It’s a very fulfilling job I have – every day I get to explain some pretty simple strategies to my patients which IF they implement them (for every damn day for the rest of their lives ….) can mostly transform their life from one of anxiety and quite a high level of bother to one of managing their condition much more easily and sometimes – many times, achieving a cure. I recently reviewed Elizabeth who had both urinary and faecal incontinence and not only had a great result with her treatment, but also had to really CHANGE her thinking about her beloved exercise. Elizabeth had great assistance on her journey from a Pilates instructor Jenni, who has taken very seriously the concept of pelvic floor safe exercising. Jenni was at the gym where Elizabeth was going and also was undertaking her level 3 Fitness Certificate and asked Elizabeth if she could study Elizabeth’s programme and help her change it to one which was safe for her pelvic floor. This journey involving Elizabeth and Jenni follows, as I asked them both to write a blog for me to help other patients.
I am a 66-year-old woman, with 3 children in their mid to late 40’s. For about 2 years I have suffered from urinary and faecal incontinence. I put up with this for quite a while, thinking that I was the only person in the world suffering, so suffered in silence, until it was happening on a daily basis, and affecting almost everything I did. I visited my doctor, who sent me for an special ultra-sound, and instead of something sinister, which I had imagined, the diagnosis was that I had a very, very weak pelvic floor.
The answer to this, according to the Doctor, was Sue Croft. I immediately made an appointment, and waited with some trepidation, but a large amount of excitement for my first visit. My life changed on that day.
Sue drew diagrams, showed me how to lift, the correct way to sit on the toilet, the importance of bracing, how to gently draw up the pelvic floor and everything else I needed to know to alleviate my problem. That was the easy part.
Then Sue explained that there would be no more caffeine and because I do daily fitness classes, she gave me a list of exercises that were second nature to me, that I could no longer perform. That was devastating…. No more boxing, planks, crunches, wide leg squats, and that was just part of it.
But I don’t do anything by halves, so from that minute on, decaffeinated coffee and tea was the go and classes at gym were adapted. For this I have to thank Jenni, my Pilates instructor from Pure Health Club. She was just wonderful, she has devoted so much time and effort into adapting exercises to suit, and without her, my improvement would not have been so marked and rapid. Also Ben, my personal trainer, who liaised with Jenni, and has also been a great help. So thank you Sue, Jenni and Ben.
I am now back to being a normal person. No more incontinence and for anyone who has suffered, you will know how good that feels.
After teaching my regular Wednesday morning Pilates class, Elizabeth indicated that she was seeking advice from a pelvic floor physiotherapist due to pelvic floor symptoms including soiling and high frequency of urination.
I asked Elizabeth to pass on any of her physiotherapist’s recommendations for exercise so that I could suggest modifications as required. Elizabeth brought me two books (Pelvic Floor Recovery Essentials by Sue Croft and Inside Out by Michelle Kenway) to read which were recommended by her physiotherapist, which I proceeded to read from cover to cover.
Upon thinking of possible candidates for my case study students for my Certificate III in Fitness, I thought of Elizabeth for my older adult and I was thrilled when Elizabeth said yes and further when her pelvic floor physiotherapist endorsed her involvement in the case study.
In order to prepare Elizabeth’s client profile report and to gain a clearer picture of Elizabeth’s current health and fitness, I asked many questions to try to develop an understanding of her medical and fitness history, which at times felt very invasive but Elizabeth assured me that she was more than happy to answer my questions. However, one of many questions was – ‘did Sue mention why you have a weak pelvic floor?’ And Elizabeth’s response was ‘no, and I didn’t think to ask.’
Through my research and client profile report, I unearthed connections between Elizabeth’s various ailments and discovered the aspects in Elizabeth’s journey in life which potentially lead to the weakness in her pelvic floor. But I found Elizabeth did not fixate on the why and bravely hopped, skipped and jumped (figuratively speaking of course!) into the ‘what can I do’.
But overall my journey to assist Elizabeth to formulate an exercise programme without pelvic floor symptoms has been a process of:
- reviewing Pelvic Floor Recovery Essentials and Inside Out
- finding acceptance that some exercises will need to be used in moderation, left out or modified to avoid leakage
- helping Elizabeth to become more in tune with her own body and be aware of downward pressure on her pelvic floor
- improving postural alignment
- identifying which exercises aggravate her pelvic floor symptoms
- finding alternative exercises that are pelvic floor safe and do not aggravate her symptoms
- then modifying her exercise program to suit all of her conditions and needs.
During the course of the case study Elizabeth applied each and every one of these steps and has had tremendous improvements to both her posture and pelvic floor symptoms. Elizabeth’s results are truly amazing and these results would have never been possible without Elizabeth’s courage to make that first step to seek out help.
Elizabeth journey is a shining example of what can be achieved through dedication to the application of Sue Croft’s recommendations for bladder/bowel management and modifications to exercise. I hope by sharing Elizabeth’s journey you are truly inspired to ‘walk, swim and ride’ into what can you can do to head towards wellness and acceptance of your new normal.
Thank you to both Elizabeth and Jenni for their wonderful stories- again two very articulate women. Sharing these very personal stories takes extra courage from the women who are suffering, but the feedback from patients is always that they related so much to the story and felt uplifted by the message in the article. So I do appreciate their time in writing for me.
Of course there are many Continence and Women’s Health Physiotherapists who can help anyone out there who is suffering in silence with continence issues. It is important to seek help urgently. Remember to access the Continence and Women’s Health Directory on either the APA website (Find a Physio) or The Continence Foundation of Australia’s Helpline 1800 33 00 66.
N.B: It is also important to understand that I am not endorsing one gym over another, this is the story of one instructor and patient from one particular club, hopefully to inspire you as an individual to seek the appropriate help. With each gym, personal trainer, Pilates instructor or yoga teacher it is important to state that you have a medical issue which precludes you from certain exercises….you could say it is a back problem if you don’t feel comfortable divulging pelvic floor issues…. and ask them to modify your programme accordingly. Many instructors have no idea about prolapse or the impact that certain exercises have on the bladder, bowel and the pelvic floor and so pointing them to the books is helpful in their development as a health professional also. It is a little like the early stages of our awareness about the link between cigarette smoking and cancer – no-one knew that cigarettes were bad for you. The Government even dished them out to soldiers at war!
And yes even now, personal trainers and other people who prescribe exercises for women have no idea of the implications certain exercises have for women who have had babies vaginally, those who have had gynaecological repair surgery and those with prolapse or incontinence issues. So beware and be warned!