Last weekend I participated in a two-day instructor training on Pelvic Floor Pilates, also known as PFilates (pronounced “Fuh-LAH-tees”). It was led by urogynecologist and PFilates creator Dr. Bruce Crawford from Nevada, and Allison Kares, exercise therapist from Niagara. It was mostly attended by physiotherapists, so I got a great immersion into functional mobility and anatomy as well.
I learned so much about the pelvic floor - that seldom talked about area between your tail bone at the back, sitz bones to the side, and pubic bone to the front. One of the best ways to break the stigma of pelvic floor disorders is to speak candidly about them, which I will do here. (If you get squeamish with this type of stuff, this is your warning!)
Pelvic floor disorders are surprisingly common, and include things such as stress incontinence (peeing a bit when you cough, sneeze, laugh, or exercise), overactive bladder (having a frequent urge to pee or having to get up to pee at night), prolapse (when the organs of the pelvic floor, such as the bladder, uterus, and bowel, begin to fall out of place), and bowel incontinence (having a hard time controlling when you pass gas or have a bowel movement). They are usually caused by childbirth, aging or obesity, and can occur in both women and men.
Some surprising stats about the frequency of pelvic floor disorders:
- 1 out of every 5 North Americans (of every age) suffer from some type of pelvic floor dysfunction at some time in their life.
- 33% of women experience problems with bladder control.
- Approximately 40% of female elite athletes suffer from stress urinary incontinence.
- 40% of women between the ages of 45 - 85 will have at least moderate prolapse.
- Vaginal childbirth is associated with almost a 1 in 3 chance of developing bladder incontinence and a 1 in 20 chance of developing an inability to control bowel movements.
- 16% of men have overactive bladder, and 5 to 15% erectile dysfunction.
The effects of these and other pelvic floor disorders can be quite severe. When compared to other common chronic medical conditions, Overactive Bladder Syndrome was second only to major depression in terms of impact on quality of life – many people just stop leaving their house for fear of an accident. Loss of bowel and bladder control is the number one reason that people end up in nursing homes.
We heard about people who had virtually stopped laughing for fear of peeing.
We saw very disturbing images of what can happen “down there” if you let a prolapse go untreated for too long.
We learned about young girls from Africa who are shunned from their village after developing a pelvic floor disorder following childbirth.
It was an eye opening experience to say the least.
In France, the government offers every woman who has had a baby some form of pelvic floor physical rehabilitation. In North America, we just don’t talk about it. For most of us, we often don’t realize that we have a condition in the first place, we accept the condition as normal and just live with it, or we turn to surgery to correct the problem once it has gotten so severe. Surgery comes with risks and potential complications, and is not a cure. In fact, 25 to 40% of all prolapse repairs will recur within 5 years of the initial surgery. If you don’t strengthen your pelvic floor through rehabilitation, you can prolapse again.
And now that I’ve completely freaked you out - here’s the good news: most pelvic floor disorders can be corrected or prevented through specific exercises!
As for myself - I have always had what’s I’ve called a “weak bladder”, and would get up often throughout the night to pee. After I had my son, my bladder became so “weak” that I was no longer able to go for a run further than just around the block. Every cough, sneeze or laugh meant that I might pee a little. I had been “doing my kegels” and am in decent shape, so it never occurred to me that this was a pelvic floor disorder, that it wasn’t normal, and that there was an easy fix for this condition.
Typically, kegels are prescribed to strengthen the pelvic floor. Now imagine for a moment, that to strengthen your quadriceps, you were asked to sit in a chair and contract and release those thigh muscles over and over again. How effective would that be? The same goes for the pelvic floor. We can strengthen it way more effectively with functional movements – moving the muscle in the way it was designed to be moved.
And this is where PFilates comes in. In 2008, Dr. Crawford studied 120 moves from Pilates, yoga and personal trainers’ routines by hooking up volunteers to an electromyography machine. He identified 10 moves that best engaged the pelvic floor and the transverse abdominals, gluteals and thigh adductors which work with the pelvic floor muscles. Using these moves, he developed the PFilates program. It combines voluntary contraction and training of both slow twitch and fast twitch muscles. (As a sidenote, the moves are a lot harder than they look! I was surprised at how much I "felt" these fairly simple movements the next day).
At our training, we got to watch the effectiveness of the PFilates movements firsthand, compared to traditional kegels. Using the Dr. Crawford's Video-EMG Synchronization (VESy) lab, two students were hooked up with electrodes and their muscle responses were recorded in real-time. It was pretty cool to watch!
The results from the program speak for themselves - 80% of patients who were thinking of going through with pelvic floor surgery, no longer needed it after starting PFilates. (As a sidenote, the success rate with surgery is 85% - only 5% higher but with all of the added risks that surgery adds).
As an added bonus, the exercises also help tone the thighs, abdomen, and butt, and improve core strength.
If you’ve given birth, they recommend starting a program of pelvic floor rehabilitation as soon as practically possible – the first 6 months post-partum are especially important while nerve regeneration is taking place. If you are pregnant, learning PFilates in your 2nd or 3rd trimester optimizes your chances of success following the birth.
The take home message – just because you can’t see them, you do NOT want to neglect those pelvic floor muscles! And if you have pelvic floor dysfunction, know that you are not alone and there ARE options available.
UPDATE - MAY 6TH: It's only been 2.5 weeks since I was first trained in this form of pelvic floor strengthening and I can already feel a huge difference. I can run again with absolutely no need for bathroom breaks! I didn't think I could feel the effects this quickly. I'm not saying that everyone will have results this quickly, but I just wanted to share my personal experience.
Interested in trying it out yourself? I offer workshops where you can learn all the moves! Learn more about the workshops here.