I LOVE squeezy app but my (minor) bugbear is that the default settings it comes with are actually the “end goal”. In the long run you want to be able to hold for 10 seconds 10 times in a row but I don’t come across too many beginners who can manage that! Not easy for beginners, and for many people a bit demoralising at first try. If you could perform like that already you likely wouldn’t need the app!
How to tweak the settings if you are a true beginner…
Go to the green-ish petal “exercise plan”.
Set yourself timings for THREE times a day.
scroll down to find the “Professional Mode” and turn it ON
Make the Slow Ones “shorter” holds
then go back to the “Slow exercises” and change to:
the number of reps to 8
squeeze time 5 seconds
Hold time 0
Relax time 5 seconds
rest time 0
Now they will be shorter on/offs to get you started. Little and often through the day.
More Tortoise than Hare?
Then go to “quick exercises” and change the dial to TORTOISE speed = Speed A. This will mean that they don’t come at you so fast giving you more time to release between contractions.
Lose the sub-max exercises for now…
Then go to “sub-maximal exercises” and choose repetitions = 0
Or a tweak if you’re a bit bored of the pre-set “slow” pattern
Our brains get bored easily and switch off a bit once something becomes familiar. Wake yourself up a bit with a pattern change:
Go to the green-ish petal “exercise plan”.
scroll down to find the “Professional Mode” and turn it ON
then go back to the “Slow exercises” and change to:
the number of reps to 10
squeeze time 4 seconds
Hold time 4 seconds
Relax time 4 seconds
rest time 4 seconds
How do you do yours?? Do share your tips, tricks and successes below!
I Mean to do my pelvic floor exercises but then I Forget.
I drift off partway through my routine.
I like to do them at top speed to get them done
I always feel guilty that I should have done more
I can’t remember how many you’re supposed to do a day?
umm… what are you supposed to do again?
Easy Solution…
NHS Squeezy App. It counts for you. It reminds you. It gives you a happy little chart and messages to tell you how clever you are when you do them. All for £2.99.
So download it NOW (or re-upload it if you already had it but it’s now back in the cloud….).
Other app features (which you may not have noticed!)
My only (minor) bugbear with it is that the default settings are actually your end goal (10 second holds, 10x in a row). And the Quick squeezes are really quick!!. Follow these instructions to make Squeezy App more user friendly for a beginner.
Any questions? Do ask in the comments below – you won’t be the only one with the same query!
There has been a recent explosion in “fem-tech” options, particularly pelvic floor biofeedback devices. On the one hand this is empowering women to improve their exercising in the privacy of their own homes, on the other hand resulting in a more than a little confusion about what they do. With most devices over £100 it is important to spend your money wisely.
Pelvic floor Biofeedback devices
Generally, we advise that if you can already contract your pelvic floor muscles then you don’t need to do passive pelvic floor muscle stimulation. Your muscles will develop quicker by doing ‘active’ exercises where the brain initiates the activity rather than a machine. Check out the videos on our Pelvic Floor School.
If you WANT to work with a gadget to do active exercises, a biofeedback device can enhance your practice. Particularly, if you need to work on your brain skills (co-ordination, multi-tasking, downtraining) as much as your isolated muscle strength & endurance (which they can be helpful for too).
How to they work?
The action of your muscles contracting is relayed to a machine which “shows” you what you are doing. There are several different ways this can be done. Some machines pick up the electrical signal from your muscles while some respond to pressure. Some give you a visual picture of what you are doing, others beep or vibrate in response to your contraction.
These are great to correctly identify your pelvic floor muscles in different positions. They also ensure you are contracting correctly and also help you focus on relaxing fully between contractions
See how well your muscles contract and relax. Have targets to aim for to improve strength, endurance and co-ordination.
Practice more complicated tasks. Skills you need for real life or your sport.
Make exercising a bit more fun (!) and interesting. This will help you to keep up long-term practice (rather like a piece of gym-kit for your pelvic floor!)
Examples of pelvic floor biofeedback devices:
To be professional, I do not recommend a single specific product or supplier. But I have aimed to narrow down the list of options for you. Please do read customer reviews to help you make your decision. Specialist physiotherapists, like myself, have units in clinic for you to try before you buy.
Electrical biofeedback devices: with connecting wires
SImplex
Peritone
Peritone EMG biofeedback unit and Simplex EMG biofeedback unit are the ones we have used in our clinic for many years (same device in different packaging). Many physiotherapy departments have these for you to use at your visit and/or to borrow. Just like French women train in their postnatal rehabiliation sessions.
They are effectively two parts. You place a small internal electrode (called a Periform, which is single person use, into the vagina. Then put your clothes back on!. Then link your internal device by a cable to the handheld Pelvitone or Simplex unit (we can loan one of these to you).
When you contract your pelvic floor muscles their electrical activity registers on the screen. This makes the lights change from orange to green and gives an audible beep.
You can practice your quick maximum power squeezes seeing how high you can make the lights go. Also, practice keeping the lights green while you cough or try moving your arms or legs. There is also a work/rest function which ‘counts’ the endurance holds for you and tells you your average squeeze score at the end.
These devices are widely available from lots of online sellers +/- £160 (including the Periform).
Pelvic floor training devices: which connect via bluetooth to a phone app
The Elvie updates the design of the traditional units above. It is popular as it has modern smart phone visuals, easy charting & a sense of community amongst users.
I have one I can show you in clinic but the internal device (the pebble) is the expensive part, and understandably single use only, so I’m afraid you can’t try before you buy.
It is a discreet, attractive, wireless bluetooth pebble-shaped device. This goes inside the vagina. Use an app to turn your phone into the biofeedback monitor/exercise tracker. No cables between you and the phone but you can’t put knickers back on or the bluetooth can’t connect. It is beautifully packaged and well designed by women. It can be used in the second trimester of pregnancy but is not recommended for the 1st and 3rd trimesters.
