This short Physiotherapist video shows you how to modify some commonly performed abdominal exercises to reduce pelvic floor loading. Scroll down below for written guidelines for how to modify intense abdominal exercises.

Intense Abdominal Exercises & Pelvic Floor Load

Intense abdominal exercises involve strong contractions of the abdominal muscles. The upper abdominal muscles generate a large amount of pressure within the abdomen. The muscles surrounding the trunk manage the pressure generated by the abdominal muscles- the pelvic floor muscles withstand the pressure generated and applied to the pelvic floor.

If the pressure associated with abdominal exercises is too great for the pelvic floor muscles to withstand, then the pelvic floor is forced downwards, causing the pelvic floor muscles to stretch and weaken. Abdominal exercises that repeatedly force the pelvic floor downwards, or particularly intense core abdominal exercises that completely overload the pelvic floor should be modified in women at risk of pelvic floor injury.

Who is at Risk with Intense Abdominal Exercises?

There is no one single abdominal exercise prescription for everyone. The capacity of your pelvic floor to withstand intense core abdominal exercises is likely to be different to that of the woman next to you in your exercise class. The abdominal exercises that you should match the capacity of your pelvic floor muscles to withstand the associated pressure.

The risk of pelvic floor injury with intense abdominal exercises increases in women with:

• Weak or poorly functioning pelvic floor muscles
• Pelvic organ prolapse
• Bladder or bowel control problems
• Pelvic pain or increased pelvic floor muscle tension.

Specific groups of women at risk with intense abdominal exercises:

• Recent pregnancy and childbirth
• Menopause and beyond
• Overweight and obese women
• Gynaecological surgery (including prolapse, hysterectomy or incontinence surgery).

How to Modify Intense Abdominal Exercises

Abdominal exercises can be modified to reduce pelvic floor loading. This is a matter of reducing the intensity of the abdominal muscle contractions, and reducing the requirement for the pelvic floor muscles to contract for extended periods of time with repeated abdominal exercises or extended abdominal muscle holds.

How to Modify Abdominal Curl Exercises

Abdominal curls or sit up exercises involve head and shoulder forward raises. It is difficult to modify the intensity of this particular exercise which should ideally be avoided in women with pelvic floor dysfunction or very weak pelvic floor muscles.
The pelvic floor loading associated with abdominal curls can be decreased by:

• Doing fewer repetitions
• Breathing out as you sit up
• Minimising resistance on abdominal curl machines.

How to Modify Double Leg Raises

Double leg raises or exercises involving both legs raised simultaneously are commonplace in gyms and women’s fitness classes including Pilates and Yoga.

The pelvic floor loading associated with double leg raises is readily modified by raising one leg and keeping head and shoulders down in contact with the mat throughout. Once again avoid breathe holding and try to breathe normally throughout.

How to Modify Plank or Hover

Full Plank or Hover involves weight bearing through the forearms and the feet. This is an intense abdominal core muscle exercise.

The pelvic floor loading associated with full Plank or Hover can be reduced with:

• Kneeling rather than supporting body weight through feet
• Breathing normally and avoiding breath holding
• Reducing the duration of the abdominal exercise
• Avoiding actively contracting the abdominal muscles or over bracing the abdominal muscles during the exercise.

Intense core abdominal muscles have the potential to overload the vulnerable pelvic floor. Many abdominal exercises can be modified to reduce pelvic floor loading for women at risk of pelvic floor injury. This is a matter of reducing the requirement for the pelvic floor muscles to work to counteract the pressure associated with intense core abdominal exercises.

About the video presenter: Michelle Kenway is a Pelvic Floor Physiotherapist, author of Inside Out – the Pelvic Floor Safe Exercise Program for Women. Inside Out is a complete pelvic floor safe exercise weekly home workout program.

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

The post How to Modify Abdominal Exercises for Pelvic Floor Protection appeared first on Pelvic Exercises.

My teenage son innocently asked “mum do you think she’s had a prolapse?” I couldn’t help thinking that in view of the exercise Anita had been doing and her pelvic floor risk factors, pelvic prolapse was definitely up there in the range of possibilities.

I had to wonder why, if my teenage son can see the potential for pelvic floor injury, does high risk exercise for pelvic floor injury continue to be inflicted on women during prime time TV? I have deliberated about writing about this issue after years of cringing every time I see unsafe exercises for women, and my son’s question has finally prompted me into action.

I will preface this article by saying one can only applaud the efforts of anyone seeking to lose weight, improve their health and fitness, and that personal trainers are well intentioned in seeking to help their clients achieve their goals, and there are now many personal trainers who are highly committed to providing pelvic floor safe exercises to their clients.

However, isn’t it time that mainstream exercise prescription for women is tailored to their individual needs rather than the one fits all model for men and women we often continue to see? The pelvic floor of a woman is vastly different from that of a male, far more vulnerable to injury with inappropriate exercise.

Who is at Increased Risk of Pelvic Organ Prolapse?

Many risk factors for pelvic prolapse and pelvic floor dysfunction apply to the mature women on this season’s ‘Biggest Loser’:

• Overweight or obese women
• Previous pregnancy and childbirth
• Menopause and beyond
• Regular heavy lifting.

These are all major risk factors for pelvic floor dysfunction including pelvic organ prolapse.

Overweight and Pelvic Floor Problems

This season’s ‘Biggest Loser’ female contestants would have been classified as obese at the outset (i.e. BMI or body mass is greater than 30). Obese women have increased load on their  pelvic floor whenever they are upright. The weight in and around an overweight woman’s abdominal organs combined with gravity weighs down  their pelvic floor. The mature female contestants admit to years of obesity – in other words years of walking around with increased load on their pelvic floor.

Scientific studies confirm that increased body weight is a risk factor for prolapse surgery in women¹. Obesity has been identified by the International Continence Society as an independent risk factor for incontinence². In other words the increased load on the pelvic floor with obesity (and overweight) potentially increases the risk of pelvic floor problems occurring. Obesity combined with exercises that potentially overload the pelvic floor make this issue more problematic for overweight women and can potentially have adverse long-term outcomes for a woman’s pelvic floor health.

Childbirth and Pelvic Floor Problems

Women who have been pregnant and given birth are at increased risk of pelvic floor dysfunction. This season the theme is for a parent and child to lose weight together – so we know the mothers involved have gone through pregnancy and childbirth at least once in their lives. Pregnancy and childbirth are known to impact upon the supportive function of the pelvic floor. Studies implicate vaginal delivery as a risk factor for pelvic organ prolapse³.

