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Flat abs… flawed ‘floor’?

Women get told to do to their pelvic floor exercises. Now they are told some gym exercises can undo the good work and even flaw the 'floor'. Fiona Cassie finds out more about the Pelvic Floor First campaign.

Sit-ups can make you feel virtuous. They can also make some women incontinent.

It is new to many of us that some exercise routines can worsen the pelvic floor dysfunction of at-risk women, and in some cases actually cause it. But it is not new to women's health physiotherapists like

Lisa Yates who have been concerned for some time.

Yates has been a driving force behind the Pelvic Floor First campaign, launched in New Zealand last month by the New Zealand Continence Association. The campaign, initiated in Australia in late 2009, includes brochures for consumers and fitness professionals to promote exercise that is safe for the pelvic floor. It is also offering workshops to educate midwives, personal trainers and gym instructors about pelvic floor dysfunction, recognising risk factors, how to confidently teach pelvic floor exercises and which exercises are "pelvic floor safe".

Yates, who is a mother of two and personal trainer herself, says the message is definitely not to frighten women or stop them exercising. "It's that one size doesn't fit all when it comes to exercise." She says the concern has arisen following the obsession in recent years with deep core and abdomen exercises and particularly with having a flat stomach.

"A lot of women are doing a lot of exercises that are inappropriate if they've got a weak pelvic floor."
Australian-trained Yates says the best example is a sit-up. "When you do a sit-up, there's increased pressure within the abdomen and that's putting pressure downwards on the pelvic floor which can weaken it and potentially cause problems to start. As women's health physios, we treat people with pelvic floor problems like prolapse and stress incontinence and we were seeing that frequently people were doing sit-ups and difficult abdominal exercises that weren't appropriate for them."

Yates says surveys of fitness professionals in Australia showed most had very little knowledge of female anatomy and the pelvic floor or knew how prevalent pelvic floor problems were. (She says one in two women will end up with a prolapse of some degree during their lifetime and one in three will have urinary incontinence.)

But most fitness professionals were keen to have a screening tool to help highlight clients at risk and indicate when to refer on to a health professional. Signs that can indicate a pelvic floor problem include accidentally leaking when you exercise, laugh or cough, or needing to go to the toilet and not making it in time.

Yates says 70 to 80 per cent of stress incontinence can be cured using pelvic floor training, led by a trained professional like a physiotherapist or nurse specialising in women's health or continence.

But better still is to avoid worsening or causing pelvic floor dysfunction, by exercising safely. "A lot of exercise classes in mainstream gyms aren't designed for women with pelvic floor issues. Doing things like boot camp regimes and lifting huge weights when they are more at risk of pelvic floor problems. Women are trying to get really slim and they push themselves really hard and eventually end up with lots of problems."

Repetitive high impact exercise can cause pelvic floor dysfunction damage for elite athletes like gymnasts, trampolinists and runners. But the aim is not to put people off exercise. "It's about being aware of your body, the ways you can exercise and how it impacts on your body, rather than frightening people."

For more information on the Pelvic Floor First campaign, go to www.pelvicfloorfirst.org.au.

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