Distinguished Chartered Physiotherapist Aoife Ni Eochaidh has been leading the campaign to increase awareness of the impact of the menopause for some time. In the week of World Menopause Day, she told the Advertiser of her delight that at last, the topic is losing its taboo-ness and that discussions about the menopause are now entering general discourse.
She told me that helping women understand menopause is one of Diageo’s 2030 social sustainability goals and that moves like this makes discussion a lot easier.
“This tackling of the topic makes it easier but they need to be out in the open and make it easier for people to come forward.
“Often we treat discussion of the menopause in clinical speak and we don’t put it in plain ERnglish enough so that it is understood. It needs to be communicated clearly. Employers and women, partners of women and their children should be aware of what they may or may not be going through.
“While she has hailed the impact of HRT to treat menopause impacts, Aoife’s expertise focuses on the physical aspect and in particular the pelvic floor. What about your pelvic floor and the menopause? What problems can arise that maybe HRT can’t resolve?
Pelvic floor muscles
“There are hormonal changes around menopause that affect the muscle function. Though HRT will work on those hormonal changes it won’t train the muscles. Menopause fatigue and sleep disturbance can also affect the muscle function. The bladder and bowel muscles themselves can be affected with the hormonal changes too.
“Sexual function can be affected too with the hormonal changes. Keeping your pelvic floor muscle function in the normal range of function is so important before, during and after menopause and it will prevent and treat these bladder, bowel, pelvic and sexual problems, along with HRT if your doctor prescribes it and if you can take it and it suits you.
So where are the Pelvic Floor Muscles?
“Firstly, think of the area of your body between your waist and the top of your legs. This is where your pelvis is located, think of it as a basin shaped region. Your tummy area is where your core muscles are located. The pelvic floor muscles form the base of the pelvic basin and are really the underneath part of your core. The pelvic floor muscles hold up or supports your organs correctly in the pelvic cavity. These organs are your bladder and your bowel and in ladies your vaginal walls and your womb too,” she added.
“The pelvic floor muscles have four main parts to normal function:
“Bulk: The muscle bulk (or muscle thickness need to be right, it should be like the fleshy part of your hand between your thumb and your wrist ).
“Fitness or Endurance: The fitness or endurance needs to be right (this is do with the number of times you can repeat a muscle contraction or a squeeze ).
“Strength: The strength of the muscle (how strong your squeeze or muscle contraction is ).
“Movement: Most importantly there is an automatic movement forward and upwards internally in the pelvis when the muscles are working correctly. This movement lifts your bladder and your bowel to the right angel to make sure it fills, stores, and empties correctly, it also is important that the muscle movement lets go or relaxes correctly too.
“The posterior part or the back section of the pelvic floor muscles is really important in this movement component. We know this from new evidence and studies from ultrasound and MRI images.
“These four elements of normal function are needed for automatic muscle action between the bladder and bowel and for support of our organs and for sexual function. When the pelvic floor muscle function is not in the normal range we have symptoms of bladder leaks, or bladder urgency and frequency or we can’t empty the bladder right, or we are up lots of btimes at night. We can have these same problems with the bowel too with wind or gas leaks and urgency to empty the bowel, going often and not being able to fully empty the bowel too,” says Aoife..
How important are they?
“The pelvic floor muscles are among some of the most important muscles in the body because they are responsible for the normal filling, storing, and emptying of our bladder and our bowels. The are important too for normal sexual function (to be able to orgasm or climax correctly ) and to hold our pelvic organs in place correctly and to guard as pelvic organ prolapse, the organs coming down (the bladder, bowel, and womb in women ).
“If the pelvic floor muscles are not in the normal range of function, then our bladder and our bowel may not fill, store and emptying urine (our wee ) and stool (our poo ) correctly. If we are not eliminating our waste material (wee and poo ) correctly we can become unwell, with urinary tract infection or obstructed bowel or constipation.
