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Strengthen Your Inside - The Importance of Pelvic Floor Exercises for Young Women

All MUSCLES need to be exercised to keep them strong.

This pamphlet will enable you to become familiar with your pelvic floor muscles, and provides a guide to relevant exercises. You may use these exercises if you already have strong pelvic floor muscles and want to keep them toned, or if you have weakened muscles and want to improve their strength.

A stronger pelvic floor can assist with:

• Improved control of your bladder. For example, it helps prevent the bladder from leaking when exercising, coughing, laughing.
• Control of your bowel.
• Improved muscle tone during pregnancy and childbirth.
• Increased sexual sensation in the vagina and enhanced orgasms.

What is the pelvic floor?

The pelvic floor is made of layers of muscles stretching like a tight hammock from the pubic bone in the front, to the base of the spine. There are three openings through the pelvic floor - for the urethra (the duct from which urine is discharged from the bladder), the vagina and the bowel.

When the pelvic floor muscles are strong they help to support the bladder, urethra, vagina, uterus and bowel in their correct position. These muscles contribute to the closing mechanism of the urethra and anus. The urethra and anus each have a sphincter (the zone responsible for the closing function). Pelvic floor muscles help to close the sphincters. These muscles can be tightened or relaxed voluntarily. They can also contract involuntarily as they do during orgasm.

What are the effects of weakened pelvic floor muscles?

• the sphincters may not close as tightly allowing leakage from your bladder or bowel.
• decreased sexual sensation

Do bladder control problems affect young women?

Some young women may have a bladder control problem as a result of pregnancy or childbirth or as a result of an ongoing problem from early childhood.

There are some activities or factors that may contribute to bladder control problems in young women including:

• consuming too much caffeine in chocolate, coffee, Coke and energy drinks
• participating in sport or exercises such as aerobics, running, hockey, tennis, gymnastics, netball, basketball etc.
• repetitive coughing from smoking or asthma
• being constipated: straining or bearing down when opening your bowels
• being over your most comfortable and healthy weight

No matter what age, the best way to ensure effective bladder control is to have strong pelvic floor muscles.

Jane's Story

I was only 22 when I first experienced urine leakage. It happened whenever I sneezed or coughed but I was too embarrassed to do anything about it. Then it started to happen during certain exercises at the gym and the leakages worsened. So I changed from aerobics to yoga. During a fitness assessment, the instructor asked if I had ever experienced urine leakage. I felt so relieved when she explained to me that doing pelvic floor exercises could help my situation. I started the exercises straight away and now, just ten weeks later, I'm back doing aerobics.

How can I strengthen my pelvic floor?

There are three different parts of your pelvic floor muscles to identify.

Before you can do the exercises effectively you need to become familiar with them.

To find the muscles that control your urine flow: While you are passing urine try to stop your urine flow midway. Try to hold for 3 seconds and then relax. If your pelvic floor is weakened you may find it difficult to slow down or stop your urine flow. Even so, this will help you to identify the muscles you will be exercising later. If you can stop the flow it is then important to relax and finish off passing urine. This is just a test to identify where the muscles are and should not be used as an ongoing exercise.

To find the muscles that control your anal sphincter: Tighten the muscles around your anus as if stopping wind. Hold for 3 seconds and then relax.

To find the muscles that surround your vagina: Concentrate on tightening the muscles around your vagina. It may help to put one or two fingers in your vagina so you can feel the muscles tighten. You should feel a squeezing, lifting movement. If your pelvic floor muscles are weak this sensation may be difficult to feel.

How to do your pelvic floor exercises

Once you have been able to identify the three parts of your pelvic floor muscles, you need to practise using them all together. You can do this sitting, standing or lying down.

1. Focus your attention on your pelvic floor muscles. Ensure that your thighs and buttocks remain relaxed.

2. Concentrate on using all of the parts together, try to squeeze and lift the muscles slowly, gradually increasing.

3. You may notice that your tummy muscles tighten but try to relax them as much as you can.

4. Imagine your pelvic floor muscles are travelling up, floor by floor, like an elevator.

5. Don't just let go. When you have tightened your muscles to your limit, release them slowly until you have let go of all the tension.

