NEW: Add-on Support from Specialist Physiotherapists
The Pelvifly is a new bit of female health kit designed to help women practice pelvic floor exercises correctly.
Pelvifly has two parts, an internal device and a phone app. The K-Goal is a blue balloon probe which you put inside your vagina leaving a small handle-like antenna resting outside on your pubic bone. The balloon part reacts to your pelvic floor squeezes and relaxations feeding information to an app on your phone. In real-time you can watch your pelvic floor exercises with your own eyes!
AND its fun! Truly. When you squeeze a butterfly moves up, when you relax it gently floats down. Getting clever you can land on flowers in an up and down pattern. Surprisingly challenging!
Pelvifly: how to use it completely by yourself
Straight out of the box, with no further costs, you sign up to the free App and Patient Portal on your phone. There are clear instructions how to wash, insert and get started.
You will immediately be sent animated “muscle tests” to do. First checking in on how well you can relax your pelvic floor muscles by breathing and keeping a butterfly still. Then seeing your ability to squeeze your muscles very strongly, medium strength and softly, as you set your butterfly off collecting flowers. Also it will test your ability to hold a contraction for several seconds.
After your test sequence Pelvifly shows you graphs and gives you some data about your muscle skills.
This data is then used to send you daily challenges according to your test level. There are 5 games with advancing levels. Clever AI will send you the right levels. Tasks will involve rockets flying through tunnels, basketballs into hoops and a cute octopus! The games are designed to focus on different skillsets that pelvic floors need to learn; how to relax completely, how to contract both softly and strongly, endurance and speed training.
A path of progress will be automatically created for you with new levels & games unlocking as you improve your skills and performance.
Stuck with the Pelvifly? How to use it with online physio support
The Pelvifly probe and free app is a fun and effective device to use DIY. However, each person has an individual story and journey. You may feel your problems need to be individually understood, and treatment & exercises planned according to your specific situation. You may wish to work with a specialist physiotherapist, who has extensive post-graduate training in pelvic floor rehab, childbirth recover and care through the changes of menopause and beyond.
Work with a PelviCoach for a one off session or subscribe for a complete support package
The ideal is to find a physiotherapist local to you for regular face to face visits. But if this won’t work for you (and this could be for a myriad of reasons other than Covid!) Pelvifly is an ideal tool to use remotely with a virtual physiotherapy service.
Who is a PelviCoach?
A PelviCoach is your personal training supervisor. In the UK Pelvifly have teamed up with the Mummy MOT network of Specialist Physiotherapists who can offer pure telehealth or hybrid virtual/clinic support, with the K-Goal for biofeedback, at the heart of your treatment package.
How can I book PelviCoach support?
Basic & Smart Plan users can select a PelviCoach from the list of available UK physiotherapists in the mobile app. The PelviCach’s photo, biography and charges for a one-off consultation will be visible on the online portal. The PelviCoach will set up an online 30 minute consultation with you within 7 days. The PelviCoach will be able to see your test results, give you tips and advice about managing your issues and help you get the most from your automated programme.
A Care Plan subscription (£96 for one month) is also available. You use the app to choose your PelviCoach from among a list of available specialists. You’ll receive a welcome message from them within 24 hours and make plans for a regular once a month online consultation with extra email or text support between. On the Care Plan your PelviCoach will have the results of your tests and exercises, and access to every training exercise to tailor a unique programme for your bespoke needs.
More about Coaching on the monthly Care Plan
A PelviCoach wants your training to give the best results possible. In the first week she will organise a mutually convenient time for an initial half hour virtual or phone appointment to discuss your goals, your problems, and the results of your DIY training so far. She may also ask you questions relevant to the proper treatment of pelvic floor muscles. This includes questions about menstruation, childbirth, health problems, and sex life.
As a specialist physiotherapist she can also answer any questions you may wish to ask. She will explain what the training is like and how muscles work & – most importantly – help you get started with your Pelvifly training programme.
Exercises tailored to your needs
The muscle test which you perform when you use the app for the first time is crucial to your training plan. Your PelviCoach can see graphs of your results:
This really important information serves as the basis to determine the right level of exercise difficulty taking your capabilities into account. For example it may appear that it is not the contraction force of your muscles that needs your attention, but the endurance of your muscles. Your physiotherapist can set up bespoke practice sessions using the full variety of games available so that you work on the skill-sets that will help you make the best and quickest progress.
Monitor your progress
Through your first month your physiotherapist will keep in touch with you by email to make sure you are getting on well. You can use the message facility to contact them too.
At then end of the month your PelviCoach will send you a second test to help you both to analyse your progress. Then each month thereafter, that you are subscribed to the Care package, you will arrange another virtual session to monitor, encourage and support you to progress towards your goals.
Its not only about Pelvifly
Mummy MOT Physiotherapists have a wealth of skills and knowledge to share with you. If you struggle with your pelvic floor technique, or want further face to face clarity or help with other issues they can arrange an additional face to face appointment with you or with a local colleague from the Network.
Supported by smart algorithms
Apart from the support of your PelviCoach, you’ll be also able to take advantage of additional in-app support. You’ll have access to motivating summaries with your training statistics and results of the performed exercises and muscle tests.
You’ll stay motivated to exercise systematically thanks to the path of progress featured in the app. It consists of 36 tasks which will help you achieve the best results possible if you complete them. By exercising on a regular basis and collecting points during your training sessions, you’ll be moving up the levels, from easier to more difficult ones. You’ll be going through three phases – consciousness, control, and improvement.
The benefits of the Pelvifly CARE plan
To sum up, the Care Plan is £96/month & includes:
individual supervision by a PelviCoach
a preliminary interview with a specialist
an analysis of the muscle test and a monthly comparison
a personalized training plan
exercises without vibration and with 20Hz/50Hz vibration, biofeedback
analysis of training sessions performed in a month
access to a PelviCoach by email or text
a history of exercises and training sessions – including results
reports summarizing your training periods
a progress path consisting of 36 tasks to enable you to achieve your goals and monitor your progress
Pelvifly is available in the UK from Pioneer Medical priced £130 (VAT exemption available)
Author: Amanda Savage MCSP MSt (Cantab) Specialist Physiotherapist
How much should you hold your pelvic floor muscles during everyday activitites?
Are you supposed to think about them?
Or should you just let them do their own thing?
First it depends if you are a naturally tense or relaxed person? Then to consider whether they have fully recovered after childbirth? They should work on ‘automatic pilot’ going up and down through a variety of gears. But you might need to re-train that skill.
