Pelvic Floor Panaceas- Minding Your Pees and Loos
By Loren Anthony, February 2010
At forty-two I’m supposed to be supremely female. I’m supposed to run with the wolves. But how’s a girl to run with the wild pack if she leaks pee when she does. I’m supposed to be peaking, not leaking! I should be in control, not bloody incontinent. The very term evokes images of my beloved nana who, at 97, could quote Keats at the drop of a hat, but who always had a vague smell of pee about her. Not an alluring scent.
And I am not alone. You can spot us a mile off. We’re self-assured and sanguine but we need to cross our legs when we sneeze. Yet this leg-crossing code remains largely ignored in our culture. Living in the post-Vagina Monologues epoch, we’re surprisingly coy about our privates. And if we’re not coy, we’re just completely clueless. Our nether regions are terra incognito, a mysterious bundle of orifices that we don’t fully understand.
I wouldn’t be quite so clueless if I had paid attention in pre-natal classes over a decade ago. Instead, I had gazed dreamily into the middle distance, lovingly stroking my burgeoning belly like a benevolent Buddha. And so I came away from the classes thinking that pelvic flaws were - what?! - battleship hips, the perineum was an indigenous plant, and Kegels were surely German pastries. And so, three pregnancies later, I leak when I laugh. Or cough or run.
Things came to a head recently at my daughter’s athletic meet. It was the Mom’s Race, a perverse little event tagged on to the program to punish mothers. There was no way I was going to do the 100metre dash at the risk of a leak. But, oh, the anguish in my daughter’s eyes as the other moms lined up at the starting line and I cowered behind the grandstand. And so I resolved to fix the problem.
It turns out that my occasional “accidents” are the result of slack pelvic floor muscles, caused mainly by pregnancy and natural childbirth, and brought on by pressure, such as jumping, sneezing and laughing uproariously. It’s clinically known as “stress incontinence.” Not a sexy term but very descriptive of what happens when sudden pressure (stress) is put on a pathetically slack pelvic floor.
“Most women,” says gynaecologist Dr Shaw, “have stress incontinence to some degree. Very few women can jump on a trampoline without problems after they’ve had children.” Oh, the things we put up with for our offspring! I had to be a bloody hero and have three natural births. But before I could seriously envy my friends who’ve had elective c-sections, Dr Shaw explained that while a normal vaginal delivery does affect the pelvic floor most, women who’ve had caesars also have stress incontinence. It’s apparently not so much the way you birth but the weight of your beloved baby on the pelvic floor that puts strain on it.
The pelvic floor muscles are a network of muscles, ligaments and tissues, shaped like a hammock, that subtends and supports the pelvic organs – your uterus, lower intestine and rectum – and like any muscle, they need regular toning. Pelvic floor slackness can lead to lousy sex and leaks.
Thankfully there’s heaps of help at hand. My first port of call was Lizelle Grundell, an Applied Psychophysiological and Biofeedback practitioner who is passionate about priming pelvic floors. Lizelle laments the fact that we’re full of bad habits. “Did you know that the best position to pee in is a squat? Failing that, the ‘brace’ position works well – lean slightly forward, with your elbows on your knees and relax. Most of us sit incorrectly on the loo, or, if we’re sharing public loos in an office or mall, we tend to perch above the loo without sitting comfortably. By doing this, we’re already using our muscles incorrectly and undermining control.”
I asked Lizelle to help me locate my pelvic floor muscles. I tried twitching everything I could twitch down below, but really had no clue what I was doing. Why is it so easy to flex a bicep but so utterly frustrating to tweak a pelvic muscle? Again, it’s this sense of basic ignorance we have about our bodies. Lizelle uses biofeedback technology to help women locate and work these hidden muscles, and retrain the brain to do it naturally.