Elvie is officially available “on prescription” but sadly, I don’t know anyone whose managed to get one this way.
Pericoach System shows your pelvic floor contractions as clear graphs on your phone. Pre-set programmes guide you to practice exercises twice daily and, like the Elvie, uses algorythms to automatically progress you as you improve your skills. You can give you physiotherapist access to your data so that she can guide you virtually.
Pelvifly/K-Goal
Pelvifly £189 with basic plan. Subscription for full integration with a physiotherapy coach.
Pelvifly is a package connecting the K Goal pressure sensor to a phone app for sensitive imaginative biofeedback games with sophisticated integration to a remote physiotherapist if required
The largest of the internal probes, which will suit those who find more petite devices fall out too easily. It responds to the pressure of your pelvic floor squeezes. This is particularly useful for those who need to learn to relax the pelvic floor (called downtraining). Pelvifly offers the greatest variety of challenges with innovative vibrant visuals – including butterflies visiting flowers, rockets flying through tunnels, basketballs into hoops and an engaging octopus!
The BASIC plan (no further cost after purchase) sends you a muscle test once a month and daily challenges. With a SMART subscription (£24/month) you will have more programs to follow to suit your chosen goals. Pelvifly are rapidly expanding their telehealth services. With a CARE package (£96/month) you will be connected, virtually, to a Pelvicoach (a specialist physiotherapist) who can interact remotely to set up bespoke assessment and training programmes, support your progress, exchange messages and save and print your progress reports.
Kegel8’s biofeedback pelvic trainer uses a pressure system where you squeeze on a larger tube (NB latex covering) which moves a dial on the hand held unit. Unsophisticated but effective for checking what you are doing and therefore a relatively inexpensive option at £79.99
Epi-No Delphine Plus £99.99
Eip-No’s primary purpose is a tool to stretch the perineum in preparation for vaginal delivery. It can also be used as a biofeedback tool before & after birth. The dial lets you visualise the amount of squeeze pressure you are creating with your muscle contraction.
Epi-No (like the Kegel8 Trainer) is less sensitive than the electrical biofeedback or bluetooth devices. However, the advantage of the Epi-No is that it is certified for use through your whole pregnancy. It can also be used in the latter part of pregnancy (after 37 weeks) to help to stretch the vaginal opening. A recent study * did not show evidence of a protective effect of the Epi-No device on birth trauma, however, anecdotally many women feel it has helped with their confidence to relax the vaginal opening in preparation for birth.
*Kamisan Atan I, et al. BJOG 2016 Does the Epi_No birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial.
Other trainers
Vibrance Pelvic Trainer
The Vibrance Pelvic Trainer is a petite internal device which vibrates when you correctly contract your pelvic floor muscles. The device is easy to insert but you may need to hold it in position. There are no wires, or external unit, the vibration is felt in the device itself.
This device could also be useful as a ‘bridge’ back to penetrative sex, if you don’t want to use a traditional vibrator. You could practice inserting the trainer at your own pace. You might find the vibration element helpful to re-sensitise your tissues. They are available directly from www.vibrancepelvictrainer.co.uk £140.83 with VAT exemption.
If you have had a problem for more than 3 months, you can declare yourself as having a ‘chronic medical condition’ and do not have to pay VAT. There will be a form to complete. This does not apply to the Elvie which is registered as an exercise tracker not a medical device. Not all the online suppliers can offer this service.
Combined Stim & Biofeedback Machines
You can buy combined units which do both functions. However, these are surprisingly expensive (and a bit fiddly. If you feel you need both systems I usually suggest you buy two separate simpler units and switch between them.
Lubricating gel
You will need a water-based lubricating gel to help the insertion of the devices. It is essential to help the electrical devices to operate correctly. A simple, in-expensive, chemist-own or basic brand name is theoretically all you need. If you have concerns about ingredients you may prefer an organic version. Do read my posts about the difference between water-based and oil-based lubricating products.
.
Not sure what YOU need?
Get clarity first
If you are not too sure how good your muscles are then before you spend ANY money on a gadget or device I would highly recommend an hour spent with a specialist physiotherapist! Your appointment will be £70-90 outside London.
Our role at physiotherapy is to do an internal assessment of your pelvic floor muscles. We will check how well they are working and teach you how to get the best from them – you may not need any gadgets at all! And if you do we can help you make the best choice for your needs.
Try before you buy
Many physio clinics can loan you both muscle stimulation and biofeedback units to try out at home. To see how well they work for you before you consider buying your own. It is particularly important to consider an individual assessment by a specialist physiotherapist if you are at all worried that your pelvic floor muscles might be too tight rather than too weak.
Physios can also teach you active exercises , which require no equipment at all! We usually combine pelvic floor exercises with appropriate abdominal muscle work as these two areas need to work well together for best support of our internal organs.
Please don’t hesitate to be in touch if you have further questions. Readers would love to know your experiences if you would be happy to share?
These units are designed to be used at home to artificially stimulate the pelvic floor muscles to work. Electrical impulses are sent from the machine directly to the pelvic floor to mimic the messages that your brain is supposed to send.
These units are ideal for people who really don’t know where their muscles are. Or what they are supposed to do! They are also good for very weak muscles that can only contract a few times before they fatigue. Or muscles that can only muster a very tiny amount of strength.
the sensations (a sort of tingly feeling) created by the electrical impulses help your brain to correctly identify the location of your pelvic floor muscles.
the machine will stimulate the muscles to work (contract). It is possible to change the settings to favour different parts of the muscle.
you can practice joining in with the machine to learn how to contract your muscles without help
the machine can help you to ‘hold’ a muscle contraction while you concentrate on learning to breathe and/or move at the same time
we usually recommend that you wait until 3 months postnatally before using a stimulation machine.
Examples of stimulation units:
To be professional, I do not recommend a single specific product or supplier. But I have aimed to narrow down the list of options for you. Please do read customer reviews to help you make your decision. Many specialist physiotherapists, like myself , have units in clinic for you to try out before you buy.
Traditionally the stimulation is delivered by a battery-operated handheld unit with wires to a internal electrode. The price points vary depending on the number of programmes available & the style of the electrode supplied. A new design on the market is Pelviva, which are wireless foam single-use electrodes.
The kegel 8 Tight & Tone Electronic Pelvic Toner £98.99 is a simple classic pelvic floor stimulation unit which we have used in our clinic for many years. The buttons are large and few! You may prefer to use it with a periform electrode
Neen Pericalm £69 + buy a probe
is often brought in by customers (availabe on amazon). I also find this one easy to follow the instructions and set the programmes. It is also very small and discreet. You will need to buy a vaginal or anal probe to go with it.
Kegel 8 Mother Nuture £79.99
Even though it is the cheapest one that Kegel8 offer it has all the programmes you will need, plus doubles up as a TENS machine if you anticipate another delivery. A periform probe is a more slender option than the one provided with it.
Nu-tek Levator mini continence stimulator.
Win-health supplies our practice. It is a good stimulator though the buttons and set up are a little fiddly until you understand how it works. I recommend you select the Periform probe (which has a hole in the middle rather than solid) most clients find it more comfortable.
Kegel8 Ultra 20 £134
has more programmes & is supplied with the shapely Glide Gold Vaginal Probe. The customer instructions are good. My videos with Kegel8 use this machine as the demo
Pelviva £44.95 for starter pack of 3/£214 for 1 month pack x15
Pelviva is a unique product that does not require a handheld unit like those above. It is a disposable single use foam electrode which is activated just before use then delivers 30-min internal stimulation. video here
I have created a series of videos to show how a machine works, what the cables and probes look like and explain in a not-too-tech way how to use them to help problems with bladder leakage, prolapse or recovery after a baby.
These videos will help you understand your condition, as well as how the machines work. Then, you will be able to decide whether a machine would benefit you and which programmes you would choose.
You will see that these videos were created as a project for Kegel8. However, you will find most of the information applies to stimulation machines in general.
Note about VAT exemption
If you have had a problem for more than 3 months you can declare yourself as having a ‘chronic medical condition’ and do not have to pay VAT. There will be a form to complete. This does not apply to the Elvie which is registered as an exercise tracker not a medical device. Not all the online suppliers can offer this service.
Combined Stim & Biofeedback Machines
You can also buy combined units which do both functions. However, these are surprisingly expensive (and a bit fiddly) so if you feel you need both systems I usually suggest you buy two separate simpler units and switch between them.
Lubricating gel
You will need a water-based lubricating gel to help the insertion of the devices. It is also essential to help the electrical devices to operate correctly. A simple, in-expensive, chemist-own or basic brand name is theoretically all you need. However, if you have concerns about ingredients you may prefer an organic version. Do read my posts about the difference between water-based and oil-based lubricating products.
.
Not sure what YOU need?
Get clarity first
If you are not too sure how good your muscles are then before you spend ANY money on a gadget or device I would highly recommend an hour spent with a specialist physiotherapist! Your appointment will be £70-90 outside London.
Our role at physiotherapy is to do an internal assessment of your pelvic floor muscles. We will check how well they are working and teach you how to get the best from them – you may not need any gadgets at all! And if you do we can help you make the best choice for your needs.
We can loan you both muscle stimulation and biofeedback units to try out at home. To see how well they work for you before you consider buying your own. It is particularly important to consider an individual assessment by a specialist physiotherapist if you are at all worried that your pelvic floor muscles might be too tight rather than too weak.
We can also teach you exercises , which require no equipment at all! We usually combine pelvic floor exercises with appropriate abdominal muscle work as these two areas need to work well together for best support of our internal organs.
Please don’t hesitate to be in touch if you have further questions. Readers would love to know your experiences if you would be happy to share?
Savage, A.M (2018). Continence products and medication devices: issues that pelvic health physiotherapists need to consider. Journal of Pelvic, Obstetric & Gynaecological Physiotherapy, 122, 30-40
Help! So many different pelvic floor gadgets – which one for me?
You have probably heard of “gadgets” to help exercise your pelvic floor muscles. If you have been thinking about buying one you may already have looked around online. My complete sympathy if you are feeling overwhelmed and confused! Not only about which one to get but also the difference between them. They range in price enormously. The language can be confusing. There are so many different suppliers..…
This post aims to help you understand:
the braod difference between a stimulation unit, a biofeedback device and weights/resistance devices and reminder devices/apps
I hope this overview will start to clear the confusion for you. Once you have a fair idea which category gadget or device interests you most do read the Supported Mums Field Guides (with regularly updated product links) to each:
There are broadly four types of pelvic floor gadget
Stimulation units
Biofeedback devices
weights/resistance devices
Trackers/Memory Aids
# Stimulation units
send electrical impulses TO your muscles to help them to contract/exercise (they wholly or partially do it for you)
show you what you are doing with your muscles when you contract/exercise them using your own brain. Some do this by sending an electrical impulse from you to the machine but there are others that do this using a pressure signal or another type of sensor.
Then there are gadgets for pelvic floors that are already working well:
# Gadgets that add resistance and/or weight
to your ‘ordinary’ pelvic floor exercises – to make the muscles work harder – just like you push or pull weights in the gym or pull against a resistance band or work with a Pilates circle
to do your pelvic floor exercises, keep track of your progress, or prompt you to follow a sequence to make sure you regular perform a full range of tasks
examples: Squeezy App, Intimina, Tena’s PPX app
Note: Combined Stim & Biofeedback Machines:
You can also buy combined units which do both functions but these are surprisingly expensive (and a bit fiddly) so if you feel you need both systems I usually suggest you buy two separate simpler units and switch between them
Keen to learn more? Check out our Field Guides
which piece of kit might be useful to you depending on your circumstances
the detail of how they work, subtle differences and where to get them
Make the most of your local specialist physiotherapist
Most electrical devices cost over £100. An hours appointment 1:1 with a specialist physiotherapist would cost £70-90 (depending on area). If you are hesitating what to buy, or even if you need a device at all, why not first have a full assessment of your situation first?
Get clarity first
Remember that a specialist physiotherapist like myself, will do a proper examination of your pelvic floor, to give you complete clarity on what your personal pelvic floor strength, endurance and function. Then together you can decide and plan the most appropriate and effective strategy for you to develop your muscles and skills further.
It is particularly important to consider an individual assessment by a specialist physiotherapist if you are at all worried that your pelvic floor muscles might be too tight rather than too weak.
Try before you buy
Most clinics will have a drawer full of gadgets and devices for you to see, touch and discuss – and many, like our clinic, have units for you to borrow if you prefer to try before you buy.
Or if you have already bought a unit or gadget and don’t feel that you are getting the most from it do book an appointment with a physiotherapist who will be able to help you to:
Or you might not need a gadget at all!
We can also teach you exercises , which require no equipment at all! We usually combine pelvic floor exercises with appropriate abdominal muscle work as these two areas need to work well together for best support of our internal organs.
Please don’t hesitate to be in touch if you have further questions. Readers would love to know your experiences if you would be happy to share?
Savage, A.M (2018). Continence products and medication devices: issues that pelvic health physiotherapists need to consider. Journal of Pelvic, Obstetric & Gynaecological Physiotherapy, 122, 30-40
Are you thinking of trying a pelvic floor muscle stimulation machine? Perhaps you’ve got one already but it’s been gathering dust?! Are you using yours correctly?
Are you are puzzled by the settings, the different electrodes and which programme to use? I can explain!
I recently wrote an article on these devices, for my physiotherapy colleagues *. Can you believe I found more than 40 different products available to buy online? The manufacturers instructions can be a little hard to follow. I didn’t feel that there was enough explanation of how the machines work to help with pelvic floor problems.
* Savage A.M (2019) Neuromuscular electrical stimulation devices Journal of Pelvic, Obstetric & Gynaecological Physiotherapy, 125, 16-26
New Videos : How to use a pelvic floor stimulation machine
How to use a pelvic floor stimulation machine for different problems eg stress incontinence, urgency, pain or prolapse or after delivery.
FAQs from clinic!
You will see that these videos were created as a project for Kegel8. However, you will find most of the information applies to stimulation machines in general.
These videos will help you understand your condition, as well as how the machines work. Then, you will be able to decide whether a machine would benefit you and which programmes you would choose.
How to use a Stimulation machine : video series link here
Stim or biofeedback??
Not sure if you need a stimulation machine (common brands are Kegel8, Nu-Tek, Sensatone or Pelviva) or a biofeedback machine (like Pelvitone, Elvie, Pericoach or Vibrance)? Start with this article which explains the difference between them.
Strengthening your pelvic floor is still first prize for bladder leakage problems. But what if you cannot create enough strength and support for the bladder with your pelvic floor muscles alone? You may benefit from one of the modern devices that tries to give some reinforcement to the bladder neck and bladder tube.
These are devices that you can buy on the internet and then insert and remove yourself. They are designed to be worn all day but not all the time.
Available in the UK at the moment are , Contam, Contiform and Uresta. They vary in price chiefly relative to how many times they can be re-used. Contiform is available on prescription.
Contam
Contiform
Uresta
Who do they suit?
If pelvic floor exercises, improving your core, adjusting your exercise regime and better bladder management have not been enough to resolve your bladder leakage then these devices may offer an alternative to surgery. They have a similar mechanism of action (mechanical support of the urethra) to the TVT and colposuspension procedures.
These support pessaries work particularly well in certain situations. If you or your physiotherapist feel that the bladder has dropped only a little bit (prolapse of the anterior wall/cystocele) but that everything else inside (particularly the uterus) is still well supported. Or if you feel you have created a good layer of muscles through exercise but still need a bit more support when you are trying to be active.
How does an internal bladder support reduce urinary leakage?
These devices work by providing more support for the bladder neck. When you move fast (jogging, playing tennis) or there is an increase in abdominal pressure (coughing, sneezing, jumping, zumba, aerobics) the pelvic floor muscle is supposed to support the bladder neck so that there is no leakage. However, if the muscles are weakened and/or untoned that support can be lost.
Would it be easier to stop the water by standing on the hose on the grass or on the path?
Are a visual person? Imagine a running hose pipe, lying on soft grass. When you lay your foot on the pipe you may slow the flow of water but you may not be able to stop it completely. However, if that under surface is firmer, because you have laid your hosepipe on your garden path (aka a good pelvic floor, and/or a device in position) when you press down on the hosepipe the water flow stops.
What type of urinary leakage will they help?
These devices are best for small leaks associated with movement. Or leaks when the bladder is under pressure from coughing, sneezing or laughing (stress urinary incontinence).
They create a mechanical uplift to support the bladder neck the way the pelvic floor is supposed to do.
They can’t help with urgency or irritable bladder
What these devices can’t do is change symptoms like urgency. If your bladder is irritated by caffeine, being too full, or you have an overactive bladder, you won’t see any improvement using one of these. Pelvic floor exercises DO help these symptoms because the pelvic floor contracting activates neurological messages which calm the bladder down. Unfortunately these devices can’t do that.
Can I leave it in to wee? What about during my period?
Yes, they are all designed to be left in when you have a wee or bowel movement. The pressure of the bladder squeezing is enough to push the urine past the supported area when you need to.
You could still use the Contiform pessary when you had a period (as the menstrual fluid can flow through it) but you couldn’t use a tampon at the same time. The other designs (Contam, Uresta) act as a block but are not absorbant like a tampon, so shouldn’t be used during your period.
Note: The term pessary can be confusing
Because these devices to reduce bladder leakage sit inside the vagina they are termed a “pessary” but they should not be confused with a traditonal pessary used for supporting Pelvic Organ Prolapse (POP). For more information about pessaries for prolapse read here
A guide to pessary devices to reduce stress urinary incontinence
Each company markets their own product and may use more than one distributor so prices can vary. Here is my personal “quick guide” to what’s out there at the moment, apologies if it has already changed again by the time you read this! Please do let me know if I have missed something out, or you find a new supplier or product before me! Please do comment to support other readers & share your experiences:
Contrelle Activgard
single use only
currently unavailable in UK but understood to be returning soon.
Contam Pessary
single use only
£26.99 for a starter set (range of 3 sizes “normal” or “large”). From £12.95 each bought singly, or just under £10 each if bought in groups of 3 thereafter. from www.stressnomore.co.uk
* use promotion code SUPPORTEDMUMS at checkout for a 15% discount
These are quite new on the market. There are no clinical trials listed.
Contam is a brand offering a variety of shapes and sizes of single-use vaginal pessaries. It is the tampon shaped ones that are suitable for supporting the bladder neck. The cube shaped ones are for going much further back in the vagina to support a more severe uterus prolapse. Unlike tampons they do not absorb moisture from the vagina. You soak them in water before use to make them pliable and elastic to insert and to prevent drying out of the vaginal wall.
It is suggested that you position them differently according to the problem: For incontinence: “insert the pessary deep into your vagina, then pull it back slightly so that it’s within reach of your fingers”
These are single use only & therefore a more expensive option than pads. However, they would suit a mums who is generally not experiencing day to day stress incontinence but knows when she is going to leak. For example if you do a longer run, or go to a Zumba class, or for an event like a wedding. You might only use them only once or twice a week. You can put one of these in before they go and not need to worry with other protection (or maybe use with a pair of washable knickers “just in case”).
Note: see a size chart under “product description” on the website.
Contiform
re-use up to 30 times
£85 starter pack of 3, £40 per unit thereafter* from contiform.co.uk
*further 20% reduction if you complete a VAT exemption form
Also available on NHS prescription from your GP [starter pack: NHS order code SKU184 , PIP code 375-5808 ]
The principle of the Contiform and its position in the vagina is to create uplift and support for the neck of the bladder. These are guaranteed to be re-usable up to 30 insertions, so if you felt you needed support daily rather than ad hoc this is likely a more economical option in the longer term.
These can be a surprisingly in-expensive & eco-friendly option, compared to disposable pads, if you know when you will leak and need to use the device only for intermittent pre-planned activities.
The Contiform Pessary looks like a plastic hollow tampon. The smaller circle supports the bladder tube (the urethra), the larger surface lies against the floor of the vagina, giving support to the bowel wall. They are made of a firm but flexible non-latex plastic and can be reused, with the guarantee up to 30 times (there is a “slit” that develops with wear to show you when the device needs changing), longer if not worn all day. There is an optional ribbon to help with removal.
You can buy Contiform online or they are available on NHS prescription. You would need to tell your GP about your symptoms, and ask him to prescribe a starter pack for you. While you are there ask for a referral to specialist physiotherapy too if you haven’t already got your own pelvic floor coach(!). Especially if using a Contiform works for you – it suggests that a stronger pelvic floor could do this job naturally for you too!
Fiona Rogers, physio, clearly explains how to use the contiform. See 2:18 to understand how the “split” works. 3:08 about removal with or without the ribbon.
Uresta
resuable for a year
£179 (ex-VAT ) + £8 P&P for a starter kit containing 3 sizes from iMEDicare on 01923 237795 or via uresta.uk
Uresta, designed and manufactured in Canada, joins this family of internal support devices with the unique selling point that it is fully reuseable with the manufacturers suggesting replacement after one year.
So if you have had good success with one of the devices above this would be a natural progression to a potentially more environmentally friendly and overall less expensive option.
A clinical trial of 32 women found that of those still using it at 2 weeks (21 women out of the original 32), 76% of them (16) were still using it at their 12 month visit.*
* Farrell SA, Baydock S, Amir B, et al. Effectiveness of a new self-positioning pessary for the management of urinary incontinence in women. Am J Obst Gynaecol 2007:196:474e.1-474.e8
There is a helpful video from their website below. If you are worried about the high initial cost Uresta offer a full money back guarantee if the product doesn’t work for you and also give good advice about how to find the right size for you.
this video is from uresta.co.uk
Beware misleading marketing
Some of the marketing blurbs list “strengthen your pelvic floor” as a benefit of using their pessary device. This is only true in the loosest meaning – while they are in place, by artificially re-inforcing the vagina wall I suppose you could claim that is “strengthening” the pelvic floor action – but they are in no way making any change to the muscle. Only exercise can change the composition and activity of the muscles or surgery the non-muscular elements. When you take the device out the structural situation remains the same. However, these devices definitely offer an alternative to surgery with a similar mechanism of action, mechanical suppport of the urethra to the TVT and colposuspension procedures.
Living life to the full
To conclude – I would suggest that these devices are part of your package of things you are doing/using to change the way that bladder leakage limits your lifestyle with your goal to cure your leakage problem rather than simply manage it, if possible.
However, if you are feeling more confident to exercise because you are not worrying about leaking, then this will be a Good Thing for your overall health, wellbeing and mood.
Do contact your local specialist physiotherapist to help support you with finding the right products, exercises and sports for your needs
Have you tried an internal bladder support device? What did you think? Any tips for other mums?
What do you do if you worry about bladder leaks when running? Or at the gym, your exercise class, or playing with your children ?? Mums I meet in clinic tell me that they are avoiding events that require them to look “sporty”. They worry about a VPL if they wear normal figure hugging gym kit. They don’t want to stand out in a baggy tracksuit trying to hide a pair of substantive knickers with a pad. Heaven forbid a party or wedding?
I’m an experienced women’s physio so I know pads aren’t (and don’t need to be) the solution but they could be a vital part of your journey out of the Miserable Place.
Tips to manage bladder leaks when running or active:
full disclosure: this article contains some affiliate links marked*. As an amazon associate I earn from qualifying purchases. If you make a purchase by clicking through from an affiliate link I receive a small commission at no further cost to you. Thank you, this helps to support this blog.
#1. Use a pad designed for bladder leakage not menstruation
Sanitary pads and incontinence pads are not made of the same thing.
The products designed to be used for menstruation are great for that purpose but do not to cope well with liquid. As they are predominantly cottonwool based, if they get wet, they just go soggy and mis-shapen. If you are moving about they can get scrunched up, rub and leave your skin in contact with urine causing chafing and soreness.
The right pads for the task are worth the little bit of extra cost. With the advent of new technology you will be amazed how slim a proper bladder leakage pad can be to hold a large amount of liquid. They also use fabrics that can wick fluid away from the surface. This keeps damp away from your skin and reduces your worries about odour.
Some of the main UK brands are Tena, Always, Poise and Boots Staydry range. All will send you free samples from their websites.
Smaller brands Natracare and Cottons aim to use environmentally friendly materials and avoid the use of parabens and bleaching processes.
The products are usually in the same ‘feminine hygiene’ aisle (or website section of an online store) but separated into one column of shelves for products for periods and one for bladder leakage.
The most common indicator is a row of variously filled ‘drip’ or circle symbols to indicate the level of leakage you wish to contain.
In general, pads for ‘lighter’ bladder leakage look and feel like pantyliners and come in boxes to keep them flat and compact. This makes a good starting point if you are looking for something to keep you confident and safe against a small leak.
but if you need more than a light pad
If you suffer with more severe leakage and could potentially empty half your bladder, or would risk getting wet clothes, then look at the pads in bags which will be more absorbent or disposable pants (see #3).
#2 Disposable Pants
No one really believes that these look like “normal” knickers. However, their big advantage is the all-around cover, front, back and sideways. For an activity involving lots of changes of direction and position (aerobics, yoga, kids tumbling) they will give the most protection against bigger leaks.
Put your biggest PE pants over the top to hide them at your waist line.
However, if you are getting this wet when you play sport your priority should be to solve the bladder problem further. Talk to your physio about what they recommend for you.
#3 Knickers with inbuilt protection
We are so lucky to be in the era of textile research and design and I am delighted to see this being applied to underwear.
Good for the environment. Great if you are usually fine but like to know you have back up. Possibly more discreet if you need a thicker pad than a liner.
Disadvantage – once they are wet you need to change the whole knicker. However, ideal for things like the gym – if you get bladder leaks when running on the treadmill or other higher impact classes. Strip off in the changing room and no worry to dispose of a pad.
Note: a couple of clients who have tried this option swear they will never wear pads again, certain that the pad itself was irritating their vulva and making their incontinence worse.
* use SUPPORTEDMUMS at checkout for a 15% discount
The gusset in these ProTech knickers is hardly thicker than your normal good robust cotton “pants” but is made of 3 layers, an absorbent fibre (holding up to 40ml = 2+ tablespoons), an odour retention layer and wick away surface. Like some of the best quality pads but fixed in place with sealed seams.
These are made by the same manufacturers as the Thinx range of period pants. A forward thinking company with their open-ness about the need for products to empower women to be active. And addressing sustainability and waste. They have a rather quirky style of presentation and some bold adverts.
Five different styles: from Hip Hugger, through classic bikini to thong. Varying prices depending on style £16 – £24 . They sent through some samples lately for me to show in clinic. The colours are fun: deep orange, blue, nude, grey and black. They are made from a silky rather than cotton fabric, much more like an ordinary fashion knicker.
NB: they are hand wash only which you might miss in the instructions (and then be very cross about!).
#4 A subtle cover-up with skorts and skirts
It started with school uniform but now we can all wear skorts! Perfect for just hiding a good pair of pants with a pad and getting on with whatever you wanted to do.
£20-£80. Offered by brands Decathalon, Salomon, Reebok and many others.
#5 Add extra support to your core from the outside
Maybe not so much worried about leaks? More that your entire lower half moves about too much? Or that exercise is straining and fatiguing your pelvic floor and core muscles. Have a look at these if you feel just generally ‘unsupported’ at the moment:
EVB Company founder, Yvonne Brady tells her story of returning to running after her third baby and struggling with muscle strength. Women’s health physiotherapists like myself are recommending these as an ‘extra’ layer. To create more lift and support for the pelvis, abdominals and pelvic floor.
Most of my clients have gone for the shorts style, giving the option of wearing them underneath any of their other leggings.
# 6 Add extra support to your bladder from the inside
The options have recently expanded for devices that aim to give support to your bladder from inside the vagina. Often called pessaries. The devices/brands you may see advertised include Contam, Contiform (available on prescription) and Uresta. The devices increase in price, partly reflecting the number of times that they can be used – from single week use only to monthly to reuseable for a year.
Contam
Contiform
Uresta
These work particularly well where you or your physiotherapist feel that the bladder has dropped only a little bit (prolapse of the anterior wall/cystocele). Yet everything else inside (particularly the uterus) is still well supported. You both feel you have created a good layer of muscles through exercise but could do with a bit more support when you are trying to be more active
……that you will not use these ideas to make you complacent about a leakage problem. Nor as an excuse to avoid the issue of your bladder for another 3 months!
Incontinence might be “common” (45% of women report bladder leakage at 3 months after birth, even 10% of those after Caesarean) …. but it is never “normal”.
Incontinence is also a sign of lack of pelvic floor support. You may need to consider how pelvic floor friendly your sport is (ummm….trampolining….)?? Or you may need to modify activities to protect yourself from risk of pelvic organ prolapse.
DO use these stop-gap options to get comfy, happier and more active NOW. But please, please commit to doing something about your pelvic floor muscles. Book an appointment with you GP to get a referral to a Specialist Physiotherapist for full assessment, support and advice. You can be much better than you are right now.
What are your tried and tested tips? Please share your experiences with other mums in our comments section below. Your story will inspire others.
Vaginal cones and weights; relatively cheap and a good way to progress your pelvic floor training
Vaginal cones and weights are a very different concept to electronic devices. They are cheaper and more accessible for most people. However, there is a bit of a knack to using them correctly.
They are particularly good for building the endurance qualities of the pelvic floor. We need this quality for holding babies, carrying shopping and going for a run.
Electronic devices monitor whether you are squeezing correctly and give you feedback on that action as well as ‘games’ to keep you occupied. However, because they are technically advanced, as well as being clever they are also expensive. Cones are a much cheaper, non-electric alternative (£25 – £30 with one type available on prescription).
Ancient arts…..
Did you know that vaginal cones are modern versions of Chinese Ming Balls? Once only available in sex shops and more associated with ancient “boudoir” skills than bladder control. But good things last the test of time and vaginal cones are now even available on NHS prescription!
Which vaginal weights are the best buy?
The main styles I recommend in clinic are: –
Neen Aquaflex Cones Pelvic Floor Exercises System – you put little weights inside a plastic cone and add more inside the plastic shell as you progress.
Kegel8 Vaginal Cones 3 different cones of lighter to heavier weight.
Lelo Luna Beads which are more obviously modern takes on the original Ming Ball concept
www.stressnomore.com and kegel8.co.uk carry all these styles – do use my promotion code SUPPORTEDMUMS for 15% discount from either site.
Aquaflex vs Kegel8?
I have had many clients use both the Aquaflex or Kegel8 system – they do exactly the same job – Kegel8 a bit prettier and more touchy-feely with a nice pointer to help you see how far in to put it in (and now available on prescription) . The Aquaflex cones have a finer retrieval cord, which appears from online reviews to make some people nervous but I’ve never had anyone have any trouble. The advantage of this design is you can put your knickers back on giving you more options of where you might use them.
Have a look at them both online and read the customer reviews – but I would say it is just a personal preference thing.
Cones and weights are a progression from the basic exercise
You do need to have a good foundation pelvic floor contraction first. Otherwise they are just going to fall straight out the minute you stand up – most disheartening.If this happens to you, I would recommend you get your pelvic floor technique checked by a specialist physiotherapist first.It is not uncommon for people to think they are squeezing quite perfectly only to find, on proper vaginal examination, that there is really not much going on at all.Don’t panic if this is you – it is all sortable but cones are not for you (yet!).
It’s like adding hand weights to your pilates routine
Good ol’ basic pelvic floor exercises come first (see thePelvic Floor School videos). You then add vaginal weights to your pelvic floor exercises to progress. Similar to adding handweights to your yoga or pilates routine. It takes the normal unloaded task and makes it more challenging by adding a resistance to work against.Adding “load” to a muscle encourages it to work harder and grow more. In the gym you can hold handweights for your arm exercises or push against a piece of gym equipment for more resistance challenge for your legs. The cones allow you to add some weight directly onto the pelvic floor.
How to use them
Though I said earlier it is like adding hand weights to arm exercises – it’s not quite like you might think.When you are exercising with the vaginal weights you are not trying to squeeze and contract, on and off like with traditional pelvic floor/kegel exercises. Now you are rather trying to hold the weight of the cone in place while you do another activity. You really are holding it to stop it falling out.
This style of holding exercise promotes the development of the slow twitch/endurance qualities of the muscle – think of channelling Mo Farah (for 2 hours on your feet at playgroup) rather than Hussein Bolt (though we need his power for The Knack when we cough or sneeze).We need to develop this endurance muscle skill for when we are lugging shopping or carrying toddlers or trying to enjoy prolonged exercise.
First find the right weight
If the vaginal weight is too heavy you will feel the cone slip out of position within 30 seconds.If it is too light you might find you have completely forgotten all about it and practically gone out shopping with it.It will have just been sitting in the vagina like a plastic tampon.
The right weight should feel like you are not doing anything terribly exciting for a minute or so. Then you start to feel that it is slipping towards the vagina opening and needs a little push to reposition it.This means that your muscles were holding it well, in an endurance hold, but as you started to fatigue, the muscles loosened and it started to move down the vagina tunnel with gravity.
When inserting the cone it can help to use a tiny dab of personal lubricant on the end to help entry to the vagina. Beware anything more than a dab or you will never hold it in. Think more cork fully in a bottle than tampon position. The Kegel8 has a marker on the “tail” to guide placement. With the Aquaflex you should have to reach inside about a knuckles depth to feel the base of the cone.
Then choose your venue
I don’t recommend wearing them out of the house as some adverts suggest. That just seems like asking for trouble to me. I suggest that you stay securely at home and start by putting the cone in for a relatively still activity. Then increasing the challenge by adding activity.
A customer favorite is to use the cones when you are going to wash your hair in the shower – based on the principle that this is about every second or third day and you don’t forget to wash your hair. I also like that you are going to be naked anyway and its a naturally clean environment. You can keep the cone you are using hidden discreetly in the bathroom. Ideally somewhere close enough to the shower that you can reach it even if you’ve already got in and got wet before you remember the cone.
First skill – just stand still!
First goal is to just stand still and wash your hair as normal.You will find yourself more conscious of your underneaths (!) and if it’s the right weight you will feel the need to reposition it a couple of times as soon as your muscles tire.About the 4th time you come to wash your hair you should be noticing that it slips less easily and then very soon it doesn’t feel like a challenge at all.
Progress to complex activities…
Now put your shampoo & toiletries on the floor while you shower. This will make you have to bend up and down a few times mid-hair wash.
When this is easy, progress by extending the showering session to include standing on the bath mat and over-dramatically rubbing dry. Then add in a little jog on the spot. The ultimate tests are a bit of jumping up and down – and a pretend cough. The thought that you could shoot the cone across the bathroom if you don’t hold on will certainly activate the right muscles.
Once you can do all these things with your first weight time to progress. If you are using the Kegel8 cones move to the next weight up, if you are using Aquaflex, unscrew the cone to add another weight inside. Now, with your heavier weight in place go back to standing still and just hairwashing, progressing through the stages as before.
And maintain weekly….
Once you feel you have improved your muscle strength, endurance and co-ordination vaginal cones are neat to establish a “maintenance drill”.Pick one of your hair washes a week (say the weekend wash) to be the “cones-wash” and as long as week on week you are still as masterful at your washing, jumping and coughing routine you know the muscles are keeping strong.
Other popular activities
ironing – progress from simple tea-towels to complex men’s shirts and put the basket of laundry on the floor so you have to bend more
emptying the dishwasher – takes longer if you are multi-tasking with the cones but a nice bit of bending/stretching and few steps about the kitchen required
childcare – my sister’s mantra was never doing anything when you child is asleep that you could have done when they were awake. Under 5’s are not going to remotely notice what you are up to. Put some music on! Start with some sedate wafting about to gentle nursery rhymes and build up to a good stomping rendition of the Grand Old Duke of York or a bit of Justin Bieber (no judgements here).
Let’s grow this list. Have you tried vaginal cones or weights?When (Where???!)do you do yours?Do share (photos optional).
If you have a smart phone you may enjoy one of the new pelvic floor exercise apps. These are great innovations. This week I have tried out a couple of reminder apps (Squeezy & my pff), a tracking app (Elvie) and an exercise workout to watch on your phone (Pelvic Floor First)
Road-testing has had entertaining moments with my phone beeping and buzzing. I have done a LOT of pelvic floor exercises this week.Perk of the job.
TIP (obvious, to everyone else I’m sure, but I did it by accident):When you are looking at them the first time and organising your settings you might find it easier to view the app on your iPad/tablet so all the buttons and instructions are bigger.
Sadly there is no app that actually does the exercises for you. Though they all have similar sounding descriptions on the app stores, I would categorise them into ‘reminder’ apps, ‘ exercise tracking’ apps (with wearable device) and ‘portable exercise workouts’ to follow on your smart device.
REMINDER APPS
Squeezy NHS app gives regular reminders and lovely visual prompts to follow
Squeezy – the NHS Physiotherapy App for Pelvic Floor Muscle Exercises, Propagator Ltd £2.99.Also offers the Apple Watch App for iphone.
This has been designed by one of my specialist physiotherapy colleagues, Myra Robson, using all her NHS experience and hundreds of clients feedback to develop an informative, easy to use, clear and visually pleasing app.You can change settings easily yourself to chose how many times a day you want to be reminded to do your exercises. It sends you a (silent!) text message to remind you to do your exercises. Then you tap on the screen to start a balloon/type bubble moving – you can’t but help start squeezing in response!Its a great visual prompt (with optional ‘boing’ noises).There are drills to practice fast contractions or slower ‘holding’ contractions.You can change the settings to make the exercises a comfortable speed for your ability. You can record your sessions, as well as how much you have been drinking.
If you are working with a physiotherapist they can help you set up your programme to fit with their training and check up on your efforts!
My pff by tena
My pff – an app sponsored by Lights by TENA.Free.
This free app is a similar exercise concept, with a screen changing colour up and down to show you how long to hold and relax for, but lacks the helpful information and bespoke settings options of Squeezy. It was very simple to chose your level (in the settings bar at the base) and then get started. I liked the very simple interface of this app but similar to the reviewers I had problems with it crashing when trying to set the reminders.Once I had set them (2 or 3 crashes but it restarted easily each time) it worked fine.I like that there was a simple button to turn the reminder off (if you finally get a daytime nap you would be hideously cross if it’s an app that wakes you up)
HACKUse your phone clock function! Free.
Set your phone’s ordinary timer to alert you every 4 hours through the day to do your exercises
Exercise tracker device with smart phone app
The Elvie is a discreet vaginal device which tracks your pelvic floor exercises on your smartphone
Elvie feedback/tracker device with free app £169 www.elvie.com
Tracking apps communicate with a wearable device. You may already have a FitBit worn on your wrist to communicate with your phone? The Elvie is, as they say, ‘the most intimate’ tracker – a small, pebble shaped unit which you put inside the vagina. Then it communicates via blue tooth to a phone app. When you practice your pelvic floor contractions a patented force and motion sensor system detects the strength of the muscle activity and shows up on your phone screen, giving you real time information about how well you are contracting. There are clever ‘games’ to play by contracting your muscles – think pacman controlled by your pelvic floor? It records your exercise sessions – great for motivation.
Important note – designed for discreet home exercise, unlike a FitBit, not for going out & about!
WORK OUT APPS WITH PELVIC FLOOR FRIENDLY EXERCISES
The Pelvic Floor First app has great pelvic floor friendly workouts
Pelvic Floor First – by the Continence Foundation of Australia . Free.
This app is not a ‘reminder-type app’, rather a portable workout regime to copy.If you like your pelvic floor exercises disguised amongst your other body part exercises then this app may be just right for you.The app is based on the Continence Foundation of Australia’s Pelvic Floor First website with the workouts designed by a physiotherapist and fitness professional to be ‘pelvic floor safe’.
There are 3 levels of workouts, using light hand weights and a gymball as props.The exercises are very clearly presented as just stills, audio or audio & video together.It has a nice feature to count down a daily workout but you do have to keep starting each new exercise by pressing the arrow on the screen.
Have you tried a pelvic floor exercise app?Did you like it? Please share your recommendations in the comments below and let me know which one I should road-test next?!