MIght your pelvic floor muscles be just wafting about?
Do your pelvic floor and tummy abdominal muscles support your internal organs and your back as you go about your day? Or might they have a tendency to droop when you aren’t paying them attention? Might you have a pelvic floor with a tendency to “waft about”??
Its probably the most common thing I point out to mums in clinic. Even if you have been religious about using Squeezy App and doing your daily pelvic floor targeted exercises. You may have one more step to go. Making sure that your pelvic floor joins in more when you do more and knows how to relax when you relax.
Should you hold your pelvic floor muscles up ALL DAY ?!?!
Yes…. and ….No. Just like your abdominals and all the other muscles of your body your pelvic floor is not a one gear, one trick pony.
We have moved on from the concept of “on” or “off”.
We realise now that your brain needs to decide at any given moment how much muscle activity is “enough” for the task you want to do. A well trained and exercised pelvic floor can automatically choose to be completely relaxed, fully sharp and contracted, with plenty of medium level options in between.
What is Your Resting Tone?
This is the amount of activity your muscles have at rest. Where they sit naturally when you are not thinking about them.
Untrained muscles, or muscles after childbirth or an episode of injury, can have terribly low resting tone.
To be fair – I think this mama is asleep – but how many of us look like this when sat on the sofa (#GBBO)??
Too Little Tone:
…leaves us “hanging” off our ligaments with a tendency to overstretch joints and muscles into saggy patterns. This has obvious cosmetic fallout. Also you will have difficult stabilising movement (getting weird joint clicks and clunks), or be vulnerable to injury. Untoned muscles are responsible for issues like incontinence, bladder urgency, difficulty emptying bowels and pelvic organ prolapse.
Or do you relate more to this Mum – fired up & alert, all the time ??
Too High Tone:
…has you perched on the edge of your seat, tense glutes, shoulders up, neck muscles tight like guitar strings – leading to neck pain, shoulder aches and pelvic pain. Sometimes also responsibe for incontinence, urgency and difficulty emptying bowels too. I know seems weird! But too MUCH pelvic floor tone can be a problem as well as too little!
Video: grading pelvic floor control in standing, carrying, reaching and JUMPING!
Today’s video was made last year, in collaboration with Tena. This is part of a series teaching pelvic floor from basics to more advanced. A Pelvic Floor Exercises 101!
In this video, experiment with me and the lovely models as we explore finding our pelvic floors and controlling how much they work – even as we move handweights and try a bit of stretching & leaping too. It takes practice to improve your “automatic pilot” function for every day life.
https://youtu.be/kPdIILv_7fg
So Mama’s. Pelvic Floor Muscles for Real Life. No pelvic floors just wafting about! Practice standing up. Add some hand weights. Stretching.
And if you want to get back to running or that trampoline you gotta practice JUMPING too!!
The information contained above is provided for information purposes only. The contents of my blogposts, articles and my videos are not intended to amount to advice and you should not rely on any of the contents if you are not a face to face client of mine. Professional advice should be obtained before taking, or refraining from taking, any action as a result of the contents of this article. Amanda Savage disclaims all liability and responsibility arising from any reliance placed on any of the contents of this article or video.
Why stretching around the pelvis could help the pelvic floor work better….
Pelvic floor STRETCHES? Are you puzzled? Were you thinking that my advice would be to work on tightening up and strengthening your pelvic floor?
Did you know that taking time to stretch and align the muscles all around the pelvis might help the pelvic floor work better? YES! Just once a day for about 6 minutes can make Mums so much more comfortable – and find their pelvic floor muscles really perk up. FAST. It’s not crazy. If your pelvis is wonky or your back is stiff – just tightening up the pelvic floor muscles won’t improve bladder control. Because the muscles can’t work properly together if they are at funny angles!
Today we are exploring WHO might need to do that (and WHY) and HOW to do the right stretches really well (and quickly).
VIDEO: Pelvic Stretches for Mums
Why we need to do pelvic floor stretches before we strengthen
The muscles must work together to control and move the pelvis.
You could picture your pelvis muscles working together just like the guy-ropes on a tent. If there is a good balance through every part of the rope network the tent sits upright, symmetrical, self-supporting – it holds strong but can sway in the wind as needed, able to adjust to change in the environment with ease. You can easily open the door and push your way in with no effort or move bags of kit back out. The tent has full height, the groundsheet is stretched perfectly corner to corner without wrinkles or twists.
Magic, when all is well…
In a similar way when the muscles around the pelvis have good length to allow the pelvic bones to sit symmetrically, at the right angles, you can sit comfortably on a chair, or move efficiently transferring your weight seamlessly and effortlessly from one leg to the other as you walk or climb stairs. Your back feels comfortable, hamstrings don’t get injured, bowels empty easily, bladders fill and empty without trouble, pelvic organs stay securely inside, sex is comfortable.
But problematic if out of kilter
However, there are problems if one or more guy-ropes is overtightened..
Changing the tension in some of the guy-ropes on one side of the tent will cause distortions to the tent not only on the side of the ropes that have been tightened but also on the opposite and/or diagonally opposite side. In the video (above) see how this distorts my ability to whistle – even though there is nothing wrong at all with my mouth muscles?
Symptoms can seem logical: soreness right where the scar is making sex painful or tampons uncomfortable, or making wearing tight clothing irritating. Or more distant issues can develop like sciatica, persistant pelvic girdle pain, bladder irritability or constipation.
Are you out of kilter? A hidden consequence of childbirth?
Did you have a difficult pregnancy with pelvic girdle pain or back pain, or just a very heavy baby (!). Were you limping around a bit towards the end?
Did you have to work your pelvic support muscles very hard during your labour? Lots of squatting, using your legs to support you? Or maybe your legs had to be up and held at a funny angle for a while? That would be something that would make your inside thigh and abdominal muscles work very hard.
And of course the common scenario that causes this type of guy-rope problem is an episiotomy or perineal tear during childbirth. The scar that forms can be more rigid than the original tissue – creating a pucker or pull on one side of the pelvic floor.
If after your baby you were really sore you might have found yourself sitting sideways in your chair, or sitting awkwardly on the edge? Or you might have limped around trying to stop everything hurting? Unfortunately, very quickly it can become a habit to have tension in the pelvis.
So tbh there are not many mums who wouldn’t benefit from doing some pelvic floor stretching!
Quick Guide: Technique
Which style of stretches & when?
Use static stretches (the ones you ‘hold’ for 10-30s). No bouncing!
