unspoken taboo: pelvic floor

by Kate Shapland

How’s your pelvic floor?  Bearing up with age?  The number of women I know with ‘stress incontinence’ – which causes the bladder neck to open and urine to escape – seems to increase by the day.  So why does it happen and what can we do about it?

While the bladder muscle is outside our voluntary control, it’s influenced by a critical set of muscles, the pelvic floor, which supports the bladder and uterus. When they contract, they stimulate the urethral sphincter to squeeze shut and so stop urine escaping. They also tighten reflexively whenever there is a sudden downward pressure on the abdomen – such as coughing, laughing, jogging, dancing or lifting – and so prevent leaking.

If such pressure is put on already weakened pelvic floor muscles (as it common after childbirth) or the muscle fibres deteriorate (as they can after menopause), sudden stress can cause the bladder neck to open and urine to escape, hence the expression ‘stress incontinence’.

The Duchess of Windsor was said to have ensnared the Prince of Wales with mysterious sexual practices that involved the pelvic floor muscles

Luckily the pelvic floor muscles respond to exercise just as readily as any other muscle in the body. Although pelvic-floor exercises are now taught as routine at antenatal classes, many western women have amazingly inert pelvic floors. In parts of the world where mothers teach adolescent daughters to use their pelvic-floor muscles stress incontinence is almost unknown. Mrs Simpson, later Duchess of Windsor, was said to have ensnared the Prince of Wales with mysterious sexual practices learned in the East. In reality, it was probably nothing more than rigorous pelvic-floor control that enabled her to tighten her grip on the heir to the English throne.

The Simple Kegel Routine

Practise regular pelvic-floor (Kegel) exercises, and add in a daily abdominal toner to keep these important supporting muscles strong as well.

First, locate your pelvic-floor muscles. Next, get yourself lots of visual prompts that will help remind you to do the exercises: wind bright elastic bands around taps in the kitchen or bathroom; stick post-it notes up on mirrors, the TV or your PC frame.  Whenever these catch your eye do a set of the exercises, aiming to do at least five sets of ten a day. If stress incontinence is already a problem, do the exercises 10 to 15 times a day for three months – it only takes a minute, you just have to remember.

Visualise the muscles as an elevator ascending a building

Initially do a number of short, sharp contractions and follow with longer, more sustained ones – squeezing up strongly, holding for a count of five and releasing gradually.

As muscles get stronger, increase the intensity of the exercise, and the demands on the muscles, by changing your posture. Start by doing them lying down with your buttocks raised on a pillow, then progress to lying horizontal, then sitting, then standing, and finally, squatting, when you will find you have to squeeze up more forcefully to counteract the downward pull of gravity.

Finally, visualise the muscles as an elevator ascending a building floor by floor in four stages, from the basement up. Contract the muscles to their utmost right up into the abdomen (the top floor) and then let the elvator descend slowly floor by floor. The challenge is to release your grip gradually, without crashing all the way down to the basement.

One simple exercise to build into your new habit stacking routine perhaps?