Lizelle gave me a probe to insert and hooked me up to a monitor. She put me through a series of exercises, ranging from short twitches, to long, sustained contractions of between 10 to 60 seconds. Oh my word, there it was, graphically clear on a graph. While the average pelvic squeeze registers 37.5 on the graph, I scored a whopping 6! Did I even have a pelvic floor, I wondered?
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Test drive the gadgets
U-Control Continence Biofeedback Device. It’s compact and nifty. You insert the probe, stick on the electrodes and hold the monitor. You can do it in any position, discreetly and in front of the kids. Very graphic and rewarding to see that you are able to hold a squeeze in the orange.
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So Lizelle put me to work. I took home a U-Control biofeedback device. You insert it, and have to squeeze to keep the bar-lightin the orange, and release it again into the green. It’s so graphic and responsive that you can really see (if not quite feel) what you’re doing. In four months, Lizelle encouraged, you’ll be sixteen again. Well, at least down below.
In the interests of research and achieving Olympian pf muscles, I decided to try all the products that were available on the market. A pile of pelvic floor improvers landed on my desk. There’s the Kegelmaster which helps you to “hold on to your femininity.” I loved that promise. It’s a really robust, muscular workout; there are sleek LadySystem vaginal cones that you can clench while you shop or have tea with your mum-in-law. We’ve come a long way, baby. At the time of Hippocrates (about 400 BC) women had to insert half a pomegranate up their fannies to tauten their muscles. There’s the Cefar Peristim Pro, designed for lazy daisies like me, which sends a pulse to the muscle, causing it to contract.
My husband, catching a glimpse of my recently acquired pelvic products, chirped happily, “Oh, sex toys. Kinky!” Well, he’d hit on something there. Toning your pf muscles can lead to quantum leaps in love-making. The blissful by-product of pelvic floor toning is tantric sex. I have to say that all that twitching and holding and releasing was not only leading to marvelous muscle tone but it also made me feel so much more libidinous.
Which is why the pf muscles are also called the love muscles. Corina Avni, a physiotherapist and pelvic floor specialist, avers. For her it’s all about awareness. Know thyself; love thyself, and the benefits flow from there. “Try to lie quietly, notice your breathing and then very gently switch your pelvic floor on and off. Say ‘hi’ to yourself. If you own your body, its movement and function, you simply have to get back to yourself after each trauma (such as pregnancy).” Simply embracing this part of your body restores dignity (no more leaks) and enhances your love-making.
Through sensory motor integration, Corina teaches her clients to feel the muscles, so they can use them. “Rather feel more, then, when you have a neat little perfect contraction, work on increasing it. Don’t increase poor initial function. Train for length, not strength (long and loose, not short and tight contractions). It’s as important to let go and relax as it is to squeeze. Kegel exercises and pelvic floor exercises should be renamed relaxes. You should squeeze then relax. Then squeeze again and relax.” Unsurprisingly, for an untoned wimp like me, the relaxing part was a challenge. It’s easy to twitch, but harder to hold, and then release properly. And it’s such a head thing. You really have to reconnect your brain to your body to get those mysterious muscles to do what you want.
Joanne Enslin, a physiotherapist who practices pilates, does visceral manipulation, a gentle technique developed by Jean-Pierre Barral. Joanne says that it begins with our posture and the way we hold our bodies. “Pelvic floor activation is hugely influenced by the alignment of the Sacroiliac Joint and the balance in the pelvic organs. Pilates has a huge influence in maintaining the correct alignment of the pelvis and balancing our musculoskeletal system.” As I’m a sloucher and have shockingly bad posture – decades of holding a baby on my hip – I knew I would benefit.
But if all else fails, if all the tweaking and relaxing and breathing and aligning doesn’t work, then there are other options. Dr Frans Van Wijk, a leading urologist, is quick to calm. “Prevention, of course, is always better than cure. Women should be doing their toning long before they have children, but, even after the fact, there is so much we can do. There are drugs and many non-invasive surgical options. Surgery is now a routine, risk-free and highly successful option.”
