(and what to do about it if this sounds like you)
Many of us put up with pelvic floor symptoms for years, either being too embarrassed to get help, or thinking that these sort of changes are inevitable after giving birth.
Pelvic floor symptoms are really common but not normal, and we shouldn't be putting up with them.
At least one in three women experience incontinence in the UK, and half of us get a prolapse after just one baby - the numbers are staggering - but loads of us still struggle to talk about it, and years can pass before getting the help we need.
The good news is that most common pelvic floor symptoms - like prolapse and incontinence - can be treated successfully, without surgery. So we really don't need to be putting up with incontinence when exercising, leaking when coughing or sneezing or changes like unexplained heaviness - or not being able to use tampons comfortably.
I have worked with many women who were told that their pelvic floor problems were to be expected after having a baby, and many women are just too embarrassed to go back and insist on help. This needs to change. And I know it can sometimes feel easier to push these concerns to the back of our minds - or use pads - but these problems are unlikely to go away by themselves. Getting on top of your pelvic floor symptoms means you can improve them, or potentially get rid of them completely, without spending years putting up with them, and spending loads of money on incontinence pads.
So how can you improve your pelvic floor symptoms or prolapse?
In the UK, common pelvic floor symptoms like prolapse and incontinence are commonly treated conservatively with pelvic floor exercises.
But, if you don’t feel like you’re getting anywhere with these - hypopressives could be a game changer for you.
'Pelvic floor - help' - these were the words I typed into Google the night I really panicked about my prolapse and stumbled across hypopressives. Having spent years working as a nurse in gynaecology and sexual health, and experiencing pelvic floor issues and a prolapse myself, I was amazed I had never come across this brilliant technique.
Hypopressives helped me get rid of the uncomfortable heaviness and bulging I was experiencing with a grade 2 bladder prolapse and my stress incontinence - and I’ve since helped hundreds of women find an enjoyable solution to improve their prolapse and incontinence symptoms.
Pelvic floor exercises or Kegels, have been around since the 1940s. In the 1980s, Marcel Caufriez, a physiotherapist working in women's health, started using hypopressives to help treat postnatal women experiencing prolapse and incontinence. It's a postural and breathing technique with many whole body benefits - but it’s also a different type of pelvic floor exercise that doesn't involve the conscious squeeze and release of the pelvic floor we're used to.
Hypopressives activates your pelvic floor by lifting your pelvic floor through the vacuum breath. As a result, your pelvic floor will work better in the background without you thinking about it. I'll go into more details about the lift it creates in the next section.
You don't need any equipment to do hypopressives - it can be done in the comfort of your own home in your own time.
And the results from our Create Lift Programme show that with 1:1 guidance, and tailored pose progressions, the symptom improvements women with prolapse and incontinence experience are frequently life changing.
The hypopressives technique offers a completely different way of thinking about and looking after our pelvic floor and conveniently combines a huge wellness element. This is one of the reasons there has been a flurry of interest around hypopressives not only in the pelvic health community but in wellness over the last few years as it offers a bumper package of other whole body benefits, including whole body tone, increasing fitness, relaxation and turbo charging your sex life - what's not to like about that?!
And one of the best things is that you don’t need to spend a lot of time doing hypopressives - you can experience these benefits with as little as 10-15 mins practise a day.
Hypopressives have turned our thinking about pelvic floor exercises around in more ways than one, and it's been showing us that we can improve our pelvic floor health in a truly enjoyable way. With recent research by Navarro-Brazalez et al (2020) showing women got results that were as good as those for women doing normal pelvic floor exercises - hypopressives offer an exciting alternative for women with pelvic floor symptoms who want to try a different type of pelvic floor exercise whilst experiencing more holistic benefits.
If you’re struggling with your pelvic floor, here are some of the ways Hypopressives can help:
1. These pelvic floor exercises lift your pelvic floor from ABOVE, rather than your squeezing from below
That sounded SO good to me after experiencing 2 years of pelvic floor and prolapse symptoms! So how does it work? In a nutshell, the breath work creates an automatic movement between your pelvic floor and diaphragm, naturally lifting your pelvic organs and working on the tone of your pelvic floor whenever you do the vacuum breath.
