Pelvic Floor – How to train it [article]
Identifying if there is a problem
It can be pretty personal asking your client about pelvic floor problems like incontinence. The reality is however that we need to. For many women and some men pelvic floor problems can be limiting their ability to confidently participate in exercise.
Building rapport with your client as early as possible in the relationship is crucial for gaining their trust and allowing them to feel comfortable discussing personal and potentially embarrassing issues with you.
Determining what the problem is and whether you can help can be done when screening a client simply by including incontinence as an option box on your screening form, or bringing it up when asking about any other factors that may affect them exercising.
Example question could look like: Do you experience incontinence?
Can you help?
If your client brings up incontinence you need to find out if the problem is due to muscle weakness or due to muscle spasm and muscle tension.
If muscle weakness is the problem they will most likely have problems when running, lifting, coughing or sneezing. Any activity that causes pressure or stress on the pelvic floor resulting in leaking is known as Stress Incontinence. It occurs because the pelvic floor is not strong enough to support the internal organs.
If the client is able to isolate the correct muscles, strengthening exercises can be prescribed. If not, then discuss seeing a physiotherapist, or their GP who will recommend an appropriate specialist. They will be able to help them isolate the correct muscles using methods including Biofeedback or electrical stimulation among others.
If muscle spasm or tension is a problem your client will have trouble holding on and will feel the need to go to the toilet more often and urgently even when the bladder is only partially full. These symptoms are associated with an Overactive bladder and Urge Incontinence. In such cases specialist care is advised.
Being familiar with biofeedback and methods used by specialist therapists will help you to discuss clients options and give them hope that there is light at the end of the tunnel. That this is not something they have to live with.
The following link will help to further your knowledge in this area.
How to fix it
So you’ve identified a problem, now determine whether your client can isolate their pelvic floor muscles. Use analogies they can relate to like tightening the muscles that would allow them to stop the flow of urine or for guys to lift the crown jewels. Make sure they are engaging the pelvic floor muscles rather than squeezing their butt and inner thigh muscles or sucking in their tummies.
It is easiest to do this lying down with one hand just below the belly button and one above. You want them to feel the lower abdominals flatten or hollow as they tighten the pelvic floor muscles. If the upper abdominals are sucking in they are not engaging the correct muscles. Conversely, if the lower abdominals push up in to a little hill, they have got the right muscles but are pushing down rather than pulling up. Practice and patience will enable clients to master engaging the correct muscles. If no success is achieved after a reasonable number of attempts they may need to see a specialist who will be able to help them isolate the correct muscles.
The pelvic floor muscles are about 80% slow twitch and 20% fast twitch. To strengthen them suggest the following:
1) Slow Pull ups: Have clients imagine the pelvic floor is like an elevator with 4 floors. They are lifting it up slow and smooth to the 2nd floor holding for 1 - 5 seconds then lowering to the ground floor. Use a breath out to lift and a breath in to lower. (The diaphragm and pelvic floor lift and lower together) Repeat 5 - 20 holds with 20 seconds rest between each repetition.
2) Fast Pull ups: fast lift to 4th floor hold 2 seconds and release. Repeat 5 holds
In all situations the lower abdominals should draw in softly toward the spine.
Encourage clients to practice these exercises frequently throughout the day. Use opportunities like sitting at the lights or stuck in traffic, waiting in a queue at the super market or cash point, brushing teeth, hanging out washing, as times to work out the pelvic floor. Negotiate what will work best for your client and how you will be able to check adherence to the plan. Frequency is the key in this stage. Clients will need to practice a minimum of 3 x a day every day.
Improvement in symptoms takes time and will vary from client to client. It can take between 8-20 weeks for most improvements to occur, but some improvement may be noticed after a few weeks. Once clients notice an improvement in symptoms and can easily engage the pelvic floor muscles, try to incorporate pelvic floor contraction as the first response to movement. Suggest to clients that when standing up from sitting, lifting something or bending down, their aim is to make contraction of the pelvic floor muscles a habitual automatic action.
Taking the time to discuss this sensitive area with clients, and working to strengthen their pelvic floor, could be one of the most valuable things you do to improve their quality of life.