Menopause and Pelvic Floor Problems

Menopause and increasing age are associated with increased likelihood of pelvic floor weakness and decreased pelvic floor support. The adult women in this season’s show are mature, some with children in late teens or early twenties, so we can reasonably expect that some are close to or past menopause. With decreased oestrogen the pelvic floor tissues becomes thin, weak and less elastic making the mature woman’s pelvic floor at increased risk of pelvic floor dysfunction.

Exercise, Heavy Lifting and Pelvic Floor Injury

Exercises that increase stress on a woman’s pelvic floor muscle supports increase the risk of pelvic floor dysfunction including incontinence and pelvic organ prolapse. It is known that lifting heavy weights, high-impact exercises and long distance running increase the risk of pelvic organ prolapse³. Intense core abdominal exercises (abdominal curls or sit ups) are known to create pressure causing pelvic floor descent in women with previous vaginal delivery⁴ – if the pelvic floor is unable to withstand repeated loading of intense core exercise, then pelvic floor dysfunction may result.

So one would expect that in a group of obese and overweight menopausal women (mothers) who have numerous risk factors for pelvic floor injury we would see appropriate pelvic floor safe  exercises to promote weight loss and avoid pelvic floor dysfunction. However  here’s just a taste of some of the weight loss exercises we have witnessed these women perform to date alongside their male counterparts:

Heavy lifting

• Pulling a semitrailer with an abdominal harness (team)
• Pushing/pulling/lifting a surf boat from end of the beach to the other (team)
• Lifting heavy weights with squats from ground height (shown right)
• Lifting and running to build a tower out of bales of hay (partner).

Intense core abdominal exercises

• Sit up exercises
• Plank extended holds
• Men’s push ups

High Impact Exercise

• Long distance running half marathon (team)
• Sprinting
• Burpees
• Running with load (surf boat, hay bale, semi trailer and harness)

Any Pelvic Floor Safe Exercises?

Participants have also performed low impact exercises including elliptical machines, walking and stationary cycling. It is difficult to comment on whether these exercises were offered as alternative pelvic floor safe exercises to some high impact gym-based exercises.

Implications for Women’s Exercise?

National television coverage of the exercises we have seen keeps us in the dark ages when it comes to promoting appropriate pelvic floor safe exercises for mature overweight women.

There are a number of potential negative implications for women’s pelvic floor safe exercise:

• This type of coverage legitimises these types of high impact heavy loading exercise interventions for overweight women and the notion that the same exercise interventions are appropriate for men, women and teenage children.
• The exercises are prescribed by personal trainers adding to this sense that the exercises are safe and appropriate for obese and overweight women to perform.

The real risk is that large numbers of unsuspecting mature women who are at-risk of pelvic floor injury owing to obesity or being overweight could readily view the types of exercises prescribed as appropriate for them to include in their own exercise regime. If pelvic floor injury is sustained, or any musculoskeletal injury for that matter during exercise it makes it all the more difficult for these individuals to adhere to their weight loss and fitness endeavours and achieve success.

Isn’t it high time that exercise interventions for women cater for a woman’s weakest link ? In many mature women their weakest link is their pelvic floor. Why aren’t the exercises for these at-risk women modified to promote weight loss and pelvic floor protection? This is a simple matter of providing or low impact exercise alternatives, pelvic floor safe lifting practices and avoiding or modifying  intense core abdominal exercises.

We want women to be able to exercise safely and effectively, and help them to avoid foreseeable pelvic floor issues they may encounter with inappropriate exercises. If this one fits all model of exercise prescription continues there is only one biggest loser – pelvic floor safe exercise for women.

Will anything change as a result of this article? Probably not, it appears that even the Australian Government funded Pelvic Floor First Initiative that seeks to educate the fitness community and broader community on pelvic floor safe exercises isn’t being heard in some quarters. At least tonight I can rest easy, and maybe, just maybe, some unsuspecting overweight woman undertaking a new exercise program may glance over this article, have a light bulb moment and save herself some considerable pelvic floor grief.

Michelle Kenway is a Pelvic Floor Physiotherapist, author of Inside Out – the Pelvic Floor Safe Exercise Program for Women. Inside Out is a complete pelvic floor safe exercise weekly home workout program.

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

¹ Mant, Jonathan, Painter, Rosemary, Vessey, Martin (1997) Epidemiology of genital prolapse: observations from the Oxford Family Planning Association study BJOG: An International Journal of Obstetrics & Gynaecology, 104, 579- 585.

² Chiarelli P (2007) Lifestyle interventions for pelvic floor dysfunction. In evidence-based physical therapy for the pelvic floor Bridging Science and Clinical Practice Editors Bo K. Bary Berghmans, B. Morkved, S Van Kampen M Toronto Elsevier p 148-149.

³ Balmforth J and Robinson D (2007) Pelvic organ prolapse. In evidence-based physical therapy for the pelvic floor Bridging Science and Clinical Practice Editors Bo K. Bary Berghmans, B. Morkved, S Van Kampen M Toronto Elsevier p235-236.

⁴ Thompson JA, O’Sullivan PB, Briffa NK, Neumann P. (2007) Comparison of transperineal and transabdominal ultrasound in the assessment of voluntary pelvic floor muscle contractions and functional manoeuvres in continent and incontinent women. Int Urogynecol J Pelvic Floor Dysfunct. 2007 Jul;18(7):779-86. Epub 2006 Oct 17.

The post Who’s the Biggest Loser? Pelvic Floor Safe Exercises for Women! appeared first on Pelvic Exercises.

Pilates has received mixed reviews over many years depending on where you read about it. You may hear claims by many models, celebrities and entertainers that daily Pilates is the way they stay looking the way they do. Others report that Pilates cured or caused their back pain.

Some women want to know whether Pilates will help or worsen their pelvic floor function. What about their pelvic prolapse? Yet again, others ask – What exactly is Pilates?

What is Pilates?

Pilates is a method of exercise developed by and named after Joseph Pilates, which targets the spinal, abdominal, and pelvic floor muscles, often termed ‘the core’. The focus is on body alignment, muscle balance and correct breathing technique, with the aim being to improve body awareness and control, strength and flexibility. Basically the emphasis is on an understanding of how to move and efficiency of movement.