Start with once a day to learn and enjoy the stretches. Then you are looking for 2-3 opportunities through your day to stop and deliberately release tension and stretch the different muscle groups. Pick stretches to suit the environment you are in. Once your problem has settled then drop to a once a day holistic sequence to keep the muscles stretched for ever.
They are best done when the muscles and soft tissues are a warmer temperature:
when you get back from a trip to the park,
after an exercise class, or dance-a-long with the kids
warmed up by a bath or shower,
after a TV snuggle under a blanket before climbing into bed….
How many & how long?
Hold each position for a comfortable stretch for 30 seconds, repeated 3 times.
Research shows that you do not achieve anything extra by doing more reps or increasing the time.
If you have a lot of pain start with fewer shorter stretches eg 2 repetitions of 15 seconds each.
Quick Guide: 3 Favorite Pelvic Floor Stretches for Pelvic Flexibility
#1 Hip Flexion with opposite leg extension
Hip flexion: gently draw one knee to your chest then let the other leg slide out straight. 30 seconds letting gravity do the stretching work. 3 x each side.
#2 Butterfly Stretch
Adductors: 20-30 seconds gently easing out the inner thighs with gravity. 3 x
start: feet on floor
progress: feet in air
#3 Happy Baby Stretch
upper hamstrings: ease the “sit bones” wider. 20-30 seconds. 3 x
start: hold thighs
progress: hold feet
Let me know if this helps you?
Try the three stretches (or 15 mins guided video sequence) every day for a week and see what you notice changing? Improved posture, easier squatting to the floor, better bowel opening, more pelvic floor awareness? Do let me know?
Which is the best electrical stimulation programme for new mums wanting to rehab their pelvic floor muscles? This is one of the topics Kegel8 founder, Stephanie Taylor, asked me about in some video Q & A sessions about the Kegel8 Ultra 20 machine. She is passionate about helping their customers get value and success from a purchase.
In this video:
What to do to help your muscles from the very early days before you can use an electrical stimulation machine.
When you can start using a electrical stimulation machine safely after birth
Why it is important to test the sensation in the nerves, have a longer rest time between contractions and how to avoid muscle fatigue.
Watch here (or read the adapted transcript below). In this video we are discussing the electrical stimulation programmes for new mums on a machine called a Kegel8 Ultra 20 V2 Electronic Pelvic Floor Toner. Other models in the Kegel8 range are very similar. The principles are the same for all electrical stimulation machines. Even if you don’t have a Kegel8 you might find this helpful to understand how your own-brand of machine works too.
https://youtu.be/EHrAtWd0Z0U
Q: Stephanie asked me: “We’ve got lots of programmes on the Kegel8. I’m a new mum. Which programme is going to be best for me – if I’m looking to get back in shape – what’s your recommendation?”
The first few weeks: simply connect your brain and pelvic floor naturally
Let’s start by thinking about a very new mum. You’ve had a baby and you are starting out with your exercising. In the first 12 weeks the body is very fragile and very vulnerable. We do want you to start exercising but we don’t encourage the use of electrical equipment in this early phase. Why? Partly because you will still have some bleeding, you might also have some hidden raw wounds but also because it is a fragile vulnerable time.
What you do need to be doing in those early days is using your muscles as best as you can. Using your own brain to to activate them. Even if all you are doing is pulsing your muscles a tiny bit and you think “Is it worth it?”. It IS. Because that pulsing action will bring blood flow close to the area. Blood flow helps healing. And helps to get healthy tissues again. In your head it will feel like little tiny pulses, not very exciting. Everything might feel swollen and engorged. But those tiny exercises are a really important thing to do. Little and often through the day. To keep your brain and your pelvic floor connected together and encourage these muscles to start working again.
From 6-8 weeks: feeling proper contractions
About 4-6 weeks you should be feeling that you have some proper pelvic floor contractions. They should feel useful to you. For example, when you want to cough and sneeze and pick up your baby. It’s all a bit mad that nature delivers through the muscles that you need and then hands you a heavy baby to look after. Not quite how you or I would have designed it. But that is the reality. So we’ve got to get these muscles working.
From 12 weeks: why you might choose to use an electrical stimulation programme?
After 12 weeks there are other options to consider.
If you are not getting enough sense of being able to exercise your muscles yourself
Or you don’t feel that you are getting a pelvic floor muscle contraction.
Or you don’t feel that you are progressing.
Then you might like to use a machine to help you.
What is special about the electrical stimulation programmes for new mums?
Some programmes on the Kegel8 V2 Ultra 20 are designed specially for postnatal mums. For example programmes 14 & 15. What makes them different?
A sensory phase
The first phase of these programmes is actually a circulation phase, a very low frequency current, to create just a tingling sensation for about 10-15 mins. This allows you to test whether you can actually feel anything. A problem that can affect new mums is finding that the nerves aren’t working properly at all and you can’t feel things properly. It wouldn’t be safe to use a machine if you couldn’t feel properly as you would have no way of knowing how high to turn it up which could be sore. So the first phase allows you to test for what you can feel. This phase is also really good for circulation. It brings blood flow to the area and oxygen to the tissues.
A muscle strengthening phase
Later in the programme it moves to a muscle strengthening phase. It actually makes the muscles tighten and release. But different to the one that is listed for stress incontinence, this phase has a longer rest time between the contractions. When we make muscles contract they do need to be able to relax completely between contractions before we ask them to contract again.
A longer rest time
When your muscles are very weak it is important to have almost twice as long resting to working. As you get stronger you can choose a programme where there are shorter rest times but when you are very new post delivery it is really important to have a rest phase.
An overall shorter programme
The overall working in this programme is 15-20 mins maximum, because your muscles will fatigue easily. Tired muscles can’t do anything. Yet you’ve got to look after the baby! So it’s really important that the machine doesn’t made you so tired that you can’t look after your baby and hold your body up!
So that is the idea behind this programme being called a postnatal programme
Q: How often would you recommend using an electrical stimulation programme for new mums?
The manufacturers say that you can use these devices up to twice a day every day. I think a lot of women feel that is an unrealistic goal. We tend to start women out in clinic using their device once every other day. As a starting place. You don’t want to put yourself off. These are plastic gadgets in in very delicate places! If you do too much too quick you end up not wanting to do anything.
So I tend to aim to underachieve at first. Use it for 20 minutes every other day. Then if that is going well, and you are liking it and you feel it is beneficial, you could go to every day. And if you were blessed with time to do twice a day that would be a bonus. I am not sure that is very many mums?! We find people get good results on every other day or once every day.