“If our bladders and our bowels are not working correctly or if we have prolapse, or sexual dysfunction our quality of life is affected. We can’t live our lives, go to work travel or exercise without worries about bladder or bowel leaks or we worry if we night need the bathroom urgently to empty our bladder or bowel. We won’t feel well if we can’t empty or bowels or our bladders and we might not sleep well either and our energy levels will be poor, and we will feel anxious.
How do we exercise the pelvic floor muscles?
“We need to train our muscles to be in the normal range or function. This involves a series of exercises. In my clinic and with my on-line patients using my on-line pelvic training videos and e-booklets I give about 12 different exercises and training routines. It can take 3-to-6-month period of time to get the bulk, endurance, fitness, movement, and automatic function working in the normal range.
“The bladder and the bowel muscle themselves need to be trained too with lifestyle changes and some other exercises. I also train the abdominal and back muscles and arm muscles and I take bone density into account too as bone changes (osteopenia and osteoporosis ) and pelvic floor muscle dysfunction are unfortunately as linked too.
“The exercises need to be targeted to the different muscle fibres, and you need to progress them and keep doing them for life (at a maintenance dose but much more frequently in the beginning ). It is not a quick fix, but it works, and it is so worth it! It is so much easier when the muscle is in the normal range to maintain then, it is harder for sure in the beginning, but it is possible!
So where should you begin?
“A good starting exercise is the Knack Exercise. In beginning to train the muscles, it’s a good idea to start with the back passage part of the muscles, this will also train the front section of the muscles as they are connected. Don’t worry if you hold your breath of you tighten the tummy or buttock muscles too.
“To do the Knack exercise tighten the muscles of the back passage as if you are trying to hold in wind (imagine that you are in a lift or at a party and that you don’t want to pass wind ) don’t worry if you hold your breath of tighten your tummy or your buttocks. Do this before and while lifting anything heavier than a jug kettle of water and before and while coughing and sneezing.
“Aim for about 10 per day. If you are lifting groceries from the boot of the car into the kitchen, squeeze the back passage muscles as if you are trying to hold in wind or gas before you lift the item and try to keep the squeeze on until you put the item down. It can be difficult to hold on the squeeze in the beginning but give it a go. This is a good first step, it is training an automatic pelvic floor bracing reflex, it’s good to guard against prolapse.
“The low grade knack is a follow on exercise, it can be done in walking and standing, to do it, you try to squeeze or tighten the back passage muscle by about 30% of what you could do, hold the squeeze for 10 sec, relax or fully let it go for 10 sec, do for 3 mins at a time (on, off, on off until you do 3 ins worth ), 6 times a day, a half hour or more, apart. Please the video and booklet for the Low-grade Knack exercise.
What age should we be starting pelvic floor exercises? Is it ever too late and should it be done before or during Menopause?
The largest group of people that we see with pelvic floor muscle weakness and bladder leakage is mothers in their 20’s, 30’s, 40’s, 50’s 60’s and 70’s. Before or during Menopause a great time to start training your pelvic floor muscles, but you will need to do it sooner if you have any bladder or bowel problems.
How long can it take to see the benefits?
In 1 week, you will see improvements, but it can take 3 -6 months to fully train the pelvic floor muscles and then you need to keep up a maintenance amount up for life.
What issues can it pose for Menopausal Women and Sex?
Pelvic Floor Muscle Dysfunction can affect menopausal women from a pain, a climax and arousal side of things.
And many people might think it’s just women that have a pelvic floor but there are many benefits for men too for having a strong pelvic floor, what are those?
Aoife added that men also need to train their pelvic floors for exactly the same reasons as women.
“Men too unfortunately get the very same bladder, bowel, and sexual dysfunctions as women,” she added.
For further information please email [email protected] or ring (087 ) 2863013. To purchase a Home Pelvic Routine Course please log on to www.ippm.ie or ring (087 ) 2863013.