Joseph Pilates originally developed a system of exercises during World War 1 to help rehabilitate injured soldiers. Later in his life he moved to the USA where he opened his own studio, which became popular with dancers, athletes and entertainers and hence was more widely known. He died in 1967, however Pilates has continued to be taught in many countries around the world and was introduced to Australia in 1986.

Many methods of Pilates have been established, each one slightly different to the next. Very broadly speaking, ‘Traditional Pilates’ methods tend to stick a little more closely to Joe’s original teaching whereas ‘Clinical Pilates’ often means that the exercises have been modified and take into account more recent research in the areas of musculoskeletal research. A good example here is Pilates and pelvic floor muscles. In Joe’s original exercises, there is no mention of these muscles, however we now realized the importance of the pelvic floor muscles in any form of exercise, particularly when exercising the abdominal muscles. In fact, the ‘hundreds’ exercise, often regarded as the signature Pilates exercise, and one of the first exercises done in a traditional mat class, would be contra-indicated for anyone doing Pilates with pelvic floor muscle dysfunction, including those with pelvic organ prolapse.

Two Forms of Pilates: Mat or Studio Pilates

1. Mat Class Pilates

• Suitable for those who are not injured,
• All exercises in mat classes with everyone doing the same thing, without programmes specifically tailored to each client
• Correct ‘core’ activation is assumed,
• Class sizes vary greatly depending on available space,
• Generally classes are specified as Basic/Beginner, Intermediate or Advanced,
• Specialty classes such as pregnancy or post-natal may be available,
• Some centres offer reformer classes where the same principles apply.

2. Studio Pilates

• Suitable for those who are injured and have specific rehabilitation needs, or those who require modification of the basic exercises such as the elderly, women who are pregnant or in the post-natal period, even elite athletes,
• Utilises Pilates equipment such as the Reformer, Cadillac (also known as the Trap Table), Wunda Chair, Spine Corrector and possibly others,
• Exercises are performed on equipment as well as the mat
• Emphasis is on the close supervision and individual exercise prescription
• Has a low client/instructor ratio to ensure close supervision and correct technique
• Each client has an individual exercise programme which may be different at each session and progressed according to signs and symptoms
• Generally each client has an individual initial assessment to determine focus areas and to ensure correct core activation. Commonly the real-time ultrasound is used. This is a similar type of ultrasound to that which is used for pregnant women. It is a very useful way of assessing correct pelvic floor muscle activation and assessing how the pelvic floor and abdominal muscles work together. If a client has difficulty in performing a satisfactory combined pelvic floor and abdominal muscle contraction, then he or she maybe referred to a Physiotherapist who has extra training in Continence and Women’s Health.

Pilates and Pelvic Floor Problems

So, let’s get back to the original question: Will Pilates help or hinder pelvic floor muscle dysfunction, prolapse or back pain? Unfortunately the answer is: It depends! Like any form of exercise, the way that you perform Pilates is crucial to gaining benefits.

Some important considerations for Pilates and pelvic floor issues are:

A. Correct core activation

This is particularly important with regards to the pelvic floor muscles. You must know that you are activating properly, and exercises must be prescribed that are appropriate for your level of function. If you are not performing an exercise properly you will not be gaining the maximum benefit from it, but more importantly you are at risk of causing damage. This can occur for a few reasons:

• Pushing downwards (bearing down) through the pelvic floor muscles instead of the correct action of squeezing and lifting up puts you at risk of developing a prolapse and impairments in bladder and bowel function

• Performing abdominal exercises which are too loaded, especially those where the head is lifted or those which cause you to hold your breath. Basically what happens is that the abdominal muscles ‘overpower’ the pelvic floor muscles, putting them at risk as above

• In situations where the pelvic floor muscles are ‘overactive,’ the programme will be quite different to someone who simply has weak pelvic floor muscles. Continued holding of these overactive muscles may actually make the problem worse

B. Thorough initial assessment

Initial assessment is important to determine what your actual problem is. This will lead to developing a list of focus areas and your programme can be developed from there. This applies for problems in all areas – from back pain to pelvic floor problems.

If you consider the factors listed above, you can see why it can be difficult to gain benefits by simply following a DVD or participating in a very large mat class prior to any other form of Pilates.

So, in summary, Pilates can be a very helpful form of exercise as long as you are:

• Activating your core correctly
• Performing exercises correctly that are appropriate for your level of function
• Performing exercises which have been correctly prescribed to assist with your signs and symptoms.

About the author: Jenny Tweedie is a Pelvic Floor Physiotherapist and Pilates Instructor. Jenny conducts pelvic floor safe Pilates exercise programmes for women of all ages and pregnancy exercise at LifeCare Physiotherapy, Wembley, WA. For more details about Jenny’s pelvic floor safe Pilates programmes email wembley@lifecare.com.au or visit www.lifecare.com.au/wembley/

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

The post Pilates and Pelvic Floor – Is Pilates Core Exercise Right for You? appeared first on Pelvic Exercises.

This short Physical Therapist video by Michelle Kenway answers “What is a pelvic prolapse?” and explains the most commonly occurring types of pelvic prolapse in women.

Read on now to learn:

• What causes a pelvic prolapse
• Risk factors for pelvic prolapse
• Different types of pelvic prolapse explained:

- bladder prolapse
- bowel prolapse
- uterine prolapse

What Causes a Pelvic Prolapse?

A pelvic prolapse results when the pressure within the abdomen and pelvis overcomes the pelvic floor support structures causing them to fail. The pelvic organ support structures are the pelvic floor muscles and strong tissues that wrap around and support the pelvic organs suspending them from the walls of the pelvis. When these pelvic supports become strained, they stretch and weaken so that they become unable to retain the pelvic organs in position. This results in one or more pelvic organs moving down into the vagina, or what is referred to as a pelvic organ prolapse.

Risk Factors for Pelvic Prolapse

Common risk factors for pelvic prolapse include:

• Pregnancy and childbirth
• Increasing age
• Pelvic floor weakness
• Being overweight
• Heavy lifting
• Constipation and/or straining to empty the bowels

Different Types of Pelvic Prolapse

The different types of pelvic prolapse are names according to the structures involved. Some types of pelvic prolapse involve the pelvic organs moving into the walls of the vagina. Others involve the uterus or upper most part of the vagina descending into the vagina. It is quite common for women to have pelvic prolapse involving more than one pelvic organ for example a woman mat have and bladder and uterine prolapse.

