In the August issue of the West Cork People I wrote an article on the importance of having a healthy pelvic floor and how pelvic floor dysfunction can impact quality of life for both men and women. At the time of writing I had a feeling I wasn’t quite done with the topic so here comes round two. This time I’d specifically like to address the importance of a healthy pelvic floor for our young women and particularly those involved in sport.
We tend to associate pelvic floor issues with post-partum and post-menopausal women for obvious reasons but a recent study carried out by Dublin City University (published in Science and Medicine in Football) on young women involved in camogie and Gaelic football revealed that 37 per cent experienced urinary leakage during training and play. Urinary leakage comes about due to stress incontinence while 47.8pc experience urge incontinence or the urge to pass urine, during training or matches. And genital pain, another consequence of pelvic floor dysfunction was reported by 43.4pc of respondents. What was so surprising about this data was just how prevalent this issue is, with just under half of young female athletes suffering with pelvic floor issues while training and participating in sports. These statistics raise a number of questions. Was the issue always there, but no-one ever thought to ask before? Is it down to the increasing intensity of impact in our sports and our sports training for both young women and young men? Or is it down to increasing stress levels for young athletes, as anxiety and stress can lead to tight and weak pelvic floors. Most likely all of the above are true to some extent.
What matters however, is not so much why this issue is arising, though it makes for interesting contemplation, but how can we take remedial action so young women do not have to suffer in silence with this issue. Early intervention is essential, as ignoring the issue does not make it go away and it can lead to chronic pelvic floor dysfunction down the line, which has real implications for female health over a woman’s lifespan. Intervention and education can be a literal game-changer for young women who experience pelvic floor dysfunction, empowering them to continue to play and thrive at their sport.
In this short article I want to write about a remedial strategy that can be undertaken immediately if this issue applies to you.
Pelvic Floor Muscle training (PFMT)
This technique has proven to be extremely effective in correcting pelvic floor dysfunction in young women. I appreciate that the following instructions may be a little technical, but for coaches and trainers or even those affected directly by this issue these following techniques work and are worth learning and disseminating.
We always need to start by tuning into our breath.
Building co-ordination with breath
You can sit or lie down and place one hand on your abdomen and one hand on your rib cage (if you are sitting make sure you have your ribs stacked over your hips and you are not slumped).As you inhale, breathe into your hands and think about filling your belly and pelvic floor with air.
Notice your hands descending as you exhale, noticing your rib cage and abdomen deflating, and imagine the pelvic floor deflating and passively lifting upward. Once you become aware of this coordination of the breath and the pelvic floor movement you can start to add in a gentle pelvic floor contraction.
Next begin to add a gentle pelvic floor contraction…as you inhale, feel your rib cage and belly expand and allow that expansion to fill your pelvic bowl and expand your pelvic floor, filling out gently. Now as you exhale feel your belly deflate and your rib cage drop and sense your pelvic floor lifting up internally. Focus on lifting up the muscles of the vagina and anus, this is the sensed experience of engaging the pelvic floor. The practice of consciously co-ordinating the pelvic floor with the breath is vital, as many of us have a breathing pattern that is out of sync with our pelvic floor (and diaphragm) movement and this helps to reset and relax us into a natural, healthy rhythm. Remember tension and stress can have an adverse effect on the adequate functioning of the pelvic floor so learning to breathe consciously here is of healing benefit.
Building endurance
Once you have a handle on the first practice you want to build in some endurance and strength exercises. These can help build the pelvic floor’s ability to maintain continence and support the pelvic organs, while also enhancing the mind-muscle connection.
These contractions take about two to three minutes to do. And for the coaches of teams or for the individual themselves you can add them to a warm-up, or do them on your own whenever you have a few minutes to practice.
To do an endurance contraction, sit or lie down and draw the pelvic floor in and up, you should feel a contraction or tightening in the pelvic floor and a bit of tightening in the lower abdomen which is the co-contraction of the transversus abdominus.
Stay as relaxed as possible, not holding the breath, tensing the shoulders or squeezing the buttock muscles and hold the pelvic floor contraction for six to eight seconds. Then relax. If this is too hard to maintain then try contracting the pelvic floor muscles a little more lightly. The important thing is to build up endurance and hold the felt sensation of the contraction for the length of time required. You should aim for eight to 12 repetitions and do two to three sets. Practice this two to three times a week.
Building strength
Once you get the hang of the endurance contractions you should have a real awareness of how to engage your pelvic floor with correct breathing pattern and can start to add it to your existing exercise routine. I would pick one exercise. For example, say you have a conditioning programme in the gym and you want to add pelvic floor training as a component to your weights session. Choose one exercise where you can practice pelvic floor contractions. Make sure the exercise is not too forceful or complex, a simple movement is best, such as an overhead press. What you would do here is consciously exhale and contract the pelvic floor simultaneously for the duration of the exertion, as you press the weight up (the hardest part of the exercise). Consciously inhale and lower the pelvic floor as you inhale to return the weight to the start. Repeat for one set of 10 or 12 repetitions.
Pick just one exercise in your programme to work your pelvic floor; you don’t want to overly fatigue the muscle, as this will be counterproductive. You can of course vary which exercise you pick from session to session, which will be good for overall training results. Varying the exercises and the load placed on the pelvic floor will help carry the strength over into functional movements on the field or in competition as well as in daily life.