Feeling more confident how to choose an electrical stimulation programme as a new mum?
I hope this post has given you more confidence to get started with a Kegel8 Ultra 20 stimulation machine or something similar? We have made several other videos about using stimulation machines. For other conditions, for example for a prolapse, for an overactive bladder or for stress incontinence. We also do a Q&A to show the different types of probes available.
Please don’t hesitate to email if you have questions and I will do my best to help. Please do comment below or on YouTube if you found these helpful.
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If you have any specific questions or concerns about any medical matter, you should consult your doctor or healthcare provider as soon as possible.
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How to get started with an electronic pelvic floor toner
Are you trying to get started with a Kegel8 Ultra 20 stimulation machine? Let’s be honest. The instructions that come with pelvic floor toner machines are not great. They are generally from the era of men in labs writing high-tech specs in teeny tiny writing. However, Kegel8 are a company working hard to make it easier for women to use a pelvic floor stimulation machine by themselves, or with their physiotherapist. I was delighted that they asked me to film a Q&A session with company owner Stephanie Taylor, to try to iron out some of the bits that frequently confuse.
In this video
What’s in the box?
Which cable goes where?
The purpose of gel and how to insert your internal electrode
Which buttons to press
A good first programme to try for muscle strengthening
Step by step what you will feel (8:47)
Turning up with confidence!
How many times a day when you are starting out?
Watch here (or read the adapted transcript below). In this video we are demonstrating how to get started with a stimulation machine called a Kegel8 Ultra 20 V2 Electronic Pelvic Floor Toner. Other models in the Kegel8 range are very similar. The principles are the same for all electrical stimulation machines. Even if you don’t have a Kegel8 you might find this helpful to understand how your own-brand of machine works too.
Using a stimulation machine to get a pelvic floor muscle contraction
These machines can be used for several different reasons. Today, let’s assume that you want to get a muscle contraction. First so that you can start learning exactly where your pelvic floor is. Second to know what it feels like when it is working correctly. And to help you towards the goal of learning how to do pelvic floor exercises yourself, without a machine. As recommended by physiotherapists (!). Pelvic floor exercises help problems with bladder or bowel leakage, to support a pelvic organ prolapse and for full recovery after childbirth.
What’s in the box?
In the video we can see everything that comes in the box. But we are not going to need the surface electrodes or the second wire at the moment. To get started with your stimulation machine all you need is the machine (with the battery in ) and one lead wire.
Step one – insert your vaginal probe
So the first thing I would get you to do is to put the probe in. In the video we are only going to pretend!
First put a nice big blob of gel on a tissue. Then put some gel on each bar, a really good coating. Twizzle it over and get the gel around the back. Then a bit on the end to help it go in.
When you put the probe in, I would suggest lying down. At home it could be on the sofa. So underwear off, lie flat and put the vaginal probe in with the bars going side to side. It’s not dissimilar to a tampon but you are not putting it in so far. You want to feel 1 cm of cable inside. You don’t want it sticking out on a stalk and shouldn’t be able to feel the plastic. And then you can put your underwear back on, which feels more natural. Have the cables down one knicker leg or out the top. Or your PJs or tracksuit bottoms. So that if anyone came into the room they wouldn’t know what you were doing!
Then connect your vaginal probe to the lead wire
There are two tails from the vaginal probe to connect to the lead wire. It will be a bit tight – you need to push them in until you can’t see the metal. It doesn’t matter which end to which. Some stimulation machines come with black and red coloured ends, which is a little bit disconcerting, as it does look like jump leads, but again it doesn’t matter which to which as long as a nice firm connection.
Note: When you put them in and take them out always use the tough plastic bit. Try not to pull on the wires as they are quite delicate.
Connect the lead wire to the stimulation machine
Now,the single connector at the other end will connect to the top of the hand-held machine. Plug the top of the lead wire into one of the ports on the top. It doesn’t matter which port you use. But whichever side you plug in at the top is the side buttons you should use. So all on the left or all on the right. We are going to plug into the top left. So we will be using the left hand buttons when we want to turn the machine up.
Turning on your machine
To get started with your stimulation machine press the classic “on” button symbol. Up on the screen will pop lots of information and symbols.
Choosing a first programme to try
First we are looking for which programme we are going to use. Today, for demonstrating a programme for muscle strengthening, we are going to choose Programme 10. I am going to press the programme button over and over until I have gone all the way to P10. It’s on a loop – so if you do what I did in the video and go too fast (!) you have to go all the way around again until you get back to your programme.
Now we can see the number of the programme and it’s name. Don’t get too bogged down by the names. They were pre-programmed a while ago and they don’t always exactly match with the symptoms women have. Kegel8 are making an updated list to help you choose (available soon). Programme 10 is called “stress incontinence” which you might or might not have. However, this is a muscle strengthening programme. Something many women know they need to do. P10 is a useful one to get started with a stimulation machine.
In the top Right corner you can see what we call the parameters – the frequency and the pulse width. Like when you tune your radio and choose your channel. The programme choice decides what style of electricity is going to come to you. Programme 10 has two phases, indicated by the two chevrons.
Starting with Programme 10 Phase 1
When you switch this programme on, the first phase of the programme is a sensitivity test, also for circulation. It’s not at first going to make your muscles work. The first phase is just stimulating your sensory nerves and letting you feel whether you can feel this machine. It’s really important that we know that you can feel. Because if you have damaged nerves for any reason you could feel sore before it was of benefit to you.
Look for the bottom number, Zero, in line under your connected cable. This is like the volume on your radio. It is zero which means you are getting no electricity at all. Go ahead and press the + button, + + +. I suggest you go up to 10 straight off because very few people feel much before this level. In the video, Stephanie has the probe in her hand. In her hand Stephanie it’s going to feel it very quickly and strongly because our hands are very sensitive! However, if the probe is inside the vagina you probably wouldn’t feel it at all at 10. However, the current is running – You can tell this because you can see the number go up (the mA). Each 10-15 seconds turn it up a bit more. Edging it up until you can feel it.
What to expect with the first feelings as you turn up
You will feel a light – tingly – maybe a bit scratchy sensation. Some people say it just feels warm. There isn’t a right or wrong feeling, but it’s something that wouldn’t be there otherwise. This is the first place we try to get to. Stimulating your sensory fibres and letting your brain go “Oh yes, that’s where my pelvic floor is!” Though mostly people will go “Oh, that’s not where I thought my pelvic floor was!”. Perhaps a bit deeper inside you than you were expecting? We often think it is all at the vagina opening but actually the pelvic floor muscle belly is deeper inside.