I resolved to go it the natural way and at the end of three months I swear I had my Kegelmaster in a death grip. Also, judging by the perpetually smug look on my husband’s face, my pelvic floor muscles are now perfectly primed.
And so I found myself back at the mom’s race at my preschooler’s mini-olympics. I am proud to report that I sailed to the finish line, pure poetry in motion, and my polka dot La Senzas remained nicely dry. And it wasn’t so much about crossing the line as about the journey it took to get there. Yes, I had gained tautened pelvic floor muscles, and tantric sex but, more importantly, I had gained an empowering knowledge of my body which I hadn’t had before.
A word of caution
As with any condition, you need to see a specialist before you begin treatment. Says Lizelle, “unsupervised treatment can be dangerous. For example, if you simply strengthen the muscles without learning how to relax them, you may make your incontinence worse by making the chronic pelvic tension better at cutting off blood flow.”
The famous Kegels
Kegels should be done in three positions- lying down, seated and standing
Elevator Kegels - Visualize the muscles of your vagina as a building, with the base of your pelvic floor as the “lobby” and the top floor at your belly button. Raise the elevator slowly (tighten the muscles) from the bottom floor to the top, give a slight hold and bring the elevator back down, slowly relaxing your muscles from top to bottom.
Sustained Kegels - Contract the pelvic floor muscles and hold for a count of 10. Repeat 10 times. If you cannot hold them this long initially, hold them as long as you can. Eventually, you will be able to do 10-second holds.
Progressive Kegels - Squeeze briefly and hold for five seconds. Then squeeze harder and hold for five seconds. Squeeze as hard as possible and hold for five seconds. Release a little, hold for five. Release a little more, hold for five. Release completely
Bipedal blunder
Interestingly, our pelvic floor is weakest when we’re standing. This, apparently, is yet another evolutionary blunder (along with post-nasal drip) as a result of being bipedal. Most other big mammals walk around on all fours and so the pelvic floor doesn’t carry all the weight.
The culprits – what causes slack pelvic floor muscles?
Pregnancy, childbirth, tearing during delivery, episiotomy, Caesarean section, smoking and the associated chronic cough, frequent straining during bowel movements, eg. constipation, IBS. Obesity, diets high in processed foods, menopause, woman doing heavy weight lifting, hysterectomy. Simple inactivity can lead to decreased pelvic floor muscle tone, strength and endurance. Source: Lizelle Grundell
Movement is key.
“Our bodies are meant to move,” says Corina Avni. “This is where any form of exercise that encourages appropriate use of the core and breathing can add value - Pilates, Yoga, Tai Chi, Feldenkrais, Alexandre Technique, Gyro, Nia, etc.” Source: Corina Avni at www.pelvicfunction.co.za
Too toned?
If you leak, have pain or discomfort during sex or when inserting a tampon, and frequently “need to go”, you may have over-taut rather than slack pelvic muscles (clinically known as vaginismus or vulvodynia). You need to see a urologist before you embark on any treatment. All the exercises mentioned in this feature will worsen and not alleviate your problem.
What is Biofeedback?
Essentially it’s retraining your brain to perform certain functions which have fallen into misuse or disuse. Biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. It’s a non-invasive form of treatment. Precise instruments measure physiological activity and rapidly and accurately "feed back" information to the user. The presentation of this information — often in conjunction with changes in thinking, emotions, and behaviour — supports desired physiological changes. Over time, these changes can endure without continued use of an instrument. Voila, you’ve trained your brain.
The love muscles
The vagina and clitoris are surrounded by the pelvic floor muscle and contribute to a woman’s sexual function and satisfaction. Pelvic floor muscle strength increase a woman’s stimulation during intercourse due to increased blood flow and nerve sensitivity and circulation to the area, which result in an intense heightened sensitivity to touch. Woman with strong vaginal muscles achieve better, longer and multiple orgasm as well as increased ability to control the timing of their orgasm. Source: Lizelle Grundell |
