|Margaret Sanger by Michelle Wright|
Margaret Sanger was an American woman who opened the first birth control clinic in Brooklyn, USA in 1916. Sanger challenged the belief of the time that state, church and husbands had more control over women's reproductive bodies than the women themselves. Sanger worked with underprivileged women who were suffering dreadfully from frequent childbirths and self-induced abortions. Nine days after her birth control clinic opened, Sanger was arrested by the police for a 30-day stint in jail. As she was being transported away, women were seen running after the police cart yelling out "Tell me the secret! Tell me the secret!"
It does make you feel extremely grateful to live in such enlightened times. Today, women are still asking to be in control of their bodies, but working only with the information that "popular culture" decides to give them. Often, talking openly and admitting issues with our sexual or pelvic organs is still something said behind our hands or in a joking manner. Unfortunately, incontinence is not very funny for those who suffer from it.
Today's role models are in our magazines holding their newborn babies while returning quickly to their skinny jeans. Many women now live away from extended family that in past would move in and help in those early days when a new baby arrived. Even hospitals are able to eject mothers from their beds and send them home within the day of giving birth. Going back to the gym, you may be asked about any past injuries but rarely will incontinence be part of this conversation.
In hospital new mothers may receive a visit from a physiotherapist who may explain the importance of pelvic floor muscles and check for diastasis (the splitting of the abdominal muscles). Pelvic floor health may be followed up by the GP at the routine 6 week post-natal check. Information may be included in the new mum course running at the Maternal Child and Health Nurse.
Or then again, it may not.
One third of all women who have children will suffer from either stress or urgency incontinence (or a mixture of both). 50% of women aged under 50 will suffer from incontinence.
Fitness professionals will learn about gluteous maximus, abdominal recti and biceps brachii, but pelvic floor as a muscle will be missing from their training manual. Group fitness instructors may give exercise options for dodgy knees or lower back pain, but not for the case where you leak urine.
Everyone who leaks will feel embarrassed and most will suffer in silence; fewer still will get help.
In the 1900's, society felt uncomfortable about having a conversation about birth control and sexuality. Today we still feel uncomfortable talking about incontinence and many want to continue believing that it is only an issue for the old folks home.
Myth #1 – crunches or sit-ups will give me a flat tummy
Performing crunches not only trains the superficial abdominal muscles to be convex rather than concave (so your tummy will stick out, rather than get flatter), but will also increase abdominal pressure to bear down on the pelvic floor. If the pelvic floor has already been compromised through pregnancy, pelvic floor dysfunction or prolapse is one step closer. Performing crunches will further split or stop the abdominals from healing back together if rectus diastasis (DRAM) has been diagnosed.
The way to get a flat tummy is by starting with a pelvic floor contraction and working north (more about this later!)
Myth #2 – Leaking (a little bit) is normal after having children
Perhaps this is true, but it doesn't need to be so! In most cases correct pelvic floor exercise training will fix the problem of leaking, improve pelvic and lower back pain and increase your sexual enjoyment.
Myth #3 – Surgery will fix my problem of incontinence
Statistics are showing that surgery may improve the immediate issues of pelvic floor function, but without necessary changes of behaviour combined with surgical nerve damage, the operation may have to be repeated. Correct pelvic floor function will still need to be performed after surgery and for life.
Myth #5 – I had a C-section so my pelvic floor is fine
Delivery is only half of the story. Carrying the weight of a growing child for nine months creates stress on the pelvic floor. However, when a woman reaches 45, she has the same chance of leaking—regardless of whether she has had children or not. Pelvic floor muscle training is important for all women and needs to be a routine part of their lives, like brushing teeth.
Here are some instructions and tips on how to perform excellent pelvic floor muscle exercises:
1. Try to keep the buttocks relaxed (sometimes these can squeeze involuntary as a way of keeping the pelvic floor lifted). Avoid clenching!
2. Make sure the muscles around your middle are relaxed and not contracted. Sucking in our tummies will also bear down on the pelvic floor, making it much more difficult or impossible to draw it up.
3. Breathe! The importance of breathing cannot be stressed enough! Holding your breath (probably because you are concentrating!) will bear down on the pelvic floor, even when you think you are pulling it up. Remember this tip for all exercises!
4. Start the contraction by pulling tightly closed the muscles around the back passage. Exactly like when you want to break wind in an inappropriate setting! And draw the pelvic floor up and to the front. Imagine that if you were sitting on a delicate silk scarf, your pelvic floor would delicately lift it up and within.
5. Allow the pelvic floor to descend back down. I like to use the image of a flower opening its petals. Always be aware when you are bearing down or straining on your pelvic floor and avoid this always.
6. Your pelvic floor is like any other muscle in your body: it needs different types of training for different uses. Practice your sprint exercises (quick, fast, grabby contractions)– these are handy for sneezes and coughs; but you also need to practice endurance—for the times when you need to hold on. These can be practiced by holding up your pelvic floor and counting slowly and being aware of how many seconds you can hold your pelvic floor up before you feel your buttocks clench, or you start holding your breath or it simply fades away. Working on your PB (Personal Best) and maintaining a hold of 8–10 seconds is a fantastic goal to work towards.
7. Your pelvic floor muscle responds really well to regular training, little by little —you can often feel improvement over just a few weeks. But unfortunately the opposite is also true: without practicing your exercises it can become weak again and cause you to leak again. These exercises are for life!
8. Your pelvic floor loves a challenge! Start to include it in your usual exercise routine. It may mean that you perform less reps and require much more concentration—but your hard work will be rewarded!
9. Your Grandmother loved you having good posture and so does your pelvic floor. Holding your body upright will not only allow the pelvic floor to function better, but you will be able to breathe better, and in turn you will look and feel better! This is also important while performing exercises. Posture counts as an exercise!
10. If you still don't feel like you are doing it properly, or you continue to leak or feel any heaviness in the vaginal area... don't wait! Book yourself in to a women's health physiotherapist who specialises in this area. You can get a referral from your GP. Continence pads do not have to be a permanent item on your shopping list!
All of this information just might seem like too much hard work, especially if you only leak a little bit or occasionally. But possessing a strong pelvic floor really can have some fantastic side effects. That flat belly that you have been lusting after since the birth of your child is achievable. Contracting the pelvic floor first will help contract those deep core muscles that your group fitness instructor or personal trainer is always reminding you about.
A strong pelvic floor will increase your sexual satisfaction, giving you stronger orgasms and also increasing your partner's pleasure as well ;)
Not leaking urine every time you exercise may encourage you to exercise more and enjoy it. That will help shed those extra kg's that have been lurking around your middle.
It is never too late to start, and the benefits are real.
Be part of a new revolution for women. Share the information with your daughters, your mothers and your friends. You may become aware of how many women you know who are suffering in silence, when they really don't need to be. Visit a physiotherapist who specialises in this area if you are unsure or you don't see any improvement; often a quick check with Real Time Ultrasound can fine-tune your exercises.
Margaret Sanger was not alone in believing that education is the key to change. And education starts with bringing the issue into popular culture, debunking the myths and having all heath and fitness modalities joining forces to providing information and support.