If you haven’t had much going on with your pelvic floor for a while, then this is all going to be new! This is learning. Just spending your first session FEELING and getting used to it could be all you need to do initially.
Why it might quickly change to a lighter feeling
It is normal that after after a few minutes you might notice “I can’t feel it anymore”. Why’s that? Your body is getting used to it – accommodating. Your body is going “Oh, this is alright”! Not as scary as you thought it would be! Your brain has relaxed and blanked it out a bit now. When it fades you need to turn yourself up a bit more, using the + + + until the feeling comes back again. In your first couple of sessions you will probably have to keep turning yourself up a bit, little and often. Until you have become a bit braver, got used to the feeling and know which settings work for you best.
Once you’ve got a bit more used to using this you will know where to head for straight away. But initially it’s best to go really cautiously. Don’t scare yourself, take your time, and get used to having sensations coming up to the brain from the vagina.
Moving to the second phase of programme 10
With this particularly programme we have chosen to use today, the sensory part of the programme takes 10 minutes. When this 10 minutes has gone by it will move to another phase. You will see the little numbers at the top change to 35Hz frequency and 250µs pulse width. This is the setting that could make your muscles work for you. From a muscle strengthening goal, this is where we want to get to. Past the sensory phase, onto the next phase.
Now I am going to encourage you to turn up the current (mA) of the machine more until you start to feel something actually happening inside the vagina area, where the pelvic floor muscles are.
It is a bit weird when it happens. People will say it feels “like a pressure”. Or it feels like “just like a contraction” or “like something tenses”. Or they feel something move – what they are feeling move is the probe. In the second phase the current will be coming on and off rather than be continuous like in phase 1. The contraction/electricity will be coming on for 5 seconds and then it will go to zero for 5 seconds. You will see the number at the bottom, the mA, coming on (say to your setting of 25) and then off again.
When you get started with a stimulation machine, it is really important that you have the rests. It is not wrong that it goes to zero. If you count, you will feel it coming on for 5 and off for 5. Another clue, is the little top right arrow moving to the highest position “work” and dropping down to “rest”.
Making sure you are getting a pelvic floor muscle contraction
At this point we want a pelvic floor muscle contraction. Now it’s a little bit of playing with the amplitude (the up and down buttons). You want to get it as strong as is comfortable. Because it’s only when it is a bit stronger that the muscle will actually contract. One of the problems we see with the machines used at home is that women have been plugged in, and they are running a moderate current through, but it’s not quite enough to actually make the muscle DO something. So they are not stimulating the muscle as much as they could. If you can’t get it to that place its fine. It is still of benefit to the muscle. But the best place is where you have felt it do something and then it relaxes.
Can you feel it doing something and relaxing? If you are not sure, another way to tell is to reach down and hold the cable. This is what I would do if you were in clinic to check you have the current high enough. When the machine comes on you will feel that there is a slight pulling inside. When the machine goes off you want to feel a letting go. Sometimes you are not sure if it has actually pulled in – but you feel it let go. That’s your clue!
How high to turn up the machine?!
Once you have got a muscle contraction, you can edge it up a bit higher. But never ever make this uncomfortable.
It’s wrong if you feel. thecurrent coming and you are feeling yourself backing off from it. That’s too high. That’s not helpful or therapeutic. You want the opposite. You want the feeling that when it comes you want to embrace it.
How to work with the stimulation machine
It is great to feel that you want to do your squeezes at the same time as the electricity is stimulating your muscles. If that happens, then the machine is telling some of the fibres to work and your brain is telling your fibres to work. So those are the best squeezes of all!
However, you probably wouldn’t be able to keep that up for the whole programme. So one of my tips would be to join in for a minute and then let the machine run for a minute. Then join in again and then let the machine run. Or you might count joining in for 5 of them, and then chilling out for 5 of them, letting the machine do it’s own thing. And then try to do your squeezes at the same time for 5 then relax for 5.
How long to work with the programme when you are starting out
The second phase is set to last for 15-20 minutes. If you are quite new to this, that could feel like too much initially. You might use it for 10 minutes with a sense that you’ve done way more pelvic floor squeezes in the last 10 minutes than I’ve done all year! In which case turn it off. Stop. Come back to it the next day or day after and do another short session.
You will know you are getting used to it when you don’t feel you need to turn it off. You find you are quite happy to run the whole cycle.
When you get started with a Kegel8 Ultra 20 stimulation machine there are no strict rules about what will work or not work. The most important thing is that it is comfortable and it is doing something useful for you. Perhaps something that you couldn’t do by yourself. Or that you can exercise better with it than you could do by yourself. Or you might be using it to remind yourself, every now and then, what a squeeze is supposed to feel like – so that when you are doing your 3 x a day squeezes to build your muscles up – you have a better picture in your head of what it should feel like and that you are in the right place.
What to do if it feels like too much or not enough stimulation
You might find, even part way through, that you want to take the stimulation current down a bit – almost like it is becoming a bit overwhelming. Feel free to use the – button to edge back. Or that you have got used to it and want it a bit stronger.
The stimulation current may not feel the same or be the same number of mA each time
It probably won’t be the same exact strength next time you use it. Firstly because you might put it in a slightly different place. Or you might have a bit more or a bit less gel. Or your body might just be in a different sensory place. You might not need it so high to get the same response – or you might need it a bit higher.
It is just like the volume on a radio. Find a level that you feel comfortable with but still a good contraction and sensation.
How to stop the machine at the end of the programme or sooner
When the programme is finished, the machine automatically turns itself off. Or you can just press stop (off) whenever you’ve had enough.
How to clean the probe after your stimulation session
First disconnect the 2 ends from the probe – use the plastic bits to pull not the delicate wires! Put the machine and lead wire to one side so that you won’t drop it all on the floor. Then, in your own time, take out probe inside. Wash it in warm soapy water. Or use the anti-bacterial spray that is provided to spray it and leave it to air dry. It’s what we call clean technique. The vagina isn’t a sterile place. The probe doesn’t need to be sterile but you do want your hands and the probe to be clean to avoid any infection.
Feeling more confident to get started with your stimulation machine?