These two images from research by Latorre, G. et al (2011) demonstrate how the bladder and uterus move up during a hypopressives vacuum breath. They found that the angle between the uterus and the vagina increased from 31-45 degrees as the pelvic organs physically lifted. This ultrasound picture helps us understand what is happening on the inside with our pelvic organs. These researchers also found that the pelvic floor or levator ani muscles also lifted and contracted during the vacuum breath
If you're someone who really struggles to do your pelvic floor exercises - this lifting increases the resting tone and function of your pelvic floor, and research has found women are actually more able to do a conscious pelvic floor squeeze after doing hypopressives (Costa T. et al 2011). Targeting the pelvic floor in this way means your pelvic floor will start working better, and more reflexively in the background without you thinking about it.
And the natural lift you feel in your pelvic floor when you're doing these exercises feels so good, especially if you have a prolapse. If you want to read more about how this all works - I've written a blog post here with more information - 'Can hypopressives lift prolapse?'.
2. They help you pelvic floor work better automatically
...in the background without you thinking about it. Just before you cough or sneeze, reflex activity is already kicking in, to manage the natural changes in intra-abdominal pressure during daily life - to help keep you symptom free.
Research by Paterna C. and Rial T. (2016), Navarro et al (2017) and Ithamar et al (2017) found that the vacuum breath used in hypopressives significantly increased the activity of the deep core muscles - the transverse abdominus muscle and the internal obliques. These core muscles and your pelvic floor help better manage these internal pressure changes.
So when you experience these natural changes in intra-abdominal pressure during your day - like coughing, sneezing, jumping or running - your body is able to cope better, helping to keep you symptom free.
Research by Soriano et al (2020), looked at improvements women experienced with their incontinence symptoms like urge and stress incontinence over a 2 month period of practising Hypopressives. Not only did their symptoms and pelvic floor tone improve, but they also reported improvements in sense of wellbeing, body image and programme satisfaction. I've written a blog post here which looks at the research study in more detail.
3. We can do pelvic floor exercises we actually enjoy doing (yes really!)
If you don't enjoy doing normal pelvic floor exercises, I totally understand - doing pelvic floor exercises 3 times a day for the rest of my life wasn't my bag either. In fact the research indicates that long term adherence to normal pelvic floor exercise is low. Why? Women often describe them as boring - or they forget to do them.
Women I work with love doing hypopressives and it will give you loads of gorgeous whole body and wellness benefits at the same time.
I've written a blog post here looking at research by Navarro-Brazalez et al (2020), which suggests hypopressives are as effective as normal pelvic floor exercises for women experiencing pelvic floor symptoms. This blog post looks at research by Juez L. et al (2019), which suggests first time mums can get increased benefits with hypopressives compared to normal pelvic floor exercises.
Some of the amazing additional benefits which come with hypopressives are great motivators - like better sex. But better sex aside (!) women I work with often look forward to their practise or talk about how much they are enjoying it, how it makes them feel calmer in those tricky parenting moments, with a stressful job or with menopause symptoms. It can be a huge relief to find something that helps your pelvic floor symptoms or prolapse, that you have time for and enjoy doing - but that also makes you feel good in other ways.
4. They’re an 'at-home' pelvic floor myofascial release treatment
Myofascial release has become a buzz word in pelvic health and prolapse treatment in recent years for good reason - here's why:
We know that if our pelvic floor muscles are moving and functioning well, we're less likely to experience pelvic floor symptoms.
Because tension within our pelvic floor can be a contributing factor in pelvic floor and prolapse symptoms - with these areas of tension essentially tugging on our pelvic organs and pulling them down or out of place - or restricting the natural movement of our pelvic floor.
We know that releasing tension in the pelvic floor can improve this movement and the ability of the pelvic floor muscles to function better. Many women report improvement in pelvic floor and prolapse symptoms after direct or indirect myofascial release. The science is based on the biotensegrity model, where our organs can't fall out of place as they are held in a complex structure of fascia and connective tissue.
This is why after only a few sessions or a few weeks of hypopressives, women can start to experience a noticeable improvement in their prolapse or leaking symptoms. During the hypopressives vacuum and alignment work, the natural synergy between the pelvic floor and diaphragm creates movement and release through the fascia - naturally helping to restore function and strength. Whether your pelvic floor is 'strong' or 'weak' - this release will help improve your pelvic floor function and improve symptoms.
5. You're likely to start experiencing pelvic floor benefits in just a few weeks with one-to-one coaching
Most women I work with are surprised at how quickly they start seeing a noticeable improvement in their pelvic floor symptoms. Again understanding hypopressives within the biotensegrity model helps explain why the improvements can happen in a relatively short space of time.
