Taking Care of your pelvic floor & the role of your coach
If you have been with me for a while then I am sure you have heard a lot of this already because I bang on about the pelvic floor all the damn time....I am sorry if you have ever innocently started asking me about my work and then were subjected to a 30 min (or more) rant about the topic of the pelvic floor. I became so obsessed with it that I got a female pelvis tattooed on my calf!!
Anyway lets get down to the information. We all have a pelvic floor (PF) and can have issues relating to its function, however, for women and those assigned female at birth (AFAB), there can be a lot more complications and issues that arise throughout our lives. If you want more information on what the pelvic floor does and types of pelvic floor dysfunction then check out this post here. Today I wanted to chat about some stats about pelvic floors dysfunction, what you can do about it and the role of an exercise coach in your rehab.
Study conducted by RCOG in 2022 of 2000 women
Pelvic floor dysfunction can have a significant impact on quality of life. Studies like this one show that many women or AFAB people are impacted in various areas of their lives. Here are examples of areas many struggle with:
anxiety around leaking or not getting to a bathroom in time
pain during sexual intercourse - causing anxiety, fear, low sexual desire which lead to impacting relationships
discomfort or heaviness that is constantly on their mind
feelings of embarrassment and shame
not participating in activities due fear or anxiety
abstaining from physical activity due to leaking or believing it will make it worse
depression
impact on sleep due to pain or discomfort
feelings of shame, feeling alone and unable to talk about it
Firstly, if you are suffering from any of the symptoms of pelvic floor dysfunction then a physiotherapist specialising in pelvic floor health will be able to help. You can go to your GP for a referral, or in some areas, you can self refer to the physio on the NHS. You can also choose to see a private physio, if financially viable. If you would like some recommendations for local physios, feel free to contact me.
A physio will be able to assess the function of your pelvic floor, guide you through doing your pelvic floor exercises, to ensure you are doing them correctly, and give you a rehab program to improve the function of your pelvic floor. It isn’t always just a case of simply doing the pelvic floor exercises. For some people, the issue may be a hypertonic (tight) pelvic floor and you may need some assistance in relaxing your pelvic floor.
PF health, and most other areas of women’s health, are under researched and I am including this most up to date information I can find, however, as new research comes light some of the info may change over time.
Pelvic Floor muscle exercises (PFME), also known as Kegels, is the best way to improve the function of your pelvic floor according to the research. This study here details some of the info regarding the effectiveness of pelvic floor training with the supervision of a PF physio.
As the popularity of women’s health issues grows, so does the misinformation and promises made to sell women something. (I am aware of the irony of that statement, when I sell services to women, believe me) You may find personal trainers and fitness influencers promising to heal your pelvic floor issues with their programs, again I have done this in the past - with the caveat that I have always referred to a physio and encouraged clients to do PFME. However, the evidence is not strong enough to support the claims that squats etc are better for your pelvic floor. In fact, in some cases exercise may have made things worse for women and AFAB people based on the type of activity, lack of knowledge on how to engage your pelvic floor or an already weakened pelvic floor.
Now you might be wondering why a business that promotes engaging in exercise for your health would be giving this info, sounds a bit like scaremongering, right? However, I promise you it is not. I believe that we are much more empowered to look after ourselves when we are armed with the correct information, good or bad.
So let me explain
The evidence isn’t there to support other forms of exercise for strengthening your pelvic floor because it just hasn’t been studied enough. On the flip side there also isn’t enough evidence to back the claim that exercise makes it worse. Time will tell if this will change. However, I believe based on the experience of those working within the field of pelvic floor health and my experience as a pelvic floor specialist coach, that exercise can help, or at the very least there are ways to exercise that will not impact your pelvic floor negatively.
THE ROLE OF YOUR TRAINER:
This brings me to the role of your fitness coach (personal trainer, exercise specialist or whatever name you refer to us) and how they can support you through your rehab and get you exercising. It is not within my scope of practice or any fitness professional to diagnose or prescribe a PFME rehab program or claim we can heal your PF dysfunction.
If you are going to a fitness class or have a personal trainer then we are going to be seeing you more frequently than your physio will. This leaves us in great position to really support you through your rehab and make adjustments to your movements, when necessary, should pelvic floor symptoms arise during exercise. This is why I think it is essential that all personal trainers and fitness coaches should have at least some basic knowledge on pelvic floor symptoms and how to adjust for that during a class or session. About 60-70% of all personal trainer clients are women and can be impacted by pelvic floor issues regardless of age, whether we have had a baby or not, or going through perimenopause, we are not a special population. We should expect that it is standard that a trainer doesn’t say things like ‘just deal with it’ or makes you feel like a burden for asking for an alternative (all things that have happened to clients of mine) Anyway that was me going off on tangent....
Women are missing out on the benefits of exercise, not because they don’t want to do it, because they are afraid, shamed, think it will make it worse.
For example, strength training benefits for women include:
Improved bone density (important for you if you are over 35 and are heading towards perimenopause)
Improved functional independence
Improved blood pressure & cholesterol
improved insulin sensitivity - good for Type 2 Diabetes and overall health
increased muscle mass
improved mood and self esteem
and all the benefits that come from being part of a supportive community. This is particularly important for new mums who may feel isolated or for women going through perimenopause and feel unseen and alone.
It is my job as a trainer to make sure that you can take part in exercise in a safe and beneficial way. I can provide an exercise program that is safe for your specific needs. Throughout a session I can adjust positions, breathing, bracing and give alternatives if an exercise is causing symptoms and I know how to introduce movements back in as you move through a training program. There is no ‘safe’ or ‘unsafe’ list of exercise, it really is based on the person in front of you.
In the early stage of a program, I will also check in with you to see how your pelvic floor is feeling, then as you progress I will teach you how to trust your pelvic floor to do what it is supposed to do without you having to think about it (I fell into the trap of overthinking it during my own rehab and ended up with a tight pelvic floor so I know this is particularly important). I will also chat with clients about how they are getting on with their rehab and how often they are doing their exercises, I will add them into the start of the session if they haven’t done them that day. I have also created a space that is open to chatting about these topics with no shame or embarrassment so clients can come to me if they start to experience symptoms. This has positive outcomes for clients
“One of my clients recently shared with me that her prolapse symptoms improved quickly, which she attributes to our sessions, as we spoke about it regularly throughout sessions and I encouraged to keep going with them. Her physio was delighted she was doing her exercises regularly as most other patients almost never do it consistently and she could see the difference. She recently started to feel some symptoms returning and she came to me to discuss it, we came up with a plan on how to progress, which allowed her to confidently continue exercising, and not be consumed with anxiety that it was getting worse with the knowledge that a plan was in place if she needed more support from a physio”
an example of working on using breath during an exercise
In summary, pelvic floor muscle exercise are the only evidence based practice known to improve pelvic floor function especially, when done under the guidance of a physiotherapist. If you are working with a fitness professional, who is knowledgable in the pelvic floor, then this can have a significant impact on the success of rehabbing your pelvic floor as well as ensuring you can take part in exercise that is going to enhance other areas of your health and life.
I am open to learning throughout my whole career and I am not always going to get it right so please feel free to contact me with any possible errors within this blog. If you have any questions regarding this blog then please feel free to email me at: Lynsey@themightymamacoach.com
