Fit to the Core

What does the gym have to do with your pelvic floor? Well, everything as it turns out. Your pelvic floor keeps you continent by closing your bladder and anal sphincters. It prevents prolapse by tensioning vaginal walls and protects your spine by contracting with your deep abdominal muscle – all of this while you exercise!

So when you climb hills on the stepper, balance on one leg to kick in a BodyCombat class, lift the weighted leg extension bar or push a loaded bar overhead in BodyPump class, your pelvic floor is a leader among muscles. Now ideally, the pelvic floor should coordinate automatically with other core muscles. But sometimes this goes wrong, resulting in weakening of the muscles, and exacerbating leakage or incontinence.

When researchers from the University of Queensland’s physiotherapy department studied which muscles activate in continent and incontinent women, they found a marked difference. The continent women tensioned pelvic floor and transversus abdominis muscles before and during movement, whereas the incontinent women strongly switched on their dominant waist muscles. The problem with this is it builds up more intra-abdominal pressure, which internally pushes down and can overwhelm the pelvic floor.

To avoid damage, it is important for all women to train their pelvic floor/core muscles to ensure they are contracting in coordination with other abdominal muscles before adding weights and high-level exercises. Once you have the correct pelvic floor/abdominal pattern, then exercise will strengthen these muscles further. If you have any pelvic floor problems, it’s important to let your personal trainer or instructor know because your gym program will need to be modified to prevent aggravating existing issues.

If you answer yes to any of the questions below, talk with a personal trainer about developing a program that will help rather than aggravate the situation.

• Do you lose any urine when you run, sneeze or cough?
• Does your bladder become urgent?
• Did you have a difficult delivery?
• Have you had a caesarean section?
• Did you get any pain during pregnancy from pelvic instability?
• Do you have any separation of tummy muscles?
• Post birth, did your doctor find any prolapse?
• Have you had any pelvic or spinal surgery?
• Do you have any concerns with bowel control?
• Are you unsure how to correctly contract your pelvic floor muscles?

Avoiding trouble

If you do have pelvic floor problems, there are certain things you should avoid at the gym – at least to begin with. Most importantly avoid sit-ups and heavy weights. Sit-ups, curl-ups, medicine ball rotations, double leg lifts or exercise ball crunches for abdominal strengthening of unfit, post-birth or menopausal women can aggravate pelvic floor problems. These abdominal exercises forcefully push internal pressure down on your pelvic floor every time you curl up. You need a strong, co-coordinated pelvic floor to resist this internal pressure. Sit-ups may cause bladder urgency, increased leaking and maybe vaginal prolapse in some women with a pre-weakened floor.

Another thing to watch out for is hollowing your back at the waist. Canadian researchers have found that drawing in or narrowing the waist destabilises the spine and teaches an incorrect abdominal muscle pattern. Are you constantly drawing your waist in to flatten your stomach? Let go of any waist tension and learn deep abdominal tensioning to flatten your stomach. This muscle tensions with your pelvic floor, not against it.

The best investment any women can make for her pelvic floor throughout her life stages of pregnancy, post birth, menopause and senior years is to visit a pelvic floor physiotherapist to gain an individual assessment and learn correct pelvic floor coordination and strengthening.

Mary O’Dwyer’s book My Pelvic Flaw – preventing pelvic floor problems throughout life, $24.95rrp, is available in all major book stores and from http://www.mypelvicfloor.info/

What to watch out for

The following are all signs of pelvic floor problems. If any of them sounds familiar, make an appointment to see a pelvic floor physiotherapist:

• Emptying your bladder before a fitness class to stop leaking.
• Frequent voiding of your bladder due to urgency.
• Vaginal heaviness or bulging after a workout or class (signs of prolapse).
• Inability to prevent wind from escaping.
• Lumbar, sacroiliac, buttock pain.
• Vaginal, low abdominal, pelvic floor pain.
• Often straining to empty your bowel or incomplete emptying.

Pelvic floor myths

• Sports women have strong pelvic floors. Not true! Studies show that elite female athletes have up to a 52 per cent rate of stress and/or urge incontinence.
• No babies, no worries. Not necessarily. A 2002 study in New York of a large group of post-menopausal nuns (no babies) showed a 50 per cent rate of stress