Floor work

We’ve all heard the saying “I wet myself laughing" but there’s a good chance the joke could become a reality. It’s time to work on your pelvic floor.

I got my driver's licence a fortnight or so after my 17th birthday. Weeks previously, I had made the mix tape that I would listen to as I drove my parents' 1975 Volvo 740 to my best friend's house. The first song on the tape was Here Comes Your Man, by The Pixies.

Fast-forward 18 years and I am dancing to the same song at a Pixies' concert, feeling a little bit like that 17-year-old again. And guess what? For the first time in my life, I felt that warm patch of shame. The reminder that I'm not 17, I have had two kids and I can't jump up and down with a full bladder and expect to stroll out of there with dry undies.

If I'm honest, I've done next to no pelvic floor exercises, despite being told
I really needed to if I didn't want to be wetting myself in my 40s (or even better, a few weeks before I turn 35). So it turns out that kids and high-impact exercise have taken their toll on my pelvic floor, that delightful, unsung muscle that holds our bladder and bowel together so we can live our lives without haphazard experiences of the toilet variety. Maybe you think yours is in good shape. Maybe you really have no idea. Or maybe, like me, you were advised to strengthen it and thought, "Yes, I will totally get around to that, just as soon as I… wait, is net-a-porter on sale?"...

What is it?
The pelvic floor is a band of muscles and ligaments that holds your bladder,
bowel and uterus (if you have one) in a sort of hammock. You want this muscle to be strong enough so that, as you age, coughing, sneezing, running or laughing doesn't end in you relieving your bladder or bowel at the same time. Do you remember Grandma farting wilfully in front of the family? More than likely it wasn't her bawdy sense of humour, but a weak pelvic floor.

Does it affect me?
Currently incontinence affects 4.8 million Australians, across all ages and sexes. If you're a bloke, you needn't care quite as much, but you should still pay heed to keeping this muscle in check – if you have endured prostate surgery or even if you're just ageing, overweight or obese, incontinence can be a risk. Even children can have weak pelvic floors. Mostly however, it's a woman's world.

"There are three hurdles for women," says women's health and continence physiotherapist Julie Lynch from pregnancy physiotherapists Bumpity Bump.

"Having kids, menopause and getting older. And you can only avoid one of them."

One in eight women under 30 will wet themselves – so youth and having no kids is still no guarantee. Even if you have had a child via caesarian section, you aren't free from the stretching that occurs from carting a baby around for nine months.

And then there are people who cough, sneeze or vomit a lot (think smokers and those with eating disorders), those who are overweight or obese, those who engage in high-impact sports, anyone with pelvic surgery or trauma, and those who strain going to the loo. They're all likely to be affected. Constipation and pushing down over time can weaken the floor, as can heavy lifting, especially if you hold your breath at the same time.

How do I find it?
"I tend to get girls to think about squeezing around their back passage, like you're trying to stop wind," says Julie. Lift up and bring that contraction to the front, as though trying to stop the flow of urine. Hold it strong for as long as you can. "It is important to relax all other muscles and breathe," says Lisa Westlake, a physiotherapist and fitness instructor from Physical Best. Holding your breath and contracting stomach muscles will create downward pressure on the pelvic floor, which is working against what you want. If you're still not sure, see a women's health and continence physio.

Am I likely to wet myself?
There are obvious signs of a weak pelvic floor, such as slight bladder leakage, constantly needing to go to the toilet, finding it hard to empty your bladder, and needing to go in a hurry and not making it in time. Other signs include painful sex
and prolapse – which is when the muscle drops, sometimes so much it appears outside the vagina. You may not be at any of these stages, yet you might not be far off either.

"In women, menopause and old age have a huge impact," says Julie. "Stats show that by the time women get to 65, two thirds will have some form of prolapse. All women should all be doing something about their pelvic floor," she warns. "Add anything like putting on a bit of weight, or if you've had a baby and go back to sprinting, abdominal work, or jumping, and then you are really at risk."

How do I fix it?
Like any muscle, the pelvic floor needs to be used to be strengthened. Exercises should be done through pregnancy, and as early as 12 hours after birth. Julie recommends 10 contractions, each held for 10 seconds, three times a day in the strengthening phase. Once you have strengthened your floor, then the same exercise can be done two to three times per week. "You never stop doing these exercises," she says. "Add it in to your daily life and gym work."

Julie also says it is critical to take away straining when going to the toilet ("Bowels before beavers," she says), and to always breathe through exercises. Lifestyle factors such as losing a little weight if you are overweight, as well as increasing water and fibre intake also make a difference. However if you have had a weak pelvic floor identified by a professional, you need to seek help from a continence physio, says Emma Boucher from Body Logic Physiotherapy. "It can be really hard trying to fly blind," she says.

How do I know if I'm doing it right?
Go to a women's physio and get an internal exam. Once you've had kids, pretty much every man and his dog has had their hand up there, so one more won't make a difference. "If you are having sex with your partner, get a really good grip and don't let him out," says Julie. "Also you can put your fingers in your vagina, squeeze around and try to draw up. If girls are using a vibrator, squeeze it and let go. If you try and aren't sure, go to your nearest women's physio, and don't give up."

Getting sweaty
"Always train for your weakest link," says Lisa. "And if your weakest link is your pelvic floor, then you will be stronger and healthier sooner if you attend to your pelvic floor and core recovery first," she says. As a rule of thumb, you are doing the right exercise for your pelvic floor if you can maintain a contraction while doing the exercise. The post-natal period is critical, with many women in a hurry to get trim and fit post baby. "It's really important to focus on inner strength," says Lisa.

"Women can push on regardless, wearing a pad, and a small problem can become big, or they give up exercise altogether because they are so embarrassed, and miss out on the emotional and physical benefits," she says. "Every woman is different, so how they do it will vary, but the main thing is to re-establish strength and function of their pelvic floor and their deep abdominal and back muscles before trying to strengthen outer muscles for weight loss or appearance."

Painful sex
The pelvic floor doesn't just cause problems when it is weak – a tight floor can also show itself through painful sex, particularly in young women. These women are often unlikely to seek help for this, thinking it's just the way they are made. And sometimes by the time they do seek help they can often have psychological issues around sex. Julie says that it is imperative for these women to seek the help of a women's health and continence physio, who can correctly identify the problem and then involve GPs and other professionals as needed.

So, long story short? "Looking after your pelvic floor is an investment in your future," says Lisa. If your pelvic floor isn't great, it can get better. So do something about it before it comes knocking on your knickers. Listen to your body, and if you are getting symptoms don't ignore it. "Get treated, it will get better," says Julie. "Don't panic too much, stay positive. Be confident with your body.

Leaking information

• One in three women who have had a baby will wet themselves.
• More than half of all women with incontinence are under 50 years of age (1.7 million).
• By 2030, it is expected that 27 per cent of the population over 15 years of age will have incontinence.
• In 2010, the total financial cost of incontinence was estimated to be $42.9 billion – or $66.7 billion, including the cost of burden of disease.

Helpful contacts

Bodylogic Physiotherapy (08) 9381 7940, bodylogicphysiotherapy.com
Bumpity Bump 0435 259 254, bumpitybump.com.au
Continence Foundation Helpline 1800 330 066, continence.org.au pelvicfloorfirst.com.au
Download their two free apps through The App Store. One focuses on pregnancy and the other on exercise. Details how to do pelvic floor exercises and look after your floor, bladder and bowel, plus sets reminders to do your exercises.
Physical Best 0413 804 647, physicalbest.com.