You know it - the doctor says to do crunches, the physio says to train your pelvic floor, even the media is starting to talk about the importance. Now it's not even just the women who are being talked to, the men have to get started too.
It can be uphill for that pelvic floor workout there though! How to do it right? It is boring! You forget it! The excuses can be many. Nevertheless, it is important if you want to avoid a future of incontinence.
So what is incontinence? Do you just pee your pants all the time? Should I wear a diaper? Can I no longer be active? As a physiotherapist, you get many questions and concerns when you meet women and men who feel they have started to 'leak'. It is known that pregnant women must make a great effort to maintain the ability to squeeze, to hold urine. Likewise subsequently to regain previous function. The situation is just that everyone can have problems, not least when we get older.
I am a physiotherapist, 36 years old, and have incontinence problems myself. Why so young? In my case, it is mainly due to my first birth and then adjacent challenges and surgeries. For others, it may be about age, repeated heavy physical loads, being overweight or something else entirely.
My best and first advice to everyone is; Seek help.
Seek the expertise of either your doctor or another professional if you are unsure how to get started.
Squat/crunch exercises sound easy peasy to most people. However, the reality is that many do not pinch correctly. The pelvic floor muscles, acting as a single muscle, provide only a very small movement, but with enormous importance. The people I've met over the years tend to tighten their glutes or stomach when they cramp, precisely because it can be so hard to get the sense of when you've really 'got' that pesky little muscle.
Many people think that they can then train the muscle when they go to the toilet – because if you can stop the jet, then that's good. Here something very important for me to point out is that this should ONLY be done to check your ability, and only once in a while. Finally, you must not use this situation to do your squatting exercises, as this may result in you not emptying the bladder sufficiently - and then you are faced with a completely different challenge.
Remember therefore - a visit to the toilet is for peeing, and now give yourself plenty of time so that the bladder is emptied.
Another thing I often come across is that you don't "get your act together" or remember to train your pelvic floor. Everyday life is filled with many other important things, and pelvic floor training therefore requires you to either lie down, sit or stand still. At least if you start from scratch. Later, you can and must also be able to keep track of the activity. This will be achievable for many who do not have internal injuries or specific problems.
Effective rehabilitation of the pelvic floor unfortunately does not happen overnight - I would guess that on average you should expect min. 3 months where you make an effort every day.
In the beginning, it is frequent short sessions. Over time, as endurance and strength are gained, you will be able to train for a longer session and therefore fewer times a day.
Patience - oh yes! It requires patience and willpower. Now it almost sounds like a completely unmanageable task, but really it is no different than if you have broken a foot, where you have to retrain your muscles when the cast comes off. The difference is simply that the large muscles are easier and faster to train.
As I often say, 'Rome wasn't built in a day and a little is always better than nothing'. I wish there was an 'easy fix' but when it comes to our bodies and physiques it rarely exists.
My second best advice over time has always been to get your training and exercises into a system. Whether it's a reminder on the phone, certain times every day or the like - just get it into a fixed routine.
My own experience is that I can easily have tens of thousands of thoughts and completely forget to pinch. Control is the key word. Control your pelvic floor muscles. You have to have full sense to get into a pinch and full sense to let go again. Some can only hold the pinch for a few seconds before the power of the pinch fades, and that should not happen. You have to be in control when you pinch and release and from there calmly increase your endurance and pinch. Pelvic floor training also includes other muscles in the pelvis, but it all has to start with the control of the pelvic floor muscle itself.
Some people feel the pinch best when lying down - others when sitting. Which position doesn't matter so much as long as you have the feel and control.
It is therefore a good idea to train in different positions. Lying down, you have no weight on the muscle that you get in a standing position.
Then there are some who can't feel the pinch at all, feel no movement, no control - just NOTHING happens! Again, best advice, get help.
There are specially trained physiotherapists with experience and specialized training for pelvic floor training, and are often referred to as 'gynaecologists'. In addition to what they manage with their knowledge, guidance and physical help, there are several aids on the market that can support rehabilitation.
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