Now use this technique to do any of the following exercises:

Slow and sustained: Squeeze and lift slowly, holding for about 5 to 10 seconds as firmly as possible, then release. Repeat up to 10 times.

Quick and short: Squeeze and lift quickly, holding for 1 to 2 seconds as firmly as possible, then release. Repeat up to 10 times.

Holding under pressure: Squeeze and lift quickly and while holding do a small cough, then release. This will help you to get used to using your pelvic floor muscles when there is increased pressure on them, e.g. when coughing, sneezing or getting up out of a chair. Repeat 2 to 3 times. Once you are familiar with this exercise it is important to practise it standing up as this is when the pressure is greatest on the pelvic floor.

Important!

• Don't bear down.
• Don't hold your breath.
• Don't over-work the muscles. Build up gradually.
• Seek advice if you experience difficulty (Refer section 'Where Can I Get Further Information?').

Judging Your Progress

It will take time to notice the effects. You could test your progress by repeating the steps in the 'How can I strengthen my pelvic floor?' section.

Attach these exercises to daily activities

• After you go to the toilet
• As part of a warm up or cool down for any exercise
• In the shower or cleaning your teeth!

Practice Regularly 5 - 6 times a day throughout all stages of your life.

Remember!

• Avoid constipation
• Drink 8 - 10 cups fluid/water per day - very important, especially if exercising
• Passing around 1.5 - 2 litres of urine per day is adequate
• Passing more than 3 - 4 litres of urine per day could indicate a problem
• Limit caffeine to 3 drinks per day (tea, coffee, Coke, chocolate)
• It's good to hold on! - in general
• Don't go "just in case" e.g. before leaving home
• Try to hold off 3 hours between visits to the toilet Holding for 6 -8 hours may be too long except when you are asleep
• It's OK to go 4-6 times per day and 0 - 2 times in the night
• Always sit down on the toilet seat to pass urine
• Contract your pelvic floor muscles BEFORE you cough, sneeze, blow your nose
• Do pelvic floor muscle exercises every day

(Adapted from Bookmark Your bladder: a busy woman's guide to healthy waterworks, Royal Hospital for Women, Sydney)

Where can I get further information?

If you're shy or embarrassed about the problem or if you aren't noticing any improvement after a few weeks there is help available. Professionals, such as physiotherapists and continence advisers, specialise in working with women to plan individualised pelvic floor exercise programs. The following services can provide further information.

Royal Women's Hospital - Women's Health Information Centre
Phone: 9344 2007; Country callers: 1800 442 007;
TTY (for the hearing impaired): 9344 2849
Fax: 9348 2134
Email: whic@rwh.org.au
URL: http://wellwomen.rwh.org.au
Staffed by health professionals who can provide information, resources or referral on women's health issues.

The National Continence Helpline
Freecall 1800 33 00 66 (from anywhere in Australia)
8am-8pm, 7days a week
Staffed by a Registered Nurse with specialist skills in providing information about bladder control, research data and local continence clinics and nurses.

General Practitioners
Many GPs have expertise to evaluate bladder problems or are able to refer you to a physiotherapist, continence clinic or specialist.

Australian Physiotherapy Association
National Office
Floor 3, 201 Fitzroy Street, St Kilda, Victoria 3182.
(03) 9534 9400
For information about how physiotheraptists can assist and how to contact them locally.

Acknowledgements

This pamphlet was produced in consultation with young women living in Melbourne; Dr Helen O'Connell, Chief of NeuroUrology and Continence, Royal Melbourne Hospital; Gabrielle Bennett, Royal Women's Hospital Melbourne; and The Royal Hospital for Women Sydney, as part of the Commonwealth Government's National Continence Management Strategy, funded by the Department of Health and Aged Care. *Reprinted with kind permission from MacLennan and Petty Pty Limited, taken from Millard RJ. 1996, Bladder Control: A simple self-help guide, 2nd Edition, MacLennan and Petty Pty Ltd, Sydney. Layout and design by Angela Scalise. Illustrations by Sonia Kretschmar.

©Women's Health Victoria and Women's Health Statewide, August 2001

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