High drama in this season’s ‘Biggest Loser’ reality weight loss show recently when 41 year old Anita, was rushed to hospital with a mystery abdominal injury she sustained doing deep wide leg squats thrusting a 5kg weight from ground level up over her head.
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:
- 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)
- 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.
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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.