Anterior Vaginal Wall Prolapse (bladder prolapse or cystocoele)

Bladder prolapse is one of the most commonly reported forms of pelvic prolapse. A prolapsed bladder involves the bladder moving into the front wall of the vagina. A bladder prolapse can become visible as a bulge at the entrance of the vagina and this one of the frequently reported prolapse symptoms. When a bladder prolapse becomes severe the front wall of the vagina can bulge out of the entrance to the vagina, and cause problems with bladder emptying.

Posterior Vaginal Wall Prolapse (rectocoele)

A posterior vaginal wall prolapse is a prolapse of the rectum (lower bowel) into the back wall of the vagina. A posterior prolapse can also be seen as a visible bulge at the entrance to the vagina as it becomes more severe. Women often report constipation and bowel movement problems with a posterior vaginal wall prolapse. This type of bowel prolapse into the vagina is not the same as a rectal prolapse which involves prolapse of the rectum within the rectum not the vagina.

Uterine prolapse

Uterine prolapse occurs when a woman’s uterus (womb) and cervix move down and descend into the vagina from above. Uterine prolapse is often accompanied by a sensation of pressure or fullness within the vagina, lower abdominal discomfort and/or low back ache. The uppermost part of the vagina can prolapse in women who have had a hysterectomy and have no uterus, and this is known as a vaginal vault prolapse.

What is a pelvic prolapse? In summary a pelvic prolapse occurs with the failure of the pelvic supports to retain the pelvic organs in their correct position within the pelvis. Pelvic prolapse in a woman can involve one or more of the pelvic organs moving downwards within and sometime out of the vagina.

About the video presenter: Michelle Kenway is a Pelvic Floor Physiotherapist, author of Inside Out – the Pelvic Floor Safe Exercise Program for Women. Inside Out is a complete pelvic floor safe exercise weekly home workout program.

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

The post What is a Pelvic Prolapse? Prolapse Video for Women appeared first on Pelvic Exercises.

Quick Quiz: What is the leading cause of death among women?

A. Breast cancer
B. Bowel cancer
C. Heart disease
D. Diabetes

If you guessed C. you are correct. Not only is heart disease the biggest killer of women, but it’s way above and beyond all the other causes, in fact 4 times the rate of death among women from breast cancer!

Read on now to learn:

• The link between prolapse and heart disease in women
• How fitness exercise reduces your risk of heart disease
• The symptoms of heart attack in women
• How to exercise with a prolapse to reduce your risk of heart disease

The Link Between Prolapse and Heart Disease in Women

Physical inactivity increases the risk in heart disease in women however keeping up your fitness can be a real problem if you have a prolapse or after prolapse surgery:

• Some women with prolapse stop exercising altogether
• Others are put off physical activity because their prolapse symptoms become worse with exercise
• Returning to fitness exercise after prolapse surgery can cause anxiety and confusion about what exercise is safe and what to avoid.

We need to be very clear on this, prolapse itself doesn’t cause heart disease in women – the consequences of having a pelvic prolapse and feeling unable to exercise can affect your overall health including your heart health. Let’s face it – mature women are already at increased risk of heart disease owing to the effects of menopause on our bodies.

How Does Fitness Exercise Reduce Heart Disease in Women?

Regular cardiovascular fitness exercise can improve your heart health in a number of ways by: 

• Lowering the bad cholesterol (LDL) that causes fatty deposits to line your arteries
• Decreasing your blood pressure which decreases strain on your heart
• Improving circulation which helps prevent clots in the heart
• Managing your body weight to reduce the work load on your heart.

Professor Noel Bairey Merz is Director Women’s Health Centre Cedar-Sinai Institute and Director of Research at the Barbra Streisand Women’s Heart Centre. Professor Merz says part of the problem is that women the symptoms of heart attack in women may be atypical and often go undetected. This contrasts with the symptoms of heart attack in men. This is part of the reason why more women now die of heart disease than men

What are the Symptoms of Heart Attack or Heart Disease in Women?

Dr Merz groups the symptoms of heart disease into 2 categories – typical and atypical symptoms. She says that the symptoms of heart disease in women may differ from those in men and this is part of the reason why heart disease in women goes undetected at times.

Typical symptoms of heart disease

• Chest pain or pressure*

*Only half of women present with this typical symptom compared with most men.

Atypical symptoms of heart disease

• Indigestion
• Sense of fullness in the stomach
• Shortness of breath
• Jaw, arm or shoulder pain
• A feeling of overwhelming fatigue.

More women experience these atypical symptoms than men, however approximately 1/3 of men may experience these atypical symptoms too.

Dr Merz talks about heart disease in women and says that raising awareness of both typical and atypical symptoms of heart disease will save the lives of more women and men.

How to Exercise with Prolapse to Reduce Your Risk of Heart Disease

Women with prolapse or after prolapse surgery may need help and encouragement towards safe prolapse exercises for their heart health despite their prolapse problems. It is indeed very feasible for many women with mild to moderate prolapse to perform effective exercise that reduces their risk of heart disease. Here’s how…

1. Choose Low Impact Fitness Exercises

Pelvic floor safe low impact exercises for prolapse are those exercises that involve at least one foot in contact with the ground throughout. Cardiovascular fitness exercises should ideally be regular and continuous so the less impact during exercise the better for your pelvic floor.

Types of low impact cardiovascular fitness exercise:

• Walking
• Cycling
• Hiking
• Bushwalking
• Water-base exercise (swimming, water walking, aqua exercises)
• Dancing (low impact)
• Exercise equipment (treadmill, elliptical low resistance, stationary cycle)
• Kayaking

2. Guidelines for Aerobic Fitness Exercise in Healthy Women

Following are the current ACSM guidelines¹ for exercising to develop and maintain cardio respiratory fitness in healthy adults. In other words how much exercise you need to do and how often you need to do it to keep your heart healthy.

• Perform at least 30 minutes of moderate intensity aerobic exercise on 5 days or more (total at least 150 minutes or 2.5 hrs/week)

Or alternatively if you are pressed for time

• Perform at least 20 minutes of high intensity aerobic exercise on 3 days or more (total at least 75 minutes or 1.25hrs/week).

1. Exercise sessions can be made up of short sessions at least 10 minutes in duration, or one continuous longer session.
2. Even if you are unable to meet these minimum requirements you will still benefit from some physical aerobic activity.
3. Regularly progress the quantity of aerobic fitness exercise you perform as your fitness improves over time.