I hope this post has given you more confidence to get started with a Kegel8 Ultra 20 stimulation machine or something similar? We have made several other videos about using stimulation machines. For different conditions, for example for a new mum, for a prolapse, for an overactive bladder or for stress incontinence. We also do a Q&A to show the different types of probes available. Another series is all about the pelvic floor and how to do exercises without a machine too!
Please don’t hesitate to email if you have questions and I will do my best to help. Please do comment below or on YouTube if you found these helpful.
Medical Disclaimer
Any information or guidance we provide is not a substitute for the consultation, diagnosis, and/or medical treatment of your doctor or healthcare provider.
You must not rely on any information or guidance we provide you with as an alternative to medical advice from your doctor or healthcare provide and we expressly disclaim all responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered by you or any third party as a result of your reliance on any information or guidance we provide you with.
If you have any specific questions or concerns about any medical matter, you should consult your doctor or healthcare provider as soon as possible.
If you think you may be suffering from any medical condition, you should seek immediate medical attention from your healthcare provider. Do not delay seeking medical advice, disregard medical advice or discontinue medical treatment because of information or guidance we provide you with.
Nothing in this disclaimer will limit or exclude any liability that may not be limited or excluded by applicable law.
Happy Father’s Day! This post is a new collection of my favorite Pelvic Health Resources for men.
Men’s health and wellbeing is important. Please do share this blogpost, not just with the fathers – uncles, brothers, nephews & friends will appreciate you thinking of them too.
Pelvic Health Resources for Men
# Pelvic Floor Exercises
Research shows that problems like:
urinary frequency
post-void dribble
urgency (strong desire at the wrong time!)
flatulance or bowel leaks
getting up at night to wee
small bladder leaks
or erectile dysfunction
all respond really well to improving pelvic floor muscle strength, endurance and control.
Download and/or print this FREE booklet from my professional organisation. Clear pictures and instructions on the best technique.
Squeezy for Men is an education and reminder App (IOS or Android £2.99)
Squeezy has been designed by chartered physiotherapists specialising in Men’s Health working in the NHS. It is suitable for all men who want to do pelvic floor muscle exercises (also known as Kegel exercises). It is simple to use, discreet & informative. The visual and audio prompts help improve your technique & timing. And it records your practice sessions.
# Bladder & Bowel Health
Sometimes it’s just “operator” error or innocence. Who teaches us what a bladder does or doesn’t like, or how to sit on a toilet to get the best bowel opening? Never too late to learn!
Do you know how much you should drink in a day (like really know, not just guess)?? Have you ever actually counted your fluid in and out?? A bit of tweaking to avoid droughts & floods, and avoid irritating the bladder lining can be life-changing. Read more here.
Keeping the bowel moving well keeps pressure off your pelvic organs, lifts your mood and helps concentration.
There are 3 Ps which you should keep in mind during your ablutions. Are you or family doing any naturally?? How do you sit? Do some people in your family take a LONG time in the toilet? Who reads the paper? Should you keep books in the loo?
You’ve heard of “tight” hamstrings or calves? Pelvic floor muscles and other muscles that attach to the pelvis (inner thighs, gluts, lats) can also get too tight, restricting your pelvic movement and causing irritation to nerves. Sciatic nerve irritation gives classic leg pain, pudendal nerve irritation can cause testicular or perineal pain.
Men’s Health physiotherapist Bill Taylor shows how to use a spiky ball to release the inner thighs. Other good pelvic floor awareness & release videos on his YouTube channel.
Both Yoga and Pilates were originated by and for men. Joseph Pilates first taught his exercises to German compatriots interned on the Isle of Wight during WW2. Pants and pony tails are optional.
Plenty of men attend Pilates classes to get the benefit of a weekly supervised stretch, strengthen and mindful movement session. Do email if you’d like to try a real class (in Cambridge area) or virtual class (Saturday mornings) or subscribe to our online PhysioPilates Library.
If you have any worries that your pelvic floor is not quite what it should be, niggly injuries that won’t resolve or would like a general “MOT” of your situation, get your technique checked before you do too much more DIY.
# Specialist Physiotherapy Assessement
There is so much a specialist pelvic floor physiotherapist can teach you to improve internal muscle strength, endurance & co-ordination. They will also check your posture, core control & consider how previous injuries, surgeries or events may impact on your pelvic health.
Through post-graduate training, we have the skills to properly assess and examine the pelvic floor muscles with an external or rectal examination. We do this in a discreet and gentle way, putting you as much at ease as we can.
We aim to help you understand how your body works. With a better understanding of your muscles’ strength, weakness or tension problems, your exercises will make sense & be motivating. We can show you how to help them to grow stronger or release & stretch.
Do you need MORE SUPPORT?
Ask your GP to refer you to the local NHS services (if you are Cambridge-based you can self-refer). Or do come to see me at my practice South Cambridge Physiotherapy or arrange a virtual appointment.
Not near Cambridge? I believe finding a local physio is best for your longer term support. My professional body POGP and Squeezy app have national directories of physios who specialise in Men’s Health.
I hope you found this collection of pelvic health resources for men helpful. Please don’t hesitate to get in touch if you have a personal question.
Bladder support pessaries: extra support from the inside
updated 2023 (original 2019)
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 bladder support pessaries that 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. These can be a surprisingly inexpensive & eco-friendly option, compared to disposable pads. Ideal if you know when you will leak and need to use the device only for intermittent pre-planned activities.
Available in the UK at the moment are , Contrelle, Contiform, Efemia and Uresta. They vary in price chiefly relative to how many times they can be re-used. Contiform and Efemia are available on prescription.
Have you done your pelvic floor exercises, improved your core, modified high impact and improved your fluid management? Still not quite resolved your bladder leakage? Then one of the bladder support pessaries may offer an alternative to surgery (NICE Guideline NG123 2019). They have a similar mechanism of action (mechanical support of the urethra) to the TVT and colposuspension surgical procedures but no side effects or surgical risk.
In my clinical experience, these support pessaries work particularly well in certain situations. For example when the bladder has dropped only a little bit and the uterus is still well supported. Or, if exercises have created a good layer of muscles but you still need more bladder support to be active.
How do internal bladder support pessaries reduce urinary leakage?
These devices work by providing more support for the bladder neck. When you move fast (eg jogging, playing tennis) or there is an increase in abdominal pressure (coughing, sneezing, jumping), 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 you lay your hosepipe on a firmer surface, like a garden path, when you press down on the hosepipe the water flow stops. A toned pelvic floor should act like that firm path. But if yours isn’t up to scratch a pessary could do that job instead.
What type of urinary leakage will they help?