For many women who have spent months doing pelvic floor exercises, with minimal improvement, this is amazing. It's hard to keep going with a treatment when you're not getting much in the way of progress or positive feedback. That's not to say that women don't experience improvements with normal pelvic floor exercises, but that the majority of women I work with are exploring hypopressives because they haven't.
Most women I work with experience a noticeable improvement in their pelvic floor and prolapse symptoms by about 4 weeks. It can take less than this or longer, but for most women it's in the first month or two. This is obviously a huge bonus when you're trying something new, providing motivation to keep going and see the improvements build.
It also means that in the long term you're more likely to stick to it and enjoy the benefits for life.
6. They are incredibly time efficient
We all lead busy lives, so it's a massive win to know that for the majority of women, 15 or 20 mins most days is enough to see significant improvements in their pelvic floor symptoms over about a 12-week period. After this, just 10 mins a day usually enough to maintain your improvements. I would still do them if I needed to do them for longer as the results have been life changing for me - but I'm also grateful that as a busy mum I don't need to spend lots of time keeping my prolapse symptoms at bay.
7. You'll experience LOADS of other GORGEOUS benefits
Most of us start hypopressives to help our pelvic floor symptoms, BUT you'll be delighted to know that there are loads of other benefits that come with the technique which is why it's quickly building momentum in the wellness world. It's very appealing to think you can spend 10-15 mins a day doing something that brings so many wellness benefits, as well as releasing tension and improving any pelvic floor symptoms you're experiencing. To name just a few here:
Relaxation: the breathing helps your nervous system move into 'rest and digest' mode, and promotes feelings of calm, relaxation and wellbeing.
Digestion: is really important for our pelvic health and Hypopressives helps stimulate the bowel, and promote function here too.
Whole body muscle tone: Hypopressives is a whole body conditioning exercise so overall you'll feel stronger and more flexible - two great things for life.
Posture: you'll be standing taller, more comfortably - and Hypopessives will help protect you against having a forward neck posture which puts weight through your neck and spine. It can also improve your back health and reduce pain.
Tummy and waist toning: whilst working on your pelvic floor, Hypopressives naturally helps slim and tone your waist and tummy.
Better sex: one of the most popular benefits.
And there are more!
So far, although hypopressives have been widely used within pelvic health in counties like Belgium, Spain and France - and although the evidence clearly indicates the pelvic health benefits - hypopressives are only just gaining momentum in the UK. It does seem astonishing that a technique that has been used within urogynecology since the 1980's in other countries, hasn't earned a place as a recommended conservative treatment for pelvic floor symptoms in the UK.
However, despite this more and more people are exploring this as a treatment option for their pelvic floor symptoms and prolapse, and experiencing the benefits for themselves.
If you'd like to find out more about our Create Lift Programme - contact me today on 07703 015295 to book a call, I'd love to speak with you.
Costa, T.F., Resende A.P.M., Seleme, M.R., Stupp, L.S. Castro, R.A., Berghmans, B. and Sartori, M.G. (2011). Hypopressive Gymnastics as a Resource for Perineal Proprioception I Women with Urinary Incontinence. Vol 12: 5.
Ithamar, L., Filho, A., Rodrigues M., Cortez, K., Machado, V., de Paiva Lima, C., Moretti, E. and Lemos, A. (2018). Journal of Bodywork and Movement Therapies. Vol 22 (1): 159-165.
Juez, L. et al (2019). Hypopressives technique versus pelvic floor muscle training for postpartum pelvic floor rehabilitation: A prospective study. Neurourology Urodynamics. Vol 39 (7): 1924-1931.
Latorre, G., Seleme, M., Resende, A., Stupp, L., Berghmens, B. (2011). Hypopressive gymnastics: Evidence for an alternative training for women with local proprioceptive deficit of the pelvic floor muscles. Fisioterapia Brasil. Vol 12 (6), p 468-471.
Navarro-Brazalez et al, (2020). Effectiveness of Hypopressives exercises in women with pelvic floor dysfunction: a randomised control study. Journal of Clinical Medicine. Vol 9 (4): 1149.
Soriano et al (2020). Effect of an abdominal hypopressive technique programme on pelvic floor muscle tone and urinary incontinence in women: a randomised crossover trial. Physiotherapy. Vol 108: 37-44.