3. Pelvic Floor Exercises to Maximise Pelvic Floor Support

What do pelvic floor exercises have to do with heart health if anything?

One of the keys to staying active with a prolapse is to ensure your pelvic floor support. If your pelvic floor is in good shape, then so too will be your ability to exercise for your heart health with regular aerobic fitness exercise. This is how regular daily pelvic floor exercises can help you exercise effectively and in so doing, indirectly help you to minimise your risk of heart disease.

In summary

If you are living with a pelvic prolapse or if you’ve had previous prolapse surgery, regular cardiovascular exercise that incorporates appropriate pelvic floor safe low impact exercises for your body can help you reduce your risk of heart disease. You can help yourself and other women in your life by recognising and being alert to the atypical symptoms of heart disease in women that currently go unrecognised.

About the author: Michelle Kenway is a Pelvic Floor Physiotherapist, author of Inside Out – the Pelvic Floor Safe Exercise Program for Women. Inside Out is your complete pelvic floor safe exercise weekly home workout program.

We welcome your comments about heart disease in women

¹ACSM Position Stand  Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise Garber, Carol Ewing Ph.D., FACSM, (Chair); Blissmer, Bryan Ph.D.; Deschenes, Michael R. PhD, FACSM; Franklin, Barry A. Ph.D., FACSM; Lamonte, Michael J. Ph.D., FACSM; Lee, I-Min M.D., Sc.D., FACSM; Nieman, David C. Ph.D., FACSM; Swain, David P. Ph.D., FACSM Medicine & Science in Sports & Exercise: July 2011 – Volume 43 – Issue 7 – pp 1334-1359

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

The post Heart Disease in Women and Prolapse – When Prolapse Becomes More Than a Pelvic Floor Problem appeared first on Pelvic Exercises.

Learn advanced pelvic floor strengthening positions and techniques, as well as how much Kegel exercise you need to do to strengthen and tone your pelvic floor in this online Kegel video.

Advanced Kegel Video Suitability

Advanced kegel exercises are best suited to women who can perform the correct basic kegel exercise technique and are seeking to progress their pelvic floor strength. Women starting out with Kegel exercises seeking a basic pelvic strengthening workout routine should refer to our Beginners Kegel Workout Video.

Kegel Video Content

1. Posture Set for Kegel Exercises

Set your upright posture for most effective strengthening by attending to your posture first and foremost. Start by lifting the crown of your head to the ceiling and ensuring that you maintain the small inward curve in your lower back throughout your exercises.

2. Advanced Kegel Exercise Technique

Basic Kegel exercises can be progressed by using the strongest possible voluntary effort with every kegel exercise you perform. It is vital to maintain the correct technique throughout and avoid bulging down rather than lifting and squeezing the muscles in and around all your pelvic openings.

Correct advanced Kegel technique involves:

• Breathing normally throughout your exercises
• Avoiding strong abdominal bracing
• Maintaining relaxed buttock and thigh muscles
• Maintaining the inward curve in your lower back throughout your exercises
• Completely relaxing your pelvic floor muscles after every effort
• Resting briefly to recover before your next kegel exercise
• 3-4 strong quick pelvic floor muscle contractions for maximal contraction and strengthening of your pelvic floor muscles.

3. Best Positions for Advanced Kegel Exercises

Advanced Kegels are best performed in upright positions. When the pelvic floor muscles are contracted in upright sitting and standing positions they are required to lift up against the downward load of the abdomen combine with the effect of gravity. This contrasts to pelvic floor exercises performed lying down where there is decreased load on the pelvic floor and gravity does not increase pelvic floor muscle loading. This is one reason why lying down may feel easier for some women when first starting out.

One major benefit of upright kegel exercise is that it trains the pelvic floor muscles to work in functional upright positions – these are the positions where most women need their pelvic floor to be functioning best. This is another reason why it can be important to progress Kegel exercises from lying down to upright positions when you feel confident in your correct exercise technique.

Advanced Kegel exercise positions include:

• Sitting (exercise ball or chair)
• Standing (feet together, feet apart, stride position).

4. Exercise Quantity for Advanced Strengthening

• Activate your pelvic floor muscles strongly for 3-10 second holds every contraction
• Repeat up to 8-12 repetitions of kegel exercises in a row for 1 set of exercise
• Add up to 4 quick strong contractions or pulses when your pelvic floor muscles are maximally contracted for four of these kegel exercises
• Repeat a total of 3 sets of 8-12 kegel exercises daily.

How to Kegel Video Series

The ‘How to Kegel’ video series is a free online Physiotherapist-guided pelvic floor training series designed to help you strengthen your pelvic floor at home. Women who have difficulty with their pelvic floor training can access assistance from Pelvic Floor Physiotherapists for exercise guidance.

• Episode 1: What is a Kegel?
• Episode 2: How to Feel Your Kegels
• Episode 3: How to Kegel with Correct Technique for Strength
• Episode 4: Beginner’s Kegel Workout
• Episode 5: Advanced Kegel Workout.

Michelle Kenway is a Pelvic Floor Physiotherapist, author of Inside Out – the Pelvic Floor Safe Exercise Program for Women. Inside Out  is your complete pelvic floor safe exercise weekly home workout program.

We welcome your comments about this Kegel video

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

The post Kegel Video – Advanced Kegel Exercise Workout for Women appeared first on Pelvic Exercises.

Kegel exercises for beginners workout video to exercise along with now shows you:

•  How to do a complete beginners Kegel strength workout at home
• 3  great lying down positions ideal for beginners Kegel exercises.

This Physical Therapist video is guided by Michelle Kenway, author of the acclaimed Inside Out pelvic floor safe exercise program for women, along with Dr Judith Goh Urogynaecologist.

The complete ‘How to Kegel’ video series of 5 episodes guides you through the process of learning how to kegel through to advanced workout at home:

• Episode 1: What is a Kegel?
• Episode 2: How to Feel Your Kegels
• Episode 3: How to Kegel with Correct Technique for Strength
• Episode 4: Beginner’s Kegel Workout
• Episode 5: Advanced Kegel Workout.

The Key Points for Kegel Exercises for Beginners

• Commence with gentle kegel exercises and focus on getting your technique correct.
• Use the correct kegel technique of lifting inside and squeezing in and around your 3 pelvic openings.
• Keep contracting your pelvic floor muscles for up to 10 seconds lifting and squeezing throughout.
• Relax your pelvic floor muscles back to their resting positions and rest sufficiently before your next attempt.
• When starting out lying down kegel exercises can help allow women to contract their pelvic floor muscles by eliminating the downward force of gravity.
• Kegel exercises should be progressed to upright positions when possible.