Bladder support pessaries 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.
These would suit women who don’t generally experience day to day stress incontinence but know when they are going to leak. For example if you know you will have incontinence if you do a run, or when you go to Zumba. Or if you feel anxious about an event, like going to a wedding, or travelling. You might only use a product like this once or twice a week. With one of these in you might not need any other protection, or would feel confident with simply a liner or a pair washable knickers “just in case”.
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 or Efemia 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
Field Guide: bladder support pessaries 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
Contrelle Activgard
single-day use only
recently available in the UK again direct from Contrelle or also Boots.
sizing kit of 3 £6. Pack of 5 £15
Contiform
available on NHS prescription
re-use up to 30 times
£97 starter pack of 3, £46 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 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.
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. Each 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. Use for 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.
Efemia Bladder Support
available on NHS prescription
re-use for 3 months
The Starter Kit contains all three sizes (S- 30mm, M- 35mm and L- 40mm) to find your best fit. £59. Thereafter £49 for each single replacement.
The newest member of this ‘family’ of bladder support pessaries. Efemia feels more petite, lighter and softer than the Contiform & Uresta. It is made of transparent flexible medical grade silicone. It is designed to sit lower in the vagina, tucking just behind the pubic bone. Similar to the space where a TVT procedure is positioned. Positioning correctly is straight forward. You leave the handle part on the outside of the body, but this could be irritating to the labia or vulva tissues for some women (efemia recommend using water based lubricant if this occurs). The external loop makes it easy to remove. It needs just a rinse between uses. You can leave it in place during menstruation but you could not use a tampon at the same time.
The Efemia website has a good video to show you the position it takes up and how this helps to support the bladder tube (the urethra) as you cough or move.
Like Contiform and Uresta it’s effectiveness is supported by small clinical trials. It is available on NHS prescription in England. 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. Especially if using an Efemia Bladder Support works for you. That suggests that a stronger pelvic floor could do this job naturally for you too!
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 for 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 on their website. If you are worried about the high initial cost Uresta offer a full money back guarantee. There is also give good advice about how to find the right size for you.
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. Or a Buy Some Time option if you need to complete your family or are undecided about a bigger procedure.
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. Make it your goal to cure your leakage problem rather than simply manage it.
However, if you are not worrying about leaking, you will fee more confident to exercise. This is a Good Thing for your overall health, wellbeing and mood.
Do contact your local specialist physiotherapist to help support you. She will guide you towards the right products, exercises and sports for your needs
Have you tried one of these internal bladder support pessaries? What did you think? Any tips for other mums?
Medical Disclaimer
Any information or guidance we provide is not a substitute for the consultation, diagnosis, and/or medical treatment of your doctor or healthcare provider.
You must not rely on any information or guidance we provide you with as an alternative to medical advice from your doctor or healthcare provide and we expressly disclaim all responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered by you or any third party as a result of your reliance on any information or guidance we provide you with.
If you have any specific questions or concerns about any medical matter, you should consult your doctor or healthcare provider as soon as possible.
If you think you may be suffering from any medical condition, you should seek immediate medical attention from your healthcare provider. Do not delay seeking medical advice, disregard medical advice or discontinue medical treatment because of information or guidance we provide you with.
Nothing in this disclaimer will limit or exclude any liability that may not be limited or excluded by applicable law.
Is running making you feel leaky, heavy or vulnerable? EVB Sports Shorts could be your new BF.
What are EVB Sports Shorts?
EVBs (as they are affectionately called) are sports kit – shorts, capris or leggings. Specially designed for women who feel vulnerable when they run or take part in higher impact activities. Women’s health physiotherapists recommend them for those who need to find discreet ways to manage a bladder or prolapse problem. They add an extra layer of support to your body from the outside. Special panels lift and protect your bladder and pelvic organs.
Affiliate + Discount code: this post is not sponsored but I received a free pair of shorts to trial. If you find this article helpful and decide that you would like to buy a pair, UK supplier Win-Health offer 5% discount to readers using my affliliate code Amanda Savage on a telephone order: 01835 864866 or Free call 08081685522.
Would you benefit?
Do you find your bladder leaks a few kms in? Or get a feeling that your entire lower half moves about too much as you pick up your pace? Or that you beloved run is counterproductive at the moment – straining and fatiguing your core muscles? Do you finish feeling leaky, achey and with vaginal or anal heaviness, spoiling the rest of your day?
How do they work? More support everywhere that matters…
EVB Sports Shorts are made of a specialist high quality stretch material. This is designed to create more lift and support for the perineum and abdominal wall. They aim to BE your essential support muscles while you work on recovering yours (with your pelvic floor exercises).https://supportedmums.com/pelvic-floor-school/
They are not just guess work or cosmetic. Their inventor, Yvonne Brady, is a chartered engineer (as well as mum of 3 and regular marathon runner). Her company have invested over a million in R & D, including projects with physios, to design-in specialised support panels. These are in the gusset, to support the pelvic floor and in the front panel to support the abdominal wall.
Ultrasound studies have shown they mimic the role of the pelvic floor muscles. They lift the bladder neck and prevent the anterior vaginal wall from moving down. Also it may be that better positioned muscles and tissues will themselves function better. Or the better positioning will train them to do what they should be doing when you run.
Reality Check – I tried them out..
I had seen and heard physios rave about these. But I like to try things out for myself before highlighting them here. I asked Yvonne to send me a pair to try and to show my mums in clinic.
Sizing – do it properly – no guessing
You size yourself by measuring your waist and hip size. NB: Not guessing!! It’s really important that you have the right size for NOW. Not who you would like to be! They need to be really tight to work well. However, if they are too tight they will they be horribly uncomfortable. And I worry that you would risk the waist band pushing down into your tummy. There is a useful video guide to sizing on their website
Styles:
The shorts, capris and leggings are intended as outerwear (knickers on underneath) – available in black
The “Boxer Brief” is available black or nude to wear underneath other clothing.
Getting them on:
They come beautifully packaged with clear instructions.
They warn that fitting into them first time can take a few minutes due to the technology they supply. Everything reassures you that you can pull them hard. “they will not rip”, it says, but I had to read that twice to have confidence! It really is a wiggle process to get them over your hips and pulled right up to give gusset support. Once you get there (!) they do fit like a second skin (with benefits) and were entirely comfortable.
