Exercise Right Week is May 23-27. Exercise is a vital part of healthy living; however, one size doesn’t fit all. If you are is at risk of pelvic floor problems, it is important you protect your pelvic floor while exercising to avoid risking further damage and incontinence.

Who is at risk of pelvic floor problems?

A woman who:

•          has ever had a baby,
•          is post-menopausal,
•          has had a prolapse (a sagging down of pelvic organs, commonly after childbirth), or
•          has had a hysterectomy or other gynaecological surgery.

Anyone who:

•          is overweight, obese or has a body mass index (BMI) over 25,
•          regularly lifts heavy weights,
•          strains on the toilet because of constipation,
•          has a chronic cough or sneeze, including those linked to asthma, smoking or hay fever,
•          has a history of back pain,
•          has suffered trauma or injury to the pelvic area (e.g. a fall or pelvic radiotherapy), or
•          has had abdominal surgery.

A man who:

•          has a prostate problem (where the prostate gland disrupts the urine flow), or
•          has had a prostate operation (and where urinary incontinence followed).

The pelvic floor

The pelvic floor is a trampoline-shaped group of muscles and ligaments stretching from our pubic bone to our coccyx and between our sitting bones. It holds up our pelvic organs and has an important role in opening and closing off our urinary and anal sphincters. Stretching and weakening the pelvic floor can increase the risk of bladder and bowel control problems, and prolapse in women.

High-impact aerobic and/or resistance exercises are more likely to place a strong downward strain on the pelvic floor and, over time, stretch and weaken the pelvic floor muscles, leading to bladder or bowel control problems.

There are many ways to become strong and aerobically fit without harming your pelvic floor.

Aerobic exercises

Unless you have a strong pelvic floor, avoid high-impact exercises such as skipping, running and jumping, or sports where you change direction suddenly. These activities will cause a much greater downward force on the bladder than the closure force of the urinary sphincter, risking leakage and the further damage to the pelvic floor.

Instead try swimming, cycling, walking, water aerobics or sign up for any of the many low-impact exercise classes now available.

Resistance training and core strength

Excessive weights or intense abdominal exercises such as crunches and lunges can exert so much downward force on the pelvic floor, they can also cause damage over time.

No matter how strong your pelvic floor is, before doing in any resistance activity, lift and “contract” your pelvic floor muscles. (This technique can also be applied before sneezing, coughing or any other activity that can cause urinary leakage.)

Don’t lift weights or do exercises that cause you to strain or hold your breath, and always ensure you are supporting your pelvic floor while doing them. A good way to do this is by using a Swiss ball, or sitting or lying down to exercise. When doing standing or squatting exercises, keep your legs no further apart than shoulder width, and avoid deep lunges.

Is leaking normal?

Leaking should never be considered normal. It should never be accepted as inevitable with ageing or childbirth, and can be prevented or cured in the majority of cases – often by adopting a few simple habits.  Go to continence.org.au for more information.

If you notice leaking when you exercise, it may indicate a weak pelvic floor, and it is recommended you speak to one of the continence nurse advisors on the free, confidential National Continence Helpline (1800 33 00 66) as a first step.

Case study

Katherine Modoo, a continence nurse advisor at the Sunraysia Community Health Service near the South Australian/Victorian border, was left speechless recently after two patients came to her during the same week with disturbingly similar problems.

One of the women was in her 40s and the other was in her 60s, and both had re-prolapsed after embarking on a vigorous fitness and exercise program.

“The woman in her 40s was quite devastated; she’d had a vaginal repair after childbirth, and had decided to start exercising to lose a bit of weight,” Katherine said.

The older woman had had a surgical sling repair done on her vaginal prolapse several years earlier, but had put so much strain on the repair it was no longer able to contain her prolapse, Katherine  said.

The women, who were unknown to each other, told Katherine their personal trainer had incorporated weight-bearing exercises and lunges into their fitness program.  More disturbingly, the trainer made no mention of the pelvic floor during the classes.

“It’s a bit of a worry that there are personal trainers out there who aren’t aware of the risk to the pelvic floor with certain exercises,” Katherine said.

“Professional personal trainers should ask the questions (about the pelvic floor).  I know the Continence Foundation of Australia has worked really hard to have a continence component incorporated into personal training courses,” she said.

Katherine said there were many ways to improve fitness and lose weight without risking damage to the pelvic floor.

“When the younger woman told me she wanted to lose weight, I thought, ‘oh no, why didn’t you go walking or cycling or swimming?’ There are so many other ways to exercise that are friendly to the pelvic floor.”

Katherine said women, particularly those with a history of pelvic floor problems, should consult their health professional before embarking on an exercise program.

“It’s great to want to exercise and be healthy, but if there are any exercises that risk damaging the pelvic floor, women need medical advice from the doctor or the surgeon who did the work so there’s no risk of injury or a repeat of the prolapse.”

More help and information

The pelvicfloorfirst.org.au website has a list of pelvic floor-friendly exercises and a free pelvic floor safe exercises app.

The continence.org.au website has an excellent demonstration video by women’s health physiotherapist Shira Kramer on doing pelvic floor exercises correctly.

Main image source: Shutterstock