Kegel Exercise Beginners Positions

Michelle demonstrates three different lying down positions that may be used to for Kegel exercises. It is up to the individual to choose the position or positions that best suit them – there is no one correct position for doing kegel exercises.

Kegel Exercise Prone Position 1

Lying down prone is a helpful position for women seeking to improve their awareness of their pelvic floor muscles contracting around the urethra or urine tube.

Kegel Position:

If you choose this position, you may choose to use a pillow or cushion under your hips and pelvis is you have lower back pain or are prone to lower back problems. This will help you to avoid hyper extending your lower back and loading the joints in your lower back. If prone lying is not comfortable for your body, choose an alternative position such as side lying.

Kegel Action:

• Activate your pelvic floor muscles for 3-4 consecutive kegel exercises.
• Maintain your pelvic floor muscle contraction for up to 4 seconds for each contraction.
• Relax and allow your pelvic floor muscles to recover in between each repetition or exercise performed
• Next perform 4 consecutive brisk and fast kegel exercises in this position to complete your first set of exercises.

Kegel Exercise Prone Position 2

Kegel Position:

This position is only suitable for women without hip problems – if you have hip problems choose one of the other positions demonstrated in this video
Position your body in prone lying with one leg bent and out to the side of your body.

Kegel Action:

• Activate your pelvic floor muscles for 3-4 consecutive kegel exercises.
• Maintain your pelvic floor muscle contraction for up to 4 seconds for each contraction.
• Relax and allow your pelvic floor muscles to recover in between each repetition or exercise performed
• Next perform 4 fast and brisk onset kegel exercises in this position to complete your second set of exercises.

Kegel Exercise Prone Position 3

Kegel Position:

This is a kneeling position so it not suited to women with knee pain. Position your body on all fours resting your forehead onto your forearms. If your knees are sore or prone to discomfort choose an alternative lying down position.

Kegel Action:

• Activate your pelvic floor muscles for 3-4 consecutive kegel exercises.
• Maintain your pelvic floor muscle contraction for up to 4 seconds for each contraction.
• Relax and allow your pelvic floor muscles to recover in between each repetition.
• Finally perform 4 consecutive brisk kegel exercises in this position to complete your final set of Kegels.

If you’ve worked through all 3 sets of exercises your beginner’s kegel workout is complete for today – well done! You can do this entire workout all at once or alternatively if you choose to, you can perform the 3 different positions on 3 separate occasions throughout the day. Remember that these positions can be varied with side lying or lying on your back according to your own physical comfort and the positions in which you best feel and perform your Kegel exercises.

Michelle Kenway is a Pelvic Floor Physiotherapist, author of Inside Out – the Pelvic Floor Safe Exercise Program for Women. Inside Out is your complete pelvic floor safe exercise weekly home workout program.

We welcome your comments about Kegel Exercises for Beginners below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

The post Kegel Exercises for Beginners Workout Video appeared first on Pelvic Exercises.

This Kegel exercise video teaches you:

• How to Kegel with correct technique in upright sitting; and
• How many Kegel exercises you need to do to strengthen your pelvic floor muscles.

Video duration: 5 minutes

Benefits of Kegel Exercises

Knowing these exercise guidelines can help women improve:

• Prolapse symptoms
• Bladder control problems (bladder incontinence)
• Bowel control problems (faecal incontinence)
• Sexual sensation and response problems.

Why do Kegel Exercises in Upright Positions?

It is important to progress your Kegel exercises from lying down positions into upright when you feel confident in your technique. When your body is upright, your pelvic floor muscles are required to support the weight of your abdomen and lift up against the added downward force of gravity. The additional load upon your pelvic floor when you are upright means that upright positions can help you to increase the strength of your pelvic floor muscles.

Your pelvic floor muscles will strengthen and work best for you in those specific positions you train your muscles in. If you do all your Kegels lying down, then your pelvic floor will become stronger when activated lying down. Most of us need our pelvic floor muscles to work well for us in upright sitting and standing, so it makes good sense to practice Kegels in these upright positions.

How to do Seated Kegel Exercises

Kegel exercises in upright positions involve the same basic underlying principles as lying down:

A. Correct Your Posture

Correct posture for Kegel exercises involves finding your neutral spine posture and maintaining it throughout your exercises.

• Sit with your body weight evenly distributed between your sit bones
• Lengthen your spine so that you sit tall (lift the crown of your head to the ceiling)
• Bring your shoulder blades back and slightly down and lift your chest
• Maintain the small inward curve in your lower back throughout your Kegel exercises

B. Contract Your Pelvic Floor Muscles

Contract your pelvic floor muscles by lifting and squeezing in and around all three pelvic openings together. Continue to lift and squeeze your pelvic floor muscles for 3-10 seconds breathing normally throughout.

C. Relax Your Pelvic Floor Muscles

Relax your pelvic floor muscles back to their normal resting position. Rest sufficiently to allow your pelvic floor muscles to recover before your next attempt.

Guidelines for Kegel Exercises to Strengthen Your Pelvic Floor

To strengthen your pelvic floor muscles with Kegel exercises:

• Ideally try to do your Kegel exercises every day
• Maintain each exercise for up to 10 seconds
• Relax your pelvic floor muscles and rest for 15-45 seconds before your next attempt
• Repeat up to 8-12 Kegel exercises in a row
• Aim to complete your exercises 3 times a day
• When you are confident in your correct Kegel exercise technique, contract your pelvic floor muscles with your strongest possible effort
• Progress your Kegels from lying down into upright sitting and standing.

When Will Kegel Exercises Make a Difference?

Some women notice that their pelvic floor condition improves within a couple of weeks of starting their exercises. Studies have shown that for weak pelvic floor muscles it can take up to 5-6 months of effective Kegel exercises to fully strengthen pelvic floor muscles.

• Episode 1: What is a Kegel?
• Episode 2: How to Feel Your Kegels
• Episode 3: How to Kegel with Correct Technique for Strength
• Episode 4: Beginner’s Kegel Workout
• Episode 5: Advanced Kegel Workout.

Kegel Exercises in Sitting video is presented by Pelvic Floor Physiotherapist Michelle Kenway. Michelle is the author and presenter of the Inside Out pelvic floor safe exercise program for women.

We welcome your comments about Kegel Exercises video

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

The post Kegel Exercises Guidelines for Strengthening Your Pelvic Floor Video appeared first on Pelvic Exercises.

How to Kegel Video Series Episode 2

If you can’t feel your Kegels you’re not alone. One of the most common problems women face when learning how to kegel is feeling their Kegels and using the correct technique.

Learn how to Kegel with Pelvic Floor Physical Therapist guidance. Michelle Kenway is the author of Inside Out – the essential women’s guide to pelvic support with Dr Judith Goh Urogynaecologist.

Kegel Video duration: 5 mins

What Causes Difficulty Feeling Kegel Exercises?

There are many reasons why women may have difficulty feeling their Kegel exercises including:

• Weak pelvic floor muscles
• Overactive (too tight) pelvic floor muscles
• Previous injury and damage to the pelvic floor nerves and muscles (pregnancy /childbirth/ pelvic floor surgery)
• Wasting or thinning of the pelvic floor muscles with increasing age
• Lack of previous Kegel Exercise
• Lack of correct instruction about correct technique
• Our pelvic floor muscles are hidden from our own view
• We don’t often learn to consciously contract our pelvic floor muscles in every day life without reason to do so.

Typical Mistakes Learning How to Kegel

There are a number of mistakes that are frequently made when learning how to kegel. Instead of using the correct technique of lifting and squeezing in and around the three pelvic openings, common mistakes include:

• Squeezing the buttocks and inside thighs
• Drawing in abdominal muscles
• Breath holding
• Straining and pushing the pelvic floor downwards.

How Pelvic Floor Physiotherapists Check Kegel Exercise Technique

Pelvic Floor Physiotherapists may use a range of different techniques to check for correct exercise technique. These techniques can include:

• Watching the movement of the three pelvic openings during pelvic floor exercise
• Internal self examination to feel pelvic floor muscles moving (this is the most commonly performed method)
• Ultrasound to view the pelvic floor muscles moving
• EMG (electromyographic) measurement of muscle activity.

Techniques to Help Feel Your Kegels

There are some techniques most women can try at home to help them find their pelvic floor muscles and check correct kegel exercise activation technique. These techniques include:

• Stopping or slowing the flow of urine using an inwards lift and squeeze of the pelvic floor muscles (this technique is best used only as a test, no more than once a week and only if you don’t have problems emptying your bladder)
• Contracting the muscles in and around the anus as if trying to avoid passing gas (wind)
• Sitting on a rolled hand towel and feeling the movement of the pelvic floor muscles lifting and lowering when activated
• Sitting on an exercise ball and leaning slightly forwards to feel an inward squeezing movement around the pelvic openings with Kegel exercise
• Touch the perineum (the skin between the anus and vagina) with a clean finger and notice your finger lift slightly inwards as you activate your pelvic floor. This technique can help you to feel whether your pelvic floor is bulging outwards with your effort.
• Feeling a couple of centimetres (half inch) inside the vagina to touch the back wall (closest to the rectum) lift and move slightly forwards with correct activation.

Techniques to Help Pelvic Floor Relaxation

Knowing how to kegel exercise involves knowing how to contract and then relax the pelvic floor muscles. Some women find it difficult to relax or feel their pelvic floor muscles relaxing having once contracted.

For some women relaxing the pelvic floor muscles feels like a lowering down and letting go sensation in and around the pelvic openings. If you can’t feel your pelvic floor muscles relaxing they may have already relaxed or alternatively they may still be contracted.

You may be able to encourage your pelvic floor muscles to relax between exercises by:

• Taking a couple of deep breaths
• Gently bulging your lower abdomen forwards.

For comprehensive details on pelvic floor relaxation please refer to this pelvic floor muscle tension article.

• Episode 1: What is a Kegel?
• Episode 2: How to Feel Your Kegels
• Episode 3: How to Kegel with Correct Technique for Strength
• Episode 4: Beginner’s Kegel Workout
• Episode 5: Advanced Kegel Workout.

How to Kegel Exercises for Women video series is presented by Pelvic Floor Physiotherapist Michelle Kenway. Michelle is the author and presenter of the Inside Out pelvic floor safe exercise program for women.

We welcome your comments about How to Kegel Exercises for Women Video

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

The post How to Feel Your Kegels – How to Kegel Exercises for Women Video Series appeared first on Pelvic Exercises.

Pessaries For Prolapse Management – A Non-Surgical Alternative For Some Women

If you have been diagnosed with a pelvic prolapse, and you are seeking to avoid surgery a support pessary may a management alternative you haven’t considered or don’t know about.

Pessaries are nothing new – they have been used for centuries by women seeking to manage their prolapse problems. The hand carved antique bone pessary (shown right) dates back to the 1860′s and is not too different to the modern day pessaries available today.

Pessaries are a safe, inexpensive and effective option for prolapse management for many women. Unfortunately many women don’t know about how a pessary may help them better manage their prolapse symptoms and in some cases avoid prolapse surgery.

Read on now to learn more about pessaries for prolapse support with:

• What is a pessary?
• Why use a pessary?
• How does a pessary work?
• Potential benefits of using a pessary
• How does a pessary feel?
• How is a pessary fitted?
• Vaginal oestrogen and pessary use
• When is a pessary not suitable?
• When is a pessary less effective?
• Side effects of pessaries
• Sex and pessary

What Is A Pessary?

A pessary for prolapse is a support device that is inserted to sit high within the vagina. Pessaries are designed to support the collapsed walls of the vagina, and the prolapsed organs (bladder, bowel and/or uterine prolapse). Modern day pessaries come in a wide range of shapes, sizes and different designs (shown right).

A support pessary is quite different from a pessary or tablet/capsule that is inserted into the vagina to delivery medication to the pelvic floor (e.g. vaginal oestrogen pessary).

Pessaries have been used by women for centuries manage pelvic organ prolapse. Reports of pessary use date back to ancient Egypt. Over the ages women have used a variety of materials for pessary support including fruit (pomegranates), stones, soaked cloth, cork,  brass and rubber. Today most pessaries are made from medical grade silicone or plastic which are readily cleaned, and non absorbent.

Why Use A Pessary?