Initially I wasn’t sure about the “look” for going out out. I am not normally a tight tight shorts person and a more fairweather jogger. But you will see on the website pictures & happy testimonials of proper mum runners! They are meant to be worn as your outerwear, shorts or capri style, with normal underwear underneath. However, the bottom-conscious could easily fit another pair of leggings/looser clothes over the top.
Returns & Exchanges
Yvonne is passionate about her EVBs and wants women to feel confident to make an investment in themselves. UK supplier Win-Health customer support is quick and responsive with generous & fair exchange & returns policies.
I support women designing for women.
I firmly believe that self-care is not self-indulgence. Looking after our bodies after birth is essential. Exercise is fundamental to both physical & mental wellbeing. Fit mums enrich their own and their kids’ lives.
We live in a modern world. With amazing technological inventions to help us enjoy our sports & hobbies and care for our bodies. Mums need Good Kit too.
Even happier to recommend them now I’ve tried them.
Content Disclaimer:
The information contained above is provided for information purposes only. The contents of my blogposts, articles and my videos are not intended to amount to advice and you should not rely on any of the contents of if you are not a face to face client of mine. Professional advice should be obtained before taking or refraining from taking any action as a result of the contents of this article. Amanda Savage disclaims all liability and responsibility arising from any reliance placed on any of the contents of this article, blog or video.
Need a Quick Win with improving your bladder leakage?
The Knack is the magical art of drawing up your pelvic floor muscles just before you cough, sneeze, laugh or pick up something heavy.Research has confirmed it works to stop urine leakage *
So simple – yet not everyone knows about it
There can be Quick Wins with pelvic floor exercises. I still clearly remember when I helped a client stop leaking in just one week by teaching her the Knack – and she was FURIOUS to have waited that long!Sarah came to physio with the problem of urinary stress incontinence, leaking urine when she coughed and sneezed. It had been happening since her second son was born……….17 years before.
She had diligently practiced pelvic floor muscle exercises as everyone had told her to. When we checked them, properly, with a vaginal examination, her muscles were firm, with an excellent strong contraction.But, no one had ever explained the connection between practising strong muscle squeezes andWHEN TO USE THE SKILL IN REAL LIFE.
I taught her about the Knack.The next time she came back she was CROSS!It worked – no leaks when she coughed – and quite rightly she was angrythat no one had taught her something so easy, so simple and so effective sooner. It was humbling.
And my priority ever since to make sure I spread the word about this technique.I don’t want today’s new mums to wait even 17 hours to figure this one out.
Your pelvic floor is like a trampette
You probably didn’t have to do this pre-contraction of the pelvic floor before you were pregnant, because a pre-pregnancy pelvic floor has a lot of natural tone and tension in it.Like a trampette, straight out of the box from Argos, you can bounce up and down on it and your body weight barely makes a dent in the springy surface.
Pre-pregnancy, most of the down pressure when you cough or jump is deflected straight back up towards your head by the pelvic floor muscles.Your bladder barely feels a bump.
However, you don’t need me to tell you that pregnancy and delivery have a notable affect on our soft tissues.
The abdominal wall is a clear indicator of what happens when you stretchelastic slowly and steadily for 9 months!
Some are more lucky than others in the natural ‘spring back’ department.Most women know that they are going to have to work to restore abdominal muscle tone and strength. The pelvic floor has carried the same baby-burden and if you had a vaginal delivery (or pushed a long time before eventually needing a caesarean) there will have also been some micro tears to the muscle fibres and their connective tissue attachments.
Now, at least temporarily, the pelvic floor behaves like the well-used trampette – a sense that if you jump too hard your feet might touch the floor!
The Knack creates supportive tension
If you tighten your pelvic floor muscles, in the exact moment before you cough, it is like two friends pulling your trampette tight for you just for that moment that you want to jump.
Yes, I admit its not ‘natural’, it’s not ideal, it requires thinking, you didn’t have to do it before……but it can make the difference between a bladder leak or not.
Practice makes perfect
Practicethe Knack with a ‘pretend’ cough after you have had a wee. Your bladder is empty so you are unlikely to come unstuck.
Then, challenge the system, gently.Hold your pelvic floor muscles firmly – cough lightly.After a few days of practice, when that is feeling safe and secure, challenge the skill by coughing a bit harder.Then increase your confidence by allowing an hour to pass so that your bladder is fuller when you cough (but start with the lighter coughs again!).
With practice you will train a “learned-reflex”, a habit.Your brain gets so used to the sequence of prepare, protect, cough that you do it on auto-pilot.
Sneezes are harder (and coughing fits, choking, vomiting….)
Sneezes are harder to resist with your pelvic floor than coughs, because you have less warning that they are coming and generally they create more downward abdominal pressure. Especially if you are one of those people who make everyone in the room jump out of their skin when you sneeze or are prone to 6 in a row? A hacking cough with a head cold, or an allergy induced coughing fit are jolly tricky too.
Work on getting the anticipated, lighter coughs sorted first and then the rest can follow as your muscles strengthen.
Allow yourself some slack
Beware multi-tasking – I remember having a full bladder, baby in one hand, the folded Maclaren in the other, one foot on the escalator, and I sneezed – NOPE – the Knack did not work!!!But hey, I could live with that – it seemed fair – it was a lot to ask of my pelvic floor system.
If you can successfully use the Knack 9/10 times and only the occasional leak gets through that is excellent.
Know when to ask for help
The Knack alone might not be enough for you. Your pelvic floor muscles can be so weak that you need help to get them working again.And it is possible to have muscles that have repaired too tight or are constantly overworking and becoming easily fatigued or sore.
Remember there are specialist physiotherapists attached to every UK maternity department who can give you an individual assessment, training and support. Don’t hesitate to ask your GP to refer you to a specialist physiotherapist
Does the Knack work for you? Any questions?Please do ask, I am very happy to help.
*Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence. Miller, J.M., Sampselle, C., Ashton-Miller, J. et al. Int Urogynecol J (2008) 19: 773. doi:10.1007/s00192-007-0525-3).
Drawings copyright of A M Savage(Proudly using stickmen since 1991)
Do you wonder what BREATHING has to do with bladder control, prolapse support or vaginal or anal pain?
Physios are not going woo-woo
It’s rather because clinical research & our understanding of the body has deepened, so pelvic floor exercises exercises are evolving. It’s no longer one size fits all.
There’s a good place for the traditional squeezes, lifts and holds, but some mums need to focus their attention more on the “let go”, relaxing and releasing of their muscles.
Pelvic floor relaxation is a thing
Previously exercises were very linear. Squeeze ON, release/turn off. Our focