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What Patients Are Asking....

Q. How often should I do my pelvic floor exercises?
A. First of all not everyone should be doing pelvic floor exercises particularly if you have pain associated with doing these exercises or have difficulty emptying your bladder or bowels.  It’s important to have a consultation with a pelvic health physiotherapist before you embark on an exercise program.  This is because your pelvic floor muscles may be overactive.  In this situation, doing too many pelvic floor exercises can increase existing pelvic pain or make emptying your bladder or bowel more difficult.
If you don’t have pelvic pain or problems with emptying your bladder or bowels, then the recommendation is to establish a habit with your pelvic floor exercises.  Performing them around 30 times a day will help with this.

Q. How do I do a pelvic floor muscle contraction?
A. You should be able to lift and squeeze when doing a pelvic floor contraction.  It is important to concentrate on relaxed breathing while you do the exercises and to work on the length of hold of the muscles (endurance).  To help you with improving stress urinary incontinence (leakage associated with coughing or sneezing), it is important to learn the knack – that is, contracting your pelvic floor muscles before and during the increase in intra-abdominal pressure that occurs during activities such as lifting/coughing/laughing/sneezing.  It is best to come in for a one on one session with a pelvic health physiotherapist to teach you how to correctly coordinate these muscles with your breathe.

Q. How long do I have to do pelvic floor exercises for? A few weeks? A few months?
A. These exercises should be maintained and completed for life.  As we age and pass through different life stages, our bodies go through hormonal changes and as a result can affect our continence state.  It is this lifetime adherence that most of us have trouble with.  It is a lot like cleaning your teeth or moisturising your face.  You would not only do that for 3 months and then stop.  You do that twice daily as a habit and that’s what we would hope you would establish as a daily habit with your pelvic floor exercises.

Q. Why is it important to strengthen my pelvic floor muscles during pregnancy?
A. The softening effect of changing hormones and the increasing weight of your baby places pressure on your pelvic floor muscles.  This can make it harder for the muscles to hold your pelvic floor organs in their correct position.  The pelvic floor muscles and ligaments are also stretched at birth, which can sometimes lengthen the tissues permanently.  Hence strengthening your pelvic floor muscles can support your organs and reduce any symptoms you may have such as incontinence or heaviness.

Q. How should I speak to my personal trainer/instructor about making sure exercises are modified for the pelvic floor?
A.  Some personal trainers and instructors are knowledgeable about exercise and the pelvic floor and others are not comfortable or familiar with the information.  Ask specific questions like “Do you teach pelvic floor safe options?”, “have you done any pelvic floor and exercise specific training and where?”.  You could also ask if they modify exercises for other clients.

Q. I’m a busy 32 year old working mum and I stay healthy by eating a balanced, fibre rich diet, drinking adequate fluids and keeping active.  But I find myself going to the toilet to open my bowels up to 5 times a day, not passing much each time and feeling as though I’m not quiet finished.  Why is this happening and what more can I do about it?
A. Being in tune with your bowel urges is important and adopting a regular toileting routine and learning effective bowel-emptying techniques are all needed for good bowel function and habit.
In a nutshell, the large bowel is most active after we wake up and after breakfast.  Unfortunately with our busy lifestyle, we often ignore these urges to pass a bowel motion which can worsen the situation of constipation and incomplete bowel emptying.  Seek help from a pelvic health physiotherapist to learn the right technique to empty your bowel properly.

Q. I’m a 40 year old mum with ongoing diarrhoaea, but I find it is just getting worse. What can I do?
A.  First of all, you will need to have a thorough medical assessment from your GP or specialist to rule out problems such as infection, inflammation, coeliac disease and food intolerances.
You may need to stop consuming bowel irritants such as caffeine, artificial sweetners and alcohol.  It may also be a good idea to introduce a bulking agent such as psyllium husk, Metamucil, Fybogel or Normafibe each day, as these can lower the water content in the stools and reduce the need for medication.  Being stressed or anxious can also cause the bowel to be more sensitive.  By combining a mind and bowel calming approach such as holding on can be effective in retraining your urges to empty your bowels.  This along with regular pelvic floor exercises are recommended, as is establishing a good toilet routine and an effective bowel emptying regime.

Q. I’m 27 years old and enjoy going to the gym especially pilates and doing core exercises.  Recently, I’ve noticed having issues with emptying my bladder and sex or penetration is painful.
A.  The symptoms indicate you may have an issue with overactive pelvic floor muscles.  Doing core and ab exercises can tighten up your core and pelvic floor muscles and make your symptoms worse.  While there has been emphasis on strengthening up your pelvic floor muscles for symptoms such as incontinence and prolapse, your body may not know how to relax these muscles properly.  As a result, tight muscles can lead to pain and your pelvic floor muscles may not understand how to relax correctly when you try to empty your bladder which leads to a slower flow or urine or not being able to empty immediately.  By all means, it’s important to have this assess by your GP first to rule out other conditions.  Then the next step is to see a pelvic health physiotherapist to assess your pelvic floor and teach you how to relax your muscles.

Q.  I've started running lately and noticed it’s caused me to leak, but I want to lose the baby weight and get fitter and stronger.
A.  This is such a common situation but shouldn’t be normal.  If you are experiencing leakage while running or with other exercises, it suggests you still have to work towards the required level of general and pelvic floor fitness.  By continuing with your runs or other exercises which causes you to leak, you may in fact be weakening your pelvic floor.  There are many exercise you can do to increase your fitness and weight loss without putting pressure on the pelvic floor. It’s best to have an assessment from a pelvic floor physiotherapist.

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