Women may choose to consider using a pessary to support their prolapse for a number of reasons including:

• A desire to avoid or delay prolapse surgery
• Early stage prolapse
• Desire for future pregnancy
• During pregnancy or following childbirth
• When unsuitable for pelvic prolapse surgery
• Previous failed prolapse surgery
• To manage stress incontinence and prolapse
• To support exercise or activity with a prolapse
• During pelvic floor muscle rehabilitation for prolapse
• With advanced age.

It may well be that by pessary devices can help women with pelvic floor exercises by lifting and supporting prolapsed tissues – this has not yet been confirmed (but is currently being investigated) by studies but this is a plausible theory.

It is a little surprising that more pessaries are not fitted to help women to exercise and stay active when living with prolapse and trying to avoid worsening prolapse and prolapse symptoms. Overweight women struggling to improve their pelvic floor strength and prolapse support are another group who might benefit from the added support of a pessary. This might be worth discussing with your medical specialist as a possible management option if this applies to you.

How Does A Pessary Work? 

A pessary provides a mechanical or physical support to hold up the prolapsed tissues within the vagina. It does this by occupying space high within the vagina. This can have the effect of lifting the walls of the vagina higher within the pelvis, and providing a support for the bladder, bowel or uterus. The image (right) shows a fitted white ring pessary sitting at the top of the vagina.

Pessaries are designed in a variety of shape and sizes, and for different types and severity of prolapse. Some of the small flexible ring pessary designs can inserted on a daily basis or as required to support during exercise or activity. The less flexible space occupying pessaries are mostly designed to stay within the vagina for a designated period of time, before being changed over by the medical specialist.

Potential Benefits Of Using A Pessary

There are a number of potential benefits that may be derived from pessary use. These potential benefits need to be weighed up against any possible side effects or risks, and in conjunction with the expert opinion of your medical specialist regarding your individual suitability.

Potential benefits of using a pessary for prolapse management may include:

• Decreased prolapse symptoms
• Delay or avoid pelvic prolapse surgery
• Possible prevention of prolapse worsening
• Allow for exercise with prolapse
• Possible aid or adjunct to pelvic floor muscle rehabilitation.

How Does A Pessary Feel?

When the pessary is well fitted, the wearer is usually unaware of its presence. Discomfort wearing a pessary can be a sign that the pessary is not the right size or that it may have slipped out of position. If you feel discomfort when wearing a pessary you should consult your treating doctor.

How Is A Pessary Fitted?

A pessary device is usually fitted by a gynaecologist or obstetrician. Your medical specialist will take some internal measurements of your vagina based upon an internal vaginal examination and will consider the nature and severity of your prolapse, whether you seek to be sexually active with the pessary fitted along with these measurements to fit the correct pessary for you. He or she will usually fit the largest size pessary possible that feels comfortable when fitted.

Successful fitting is usually indicated when the pessary:

• Stays in place with walking, coughing and bending
• Feels comfortable and pain free
• Does not interfere with bladder or bowel emptying
• Does not cause unwanted bladder leakage.

Sometimes it takes a couple of attempts with different styles or sizes of pessary to get the correct fit. It should be possible to fit a finger around the outside of a well fitted pessary. It is useful to know that you can empty your bladder normally with the pessary in place comfortably before leaving your pessary fitting so that it can be changed if necessary.

Some of the flexible pessary designs allow women to use and remove themselves as desired. Other pessaries are designed to stay in place once fitted for a specified time before being changed by the specialist. This may be something you wish to discuss with your specialist before fitting.

A woman needs to be willing to have regular medical follow-up, have intact cognition and adequate manual dexterity to be considered appropriate for fitting with a pessary.

Vaginal Oestrogen and Pessary Use

Vaginal oestrogen is commonly prescribed before or at the time of pessary fitting. Vaginal oestrogen is often prescribed for pessary use to improve the thickness and condition of vaginal tissues for prevention of infection or tissue erosion. This is a consideration for women with previous breast cancer, where consultation with their treating breast specialist is warranted for assessment regarding their individual suitability for vaginal oestrogen.

When Is A Pessary Not Suitable?

A pessary is not appropriate for women with:

• Active vaginal infection
• Pelvic Inflammatory Disease
• Ulceration of vaginal walls
• Vaginal bleeding where the cause is unknown
• Allergy to silicone and latex
• Poor compliance with ongoing medical supervision and follow-up.

When Is A Pessary Less Effective?

It is quite common to require a number of pessary fittings to achieve the correct size and design. There are a number of recognised predictors of poor success when fitting a pessary. Poor predictors of success¹ may include:

• Shortened vaginal length
• Wide vaginal opening
• Past pelvic surgery (including hysterectomy).

Side Effects Of Pessaries

Pessary devices are generally considered to be a safe prolapse management option for women with few complications². Possible complications or side effects can usually be avoided with ongoing medical monitoring have once been correctly fitted.

Some of the more commonly reported side effects of pessary devices include:

• Vaginal bleeding , constipation²
• Mild vaginal discharge, increased odour¹

There have been some reported rare serious complications associated with pessary use, usually with devices that have not received regular ongoing medical supervision having once been fitted¹.

Sex And Pessary

Your doctor will take into account your preference for sexual activity when fitting you with an appropriate pessary for your lifestyle. Sexual intercourse can proceed with certain styles of support pessary not needing to be removed (e.g. ring, gehrung). Some of the space occupying pessary designs do need to be removed before intercourse (e.g. cube). Some pessaries, particularly those used for more severe prolapse cannot be removed by the user (e.g. gellhorn shown above right) and are therefore unsuitable for women seeking to remain sexually active with a pessary fitted.

Pessary Summary

A support pessary can provide a simple and effective prolapse management strategy, and may be particularly for women seeking to avoid or delay prolapse surgery and minimise prolapse symptoms. Pessaries are not for everyone with a prolapse – some women choose to wear a pessary as an interim prolapse management measure while others find that a pessary helps them to manage symptoms as an alternative to prolapse surgery. The decision about whether or not to wear a pessary ultimately rests with you and your Obstetrician or Gynaecologist.

We welcome your comments about pessaries below

¹ Shah et al (2006) The history and evolution of pessaries for pelvic organ prolapse. International Urogynecology Journal of Pelvic Floor Dysfunction. Feb;17(2):170-5.

²  Guidelines for the Use of Support Pessaries in the Management of Pelvic Organ Prolapse. Continence Foundation of Australia and International Centre for Allied Health Evidence, 18th July 2012.

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

The post How Pessaries Can Help Prolapse Symptoms And Support appeared first on Pelvic Exercises.