 2013 this is still an issue with uh
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females who participate in high impact sport so i'll get you guys to pause the
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video here and go away and click on that youtube link and
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have a think about what you see there
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cool hopefully that uh link link worked for you so really interesting there isn't it
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that um working through there a lot of those uh women and in that high impact sport of crossfit
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they had essentially normalized this stress urinary incontinence
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or as they talk about in their exercise induced urinary leakage
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so the medical term is stress urinary incontinence and what that means is an involuntary
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loss of urine on effort of physical exertion and this can happen
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with things like sporting activities uh sneezing coughing laughing
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it's really common in uh sporting activities such as double unders because
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double unders are a really really quick exercise and your pelvic floor doesn't
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really get a chance to fully release and relax before you kind of back up in the air again so if you do have some
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dysfunction there it can really test it so whilst that video was in 2013
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there's actually been a number of studies that have been published looking at crossfit in the last few years
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probably since about 2019 and in 2022 there was a a meta-analysis
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done so that's when they look at all kinds of studies that that fit uh criteria and they um
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judge them to actually see what the kind of level of evidence is in each of those studies and overall
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they found that there's a prevalence of about 44 and a half percent among female
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crossfitters so these studies did actually include women who hadn't had children so nulli
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paris woman uh and women of all ages so from 16 to
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65 was roughly the population that they were looking at
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uh noting there that obviously women who have had kids are more likely to have
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these issues um the other thing here is that just
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because you have these issues doesn't mean you can't do your high impact sport so it's not just crossfit it's really
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prevalent in runners in particular people who do a lot of long distance
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running so the the prevalence of urinary incontinence of stress urinary incontinence and long-distance runners
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is very similar to in crossfit around 40 percent uh that increases in some sport so such
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as trampolining the prevalence of stress urinary incontinence and that sport is
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up above kind of 60 and the other sports that also have quite high prevalence uh olympic lifting
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so studies vary in that between kind of 40 and 60 60 prevalence
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uh and also uh gymnastics
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the thing here is you do not have to give these sports up so you want to train to the weakest link so we had that
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diagram before about the core and often a lot of people work really really hard
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to get that really killer six-pack and they forget about their pelvic floor
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so key thing throughout if you're training the training the cord don't forget the floor so it's really
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important to kind of train to that weakest link because you're only as strong as that weakest link
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so we can't we can increase the strength there which we'll talk about later on in this presentation
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about 80 percent of people will improve or fully resolve with pelvic floor
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muscle training so it is able to be treated if that muscle is intact and it's not
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structurally damaged and it has a nerve supply it's the same as any other muscle
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in your body so if you pull your calf you tend to do some rehab you know some
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calf raises some stretching to strengthen that up and then then you're away again same thing with
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your pelvic floor it is a muscle that we can control and it is a must and it is muscles that we can train
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so some risk factors for pelvic floor dysfunction i've already talked about a couple of them but one of the kind of
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main ones out there is parity so the number of pregnancies that an individual has had so this incr this increases your
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risks of developing a pelvic floor dysfunction the more pregnancies you have
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and it exponentially increases after the kind of third pregnancy
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a vaginal delivery is associated with a greater risk of pelvic floor dysfunction
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this is obviously understandable here so during a normal vaginal delivery your
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pelvic floor muscles can stretch anywhere between 62 and 276
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percent of their original uh tensile strength that's uh
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that's a phenomenal amount when you compare to another muscle like
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your hamstring or your calf you start doing damage when it gets to kinda 30 to
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50 percent above its normal normal load
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a long second stage of labor so that is the active pushing stage of labor so if
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you have been in labor and you were pushing for more than 60 minutes that
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increases your chances of developing a pelvic floor dysfunction if you have a
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large baby and a large baby is considered 4 kgs or more for obvious reasons it's more likely to
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do more damage if you are overweight this is a significant risk factor irrespective of
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if you have had ever been pregnant or had any children
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this is a particular risk factor for developing pelvic organ prolapse
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a chronic cough so things like having allergies that mean you cough or
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sneeze quite often having asthma and smoking so a chronic
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cough coughing increases your intra-abdominal pressure and increasing your intra-abdominal
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pressure forces that pelvic floor down and if you're doing it too often it can
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then actually lengthen and damage those structures in your pelvic floor such as
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the muscles or the fascia these two are highlighted in blue
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because they are something that uh potentially you could say is an occupational risk factor for being a
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being in the military so if your occupation involves regular heavy lifting so be that as occupation so a
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lot of studies have been done in nurses and uh traditionally that is an
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occupation that involved a lot of heavy lifting before you know they had like
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hoists in that to assist uh but also a lot of recreational
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lifting so things like olympic lifting and going to the gym lifting heavy weights
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things like that uh the other risk factor there is high impact exercise so
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in particular things like running in gymnastics they have traditionally been um
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been sports where there is a high prevalence of pelvic floor dysfunction uh but also
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recently a lot of work and with the kind of popularity of high intensity interval training such as
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crossfit f45 um that has also
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started to um to have a prevalence that is similar to
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these other traditionally high impact sports and this is also interesting this sport because it's really taken off with
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females uh input you know females haven't traditionally been
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big gym goers and big weightlifters but crossfit is actually allowing a lot
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more people to actually get involved in these sports
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other risk factor is any kind of pelvic surgery so if they have actually gone in
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and uh cut through the tissues in there or removed any of the structures in your
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pelvis such as your uterus and a hysterectomy that can be a risk factor
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for developing pelvic floor dysfunction a lot of these are for males but uh
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prostate cancer so if you've had prostate cancer and you've had that that treated be it surgically or they've used
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radiotherapy on that that is a significant risk factor for developing pelvic floor dysfunction
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in particular urinary incontinence and erectile dysfunction for that one uh if
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you post menopause so due to the um decrease in in the
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hormones post menopause the tins the tins the tissues and the and the
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pelvic floor can become thin and drier which then actually and the
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muscles can actually atrophy which obviously increases your chances
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of developing a dysfunction uh if you had an assisted delivery so if
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you gave a vaginal birth and they needed to use things like
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forceps or suction or do an episiotomy these things can
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increase your chances of a pelvic floor dysfunction if you have a history of trauma
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so people have been sexually assaulted or if they've had quite a significant
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injury to that area such as a pelvic fracture or a fracture in their
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in their tailbone they can develop pelvic floor dysfunction
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if you have chronic constipation it makes sense here if you are constantly straining
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and your bowel has been uh impacted
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then this can also lead to pelvic floor dysfunction and the last one there is a family history there's starting to be a
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lot of evidence out there that says pelvic floor dysfunction uh
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has a genetic component and a lot of this is around the kind of fascia and
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how kind of um i suppose loose your fascia fascia can
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become so if your kind of mother and grandmother had have issues with their
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pelvic floor then potentially this is something that you you could develop
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so all these risk factors they're just risk factors so you might have everything on there and your pelvic
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floor might be a hundred percent but they're just things things to look out for and to be aware of and maybe
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actually take some kind of preemptive rehabilitation in there and work on your pelvic floor before it uh
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has any issues so there's a number of different types
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of pelvic floor dysfunction that's out there
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and the most common one is stress urinary incontinence which we talked about before so that's that involuntary
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loss of urine on effort or physical exertion so this is uh things like
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sporting activities or if you're increasing your intra-abdominal pressure so such as with a coughing
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or sneezing it's activity related and does not have a psychological
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component it is one of the most common urinary tract disorders that women
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seek medical attention for it is not very common in males unless they've had
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prostate surgery so the other type of uh incontinence out
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there is urge incontinence so this is an involuntary leakage of urine that is
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accompanied or immediately preceded by urgency so you get that need to go and
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you need to go now if you don't make it to the toilet uh
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you can end up having an accident so
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it's as often things like every time when you get home from work and you put the key in the door that act of putting
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the key in the door triggers yes i need to go toilet and i need to go now you've
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also got mixed incontinence which is a mixture of the stress urinary incontinence and the urge incontinence
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you can have anal incontinence and so that is things like actual fecal matter so it
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might be just kind of liquid or it could actually be formed stills
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or you have loss of uh flattest so so farting that is actually
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a form of anal incontinence if you were trying not to fart but couldn't
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hold them and one kind of slipped out sexual dysfunctions so these are quite
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common in people with pelvic floor dysfunction so some of the common ones that you'll
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see are pain and that's uh in women that can be both with penetration but also around the um
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the vulva uh and with men kind of the most common
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things that you'll see with men are erectile dysfunction so an inability to get an erection or an
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inability to maintain their erection and also things like premature
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ejaculation so not being able to control when they ejaculate
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uh pregnancy big risk factor here and likely to cause pelvic floor dysfunction
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because you've got a heavy baby that is basically pushing down on
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your pelvic floor uh so some other types of dysfunction are people with
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persistent pelvic pain quite often they can have a dysfunctional pelvic floor so
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their pelvic floor might not be working in harmony with their um other parts of
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their core it might be too tight and not relaxing at the right time or it might
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be relaxing when it's meant to be contracting um similar to the uncoordinated and
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disenergy down there a pelvic floor disorders also really
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really common in people who have chronic low back pain so they've done some
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studies and they reckon that about 70 percent of people who have long term chronic low back pain have an element of
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pelvic floor dysfunction in there so often it's really important if you've
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got back pain and it doesn't seem to be resolving it's actually really important to maybe consider hey is there an
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element of pelvic floor dysfunction here that is also the same with long-term hip
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and groin pain the disc synergy and the uncoordinated
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pelvic floor a lot of that is around um
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it potentially being too tight or hypertonic and not being able to relax when it's meant to be relaxing i.e when
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you are having a bowel motion you want everything to be
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relaxed so those are the different types of pelvic floor dysfunctions out there
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for females far and away the most common type of pelvic floor dysfunction would
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be the stress urinary incontinence uh pain and sexual dysfunction so pain
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on intercourse is actually also very common in particular with a woman who
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have not had children and maybe are doing quite a lot of high impact
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exercise they can have a a deep kind of pelvic pain on
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intercourse so what are some of the management
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strategies for pelvic floor dysfunction that we have talked about here so
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first thing we want to do is actually id if you have dysfunction so how we can do that is
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obviously going to visit a pelvic health physio so in new zealand probably a pelvic health physio is the
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the main type of person who would assess this there is also some continence nurse
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specialists out there uh so they tend to identify functional
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issues um whereas if you went to like a gynecologist they are more likely
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to identify if there is structural issues going on
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so really important to to self screen and i've got a a link on the next slide
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that you can have a look through that's just a kind of quick link to identify if you're potentially at risk of having a
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pelvic floor dysfunction or if maybe you do have an element of pelvic floor dysfunction
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uh losing weight so maintaining a healthy body weight this is a really important
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step that you can actually do to decrease your chances of developing a
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pelvic floor dysfunction in particular pelvic organ prolapse which i don't think i covered on the
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last slide so pelvic organ prolapse but it can also help with our stress
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urinary incontinence as well so we want to try and maintain a healthy body weight you want to strengthen your
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pelvic floor muscles but it's also really important to fully relax these muscles as well as strengthening
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them you want to have a look at how you're going to the toilet because there's strong links between our dysfunctional
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bladder and bowel habits and pelvic floor dysfunction you want to have a look at your diet are you drinking
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enough uh are you getting enough fibre or maybe if you've got some urge
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continents actually you are taking a lot of substances that are bladder about
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irritants so a key one out there is caffeine caffeine is a really strong um
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irritants for the bladder as is alcohol and you want to make sure that you are
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conducting regular exercise because this in general just keeps everything moving
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in your um bowels but it also helps keep the
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muscles of your core uh in good tone there are some exercises out there that
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aren't pelvic floor friendly and you just need to be careful about these if you do have dysfunction so some prime
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examples of uh exercises that aren't very friendly on the pelvic floor are things like box
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jumps double wonders burpees deep sumo squats running
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the other thing is you need to address any chronic constipation or chronic cough that you have by talking to your
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gp and the definition that we're using here of constipation
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is a bowel motion that is
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there's not really any definitions out there on constipation but
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it's like that complaints of a bowel movement that's infrequent and or incomplete so you don't feel like you've
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got everything out and it wasn't satisfying
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really key here to talk to your doctor about uh getting on top of this because the
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longer you let that chronic constipation and chronic cough happen the more damage they're going to be doing to your pelvic
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floor so really important to talk to your doc about getting some help with that
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this slide has just got some links on it to a really easy basic screening tool
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that you can do it's a screening tool that's been designed for fitness professionals so if you are
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going along to a gym to see a trainer it's a screening tool that's been designed for use by trainers
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um but it's actually a really easy to go through screening tool in general
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so there's one for males and one for females and they are from the continents.org dot nz website but they
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have been adapted from the continents foundation of australia which are the really those two websites are really
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good websites to look up a lot of different resources and kind of tips out there around uh managing the pelvic
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floor so how so if we've id'd we think maybe
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we have an issue uh you can actually do a self-test it's not
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as obviously it's not as reliable as actually going to get a professional who is trained to do
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internal assessments and assess the pelvic floor muscles but it's a it's a good start if you're
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not yet comfortable to reach out to a health professional trained in this area
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so for females really really important to actually
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see what it looks like down there um and you know they're all they're all
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different um and so it's really important to actually have a look what what it looks like down
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there on you so the easiest kind of position to do this is kind of reclined
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on your back with your your hips and your knees kind of bent so kind of lying in the sit up position
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you want to look for closing and tightening around the anus and vagina and a lifting of the perineum so the
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perineum is that little bit of skin between your vagina and your anus the
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muscles should draw in and up you really want to make sure that when you're contracting them that they're not
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kind of pushing out uh as that could mean you're bearing down and if you are bearing down you
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could increase you could do damage to your pelvic floor
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roughly about 30 of people do not know how to do a pelvic floor
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uh sorry about 30 percent of people when they're
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doing a pelvic floor contraction they are actually bearing down
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which is actually quite uh quite a large number of people
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probably only about 30 percent of people can actually do a pelvic floor muscle properly without being trained at pelvic
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floor muscle contraction properly without being trained to do this
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um the other thing you can also do is a self-internal vaginal palpation
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so to do this you want to again adopt a comfortable position so it's really important that you're as comfortable as
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you can be because you actually want these muscles to be relaxed i
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recommend using a small amount of lubricant on your finger just to make it more comfortable and you
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want to insert one finger into your vagina and it only needs to go in about
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two centimeters the pelvic floor muscles are relatively superficial so it basically only really needs to go into
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that kind of middle finger joint and you want to press into the side walls of your vagina not the front and the back
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because at the front there's your bladder and at the back there's your rectum so they don't have kind of that
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that's not where the muscles are so once you're pressing onto the side wall of your vagina
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you want to think about contracting your pelvic floor muscles so using cues like thinking about um
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sucking a tampon up and in and you want to think about
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and see if those muscles can contract around your finger and does it feel even
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on both the left and the right sides you could also think about holding a fasten
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and the other thing that you can do key here do not do it more than once a week
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because it can actually cause you a pelvic floor dysfunction
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thinking about when you're going through a wee thinking about trying to stop that flow of urine
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can you stop the flow of urine or um is that difficult for you so that is the
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action that we are trying to look for for men a lot easier for you to um to
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assess your pelvic floor so again you won't have a look that's it's
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it's so much easier with visual cl uh visual cues so for men you want to stand in front of
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a mirror without kind of pants and undies on so you can see roughly belly button and below
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spelling mistake on that slide but you want to think about contracting your pelvic floor so they've actually done
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studies on what cues work really well for men and for most men the cue
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bring your nuts to your guts is a really easy cue for most men to actually figure
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out and get the right movement the other thing you can think about is visualizing if you're say walking
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into a really really cold cold river and it's starting to get kind of
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slowly creeping up your your thighs what are your test is likely to do they're
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likely to go up and in aren't they so we're thinking about this we're
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thinking about contracting the testes so that they lift up and
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what we what we should see in our mirror is we should see the testicles lift up
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and there should be a little dip kind of like a little dimple that just appears just above your penis if that happens
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you are lightly doing a correct pelvic floor contraction next thing there is to actually see how
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long you can hold that for you can also do some self palpation of
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the perennial muscles so when that happens does your perineum lift up and away from your
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fingertips uh also practicing holding a fountain and for men
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stopping that flow of urine again no more than once per week just because it
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can actually cause issues with your bladder by teaching you not to fully empty your
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bladder so next thing there is moving on to
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actually learning how to go to the toilet properly you may think i've been going to the
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toilet all my life i know how to um actually go and have a poo
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but you'd actually be surprised about at how many people do not know how to
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adopt a position that takes the pressure off their pelvic floor muscles
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and there's a lot of strong links here between poor toileting that's the bladder and bowel and pelvic floor
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muscle dysfunction and again for females we're more likely to have poor toileting technique
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and that can be for a number of reasons so you know busy with children getting
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them off to school you haven't actually got time to go to the loo you hold on or social reasons you might
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not want to go and have a poo in a public area for example so that leads you to then
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to then hold on which can then um make it difficult for you to then uh
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pass that stall later on so this is the bristol stool chart so
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designed obviously in the in the uk and basically it just outlines seven different types of stools that you can
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have and the key thing we want to actually sit between a three and a four
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so kind of like a sausage number three like a sausage and number four like a smooth
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sausage so that's the key there we want it to be kind of well lubricated
37:58
but formed uh other things here you know if you're
38:04
kind of down in that type 1 and type 2 what is your fiber and fluid intake like
38:10
if you're higher up there are you actually taking something that really does not agree with your bowels is it
38:17
links to a certain type of food um if you are having issues with this and
38:24
it is long term go and talk to your gp because
38:29
you actually want to make sure that you are pooping correctly
38:36
uh next thing um so what what's actually normal so there's not really real
38:42
definition of normal out there the key thing is what is normal for you and what we're looking for here is any changes in
38:49
normal so normal can be anywhere between going three times a day
38:55
to three times per week it has a consistent pattern and that's
39:01
what we're looking out for here so pooping technique
39:08
this lovely drawing here is the position that you should adopt when both for men
39:14
and women you are going for a number two the other thing here is don't hold on so
39:21
when you first feel the urge make sure you act on it obviously occasionally you do need to
39:28
hold on but ideally when you feel the urge to go you want to go within 10 to
39:35
15 minutes of feeling that first uh need to go and have a poo
39:43
so position so you want to be seated with your whole foot supported so you want your feet kind of flat you want to
39:49
have your knees higher than your hips so 30 degrees kind of hip hip flexion you may need to elevate your
39:57
feet to achieve this so thinking about like a toilet roll is like two toilet
40:02
rolls that's kind of the ideal height or um make some kind of stool up no pun
40:09
intended there all these other devices out there such as the squatty potty which are
40:15
purposefully designed for this this is only really an issue in western
40:21
cultures where heat where we have designed our toilets to basically sit us
40:27
in an unnatural position humans are designed to squat to go
40:34
number for a poo um not obviously an issue if you're in
40:40
asia because their toilets are actually designed to put your bowel in an ideal
40:46
position when you are going to the loo the other thing here is you actually want your feet to be
40:53
at least kind of 30 centimeters apart and leaning forwards propping your arms
40:59
on your thighs you want to maintain a neutral spine position so you're not
41:04
kind of rolled back flattening your back and you're not all the way arched forward you're just nice and neutral
41:11
with that slight bend in your lower back you want to relax and you want to
41:16
actually bulge your belly out rather than pushing down through your bum you want to kind of bulge your belly out
41:24
relax breathe and it should happen now the other little note down there is
41:31
if you ask someone who has a prolapse so uh part of your bladder or bowel has moved
41:39
then uh you may need to support that so ie holding your perineum or there is
41:45
devices out there to assist with that
41:50
i don't think i talked about prolapse when i was talking through the pelvic floor dysfunction so prolapse is
41:57
basically when uh one of your organs has moved into a different area so for
42:05
example in women you can have an anterior wall prolapse so in that
42:10
situation your bladder can bulge into your vagina
42:15
you can have a posterior prolapse where your rectum is bulging into your vagina
42:22
or you can have a a prolapse where your uterus descends
42:28
down into your vagina men can also get prolapses they are not as common but
42:35
men can actually prolapse their rectum
42:43
prolapses are actually really really common so 50 of women
42:49
will have or will develop a prolapse at some time in their life they are very
42:55
common i'll get you guys to break here to pause
43:02
the video here and if you feel like a good laugh after talking about poo
43:07
i'll get you to click on that if you haven't seen it before and it will cement everything i've talked about with
43:14
great comedic relief
43:28
cool welcome back hopefully uh you guys haven't laughed so hard that tears have been running down your legs because of
43:36
that if that was the case we've got some interesting stuff coming up for you
43:42
so we think we might have an issue we've done some screening
43:47
actually how do we treat this so pelvic four muscle training is the gold
43:52
standard treatment for most pelvic floor dysfunctions
43:59
pelvic floor muscles same as pretty much any other muscle musculoskeletal kind of skeletal muscle
44:06
in our body and it responds to standard muscle strengthening principles so we've
44:12
got to overload it we've got to rest it we've got to progress it constantly
44:17
challenge it and it will adapt it's really really important with pelvic floor muscles to start with isolated
44:24
strengthening first so you want to work that pelvic floor all on its own to make
44:29
sure we're actually getting it to work because quite often with the pelvic floor
44:35
um your body kind of compensates by cheating by using your abdominal muscles
44:40
and your kind of glutes to try and get that stability in your pelvis and these are really strong muscles so quite often
44:47
they can dominate and your pelvic floor doesn't actually get a chance to work
44:53
so really important here to start with that isolated strengthening so we know how to target that pelvic floor we can
45:00
work on it get it strong all on its own and then we want to put it into more
45:06
functional movements with other muscles around it working to stabilize
45:13
so another key thing here is we want to progress up to training in the position that causes symptoms so if you have
45:19
symptoms when you're out running you need to work on your pelvic floor
45:26
muscle position in a position similar to running such as standing so you're
45:31
having to fight those forces of gravity particularly important if you do have a
45:36
prolapse things like jumping things like dead lifting we want to actually try and
45:43
start working our pelvic floor muscles in these positions that cause us issues
45:49
so if you are dead lifting and you have some stress urine incontinence when you
45:55
lift 100 kilos but when you lift 70 kilos you don't have any issues
46:01
go back to the 70 kilos work on your pelvic floor strength and slowly build
46:06
up from there you will get up to what you wear lifting and possibly you'll end up overtaking
46:13
your pb because now your core will actually be working together and you'll be able to be stronger and generate more
46:20
power so initially you might be weaker but in the long run you will end up stronger
46:26
guaranteed so the other thing to think about with our pelvic floor contraction especially
46:33
if we're really struggling is to think about linking it to the breath so naturally when you exhale if if your
46:42
pelvic floor is working in synergy with the rest of your core when you exhale
46:47
your pelvic floor muscle should contract and lift up so initially start thinking about tying
46:55
that contraction to the exhale breath but as you become more stronger
47:00
you need to be able to work maintaining that pelvic floor contraction throughout the breath cycle
47:08
key thing here when you strengthen the core remember the floor so i like to always start with pelvic
47:15
floor isolation work before moving on to other core work just to make sure that
47:21
that pelvic floor is activated and engaged
47:26
how do we strengthen the pelvic floor so these exercises you might have heard people talking about kegels
47:32
so they basically kegels are exercises to
47:39
strengthen the pelvic floor named after an american kind of
47:45
gynecologist who came up with this in the 1940s
47:50
and he noticed that he was a gynecologist and he noticed that his
47:56
patients who he got to do strengthening work they recovered from childbirth a
48:02
lot quicker than the ones who didn't so that's kind of where where this this started
48:08
so the key thing here is if if you don't know how to do these positions you want to
48:14
do these exercises sorry you want to start in a position where you're not
48:19
having to counter gravity so it's easiest to actually start these when you're lying on your back
48:26
if you're pregnant uh and your past kind of 20 weeks
48:32
it's probably best to start in like four point kneeling or uh sitting on the edge
48:38
of a chair or lying on your side but for most people it start lying on your back
48:45
you might want to place a pillow under your pelvis just to make it a little bit more comfortable and it just helps to
48:51
kind of open up that pelvic area you want to think about visualizing a
48:56
marble at the opening of your vagina and you want to squeeze and lift and thinking about squeezing and lifting
49:04
through the vagina and the anus or thinking about bringing that tailbone
49:09
towards the pubic bone you want to keep working to maintain this maximum effort
49:15
for 10 seconds that's our kind of goal but if you can only hold it for a couple
49:20
of seconds come off there don't don't try and hold a sub
49:25
standard rep for the 10 seconds if you can only get to 2 seconds so work on quality over
49:33
quantity you want to rest for 10 seconds in between and then repeat 10 times and you
49:41
want to do this three times a day other thing here is you want to try not
49:46
to use your glutes or abdominal muscles because as we previously mentioned really important to do these isolated
49:53
exercises first make sure you breathe a lot of people hold their breath when they're trying to
49:58
strengthen their pelvic floor which means you're not going to get very far because it has to work
50:04
synergistically with that diaphragm to be functional so make sure we breathe
50:11
in addition to those holding maximum effort for 10 seconds it's also really
50:16
important to train the fast twitch fibers in your pelvic floor so muscles have fast twitch and slow
50:22
twitch fibers and the fast twitch fibers in your pelvic floor are really important for things like if we suddenly
50:29
squeeze or cough or change direction they kind of come on really quickly
50:35
really reflect with it reflectively and we want to make sure that they are all
50:41
so strong so adopting that same position as we previously talked about we want to
50:47
activate our pelvic floor at a fast maximal contraction we want to relax
50:53
immediately after hitting that maximum force and then repeating 10 times
50:58
you really want to make sure you relax fully between each contraction
51:05
it's that short fast contraction all the way on all the way off that we're working for here same thing again three
51:12
times a day so key points here for that strengthening
51:18
to progress this you're going to increase the duration of the hold so if you're a long distance runner and you're
51:25
out running for hours at the end you might actually need to work up to being able to hold a maximum pelvic floor
51:32
contraction for 60 seconds those muscles are going to need really good endurance
51:39
uh you also want to think about changing positions so moving into a more functional position so maybe the bottom
51:46
part of the squat that is quite a challenging position for the pelvic floor because your um
51:54
pelvic hiatus actually opens up a little bit when you're down at the bottom of a squat so a lot more challenging to try
52:01
and contract it in that position the other really important thing here is relaxing the pelvic floor that's really
52:09
really important and actually some people can actually have issues with relaxing their pelvic
52:16
floor so strength is not so much the issue it's the relaxing of the pelvic floor
52:21
and these are more likely people who have like pain on intercourse they tend
52:28
to have a more um i suppose hyperactive uncoordinated
52:34
pelvic floor as opposed to a weak pelvic floor
52:39
so being able to relax is really really important and that's kind of the benefit
52:45
of actually going to visit someone who's trained to do uh internal pelvic floor
52:51
assessments they can actually pick up if you're one of the few those few minority
52:57
individuals who actually have issues with relaxing your pelvic floor as
53:03
opposed to your pelvic floor being weak
53:09
relaxation really really important because you might be working on this and then you throw yourself to be one of
53:16
those people who can't actually relax their pelvic floor so really really important to
53:23
to relax the other thing that you can do to kind of increase the the challenge of your
53:29
pelvic floor there's a number of kind of um training aids out there that you can
53:34
utilize to assist so some of them you've probably heard of so things like benoit balls and yoni
53:41
eggs there's also quite a lot of now more
53:47
integrated pelvic floor muscle trainers out there so such as there's a new
53:52
zealand one that's got a lot of research behind it called fimfit by junofem
53:59
perryfit that's a device that they use kind of biofeedback and a lot of them are linked to games
54:06
that you can play on your cell phone so they can actually make pelvic floor muscle training really fun and really
54:13
interactive
54:18
but the more the most important thing there is getting the basics right first before you're going to buy any of these
54:25
flash devices vaginal weights etc you've got to do the basics first and these are
54:31
just adjuncts to increase that challenge on your pelvic floor particularly if you
54:37
uh do a lot of sports that will challenge your pelvic floor
54:42
so basically where to from here really important again cannot emphasize how
54:47
important it is to talk to your doc about managing chronic constipation and cough this can do a lot of damage
54:56
that it just won't recover from so actually you really want to get on top of
55:01
managing that constipation and your cough if you're pregnant postpartum or had any
55:07
prostate kind of treatments recommended to get an assessment by a pelvic health physio
55:15
to actually have a look at how those pelvic floor muscles are functioning are
55:20
you likely to have have some issues develop afterwards
55:26
uh generally if you've had no improvement in four to six weeks of doing strengthening you do act if if
55:33
you're just going to strengthen without without being under the um guidance of a
55:40
person who's trained in this area if after four to six weeks you're still having the same level of symptoms and
55:47
you've had no change no improvement in your symptoms you want to go and get a review because you might actually be one
55:55
of those few that actually bear down instead of contracting up or
56:00
you might actually have some structural damage in there so for example the actual nerves might have been damaged in
56:08
childbirth so that muscle it isn't going to work because it doesn't have any nerve supply to it
56:14
or um the other injury that's not common but it it can occur i think it's about
56:20
10 of people can actually evolve their pelvic floor muscles can come off
56:26
the bone during labor so in general you're not going to be
56:31
able to actually see improvement in that because the muscles are not attached or they're not receiving innovation
56:38
so it's really it's important to actually know this there's not a lot that they can do for it at the moment
56:45
but it's actually important to actually know if you do have that issue
56:50
um and some other things like is there been damage to some of the like sphincter
56:57
muscles things like that and they can sometimes need kind of
57:02
surgical repair for those but the good news is a majority of
57:08
pelvic floor dysfunctions can be managed by conservative treatment so roughly 80
57:14
percent of people with pelvic floor dysfunction will be fully resolved or significantly their
57:21
symptoms will be significantly improved just by undertaking pelvic floor muscle
57:26
training do not suffer in silence they reckon about 80 percent of people do not build
57:34
up enough courage to talk to their health care provider about this and on average it takes seven years for people
57:41
to actually go and start seeking treatment get help get help early it's common it's
57:48
not normal don't let anyone tell you it is normal to wee when you're doing a double under
57:54
it is not normal common not normal uh and the last but not least really
58:01
important to train the weakest link in that chain and quite often it is the
58:07
pelvic floor because we spend a lot of time working on our on our six-pack
58:13
um and diaphragms and generally in most people in good condition because you know you breathe all the time
58:20
um so really important to train that weakest link and it's often the pelvic
58:25
floor this uh website is just showing some really good kind of resources that you
58:32
could click on the links should work so that first one's just a really good summary that's done up by pelvic floor
58:38
physio that's based in wellington the other two are links for those screens which we had further on
58:46
and have a look on the continents foundation australia and continents.organz they've got some
58:52
really good information on there uh in particular around pelvic floor safe exercise uh pelvic floor accredited
59:00
trainers in both new zealand and australia
59:05
good tips on maintaining bladder and bowel health and the last link on there is just a
59:12
really really good laugh to really test your pelvic floor if it's working well it's a pelvic floor physio who's
59:20
actually a comedian and her kind of stand-up gig is all around the pelvic
59:27
floor last is just some extra reading if you're interested
59:34
thanks very much for listening to this webinar and if you have any questions
59:40
feel free to email me i'm just on dixus narissa chapman
59:46
and i will get back to you if i can help you out or send you on to someone who
59:52
can cool do not suffer in silence thank you
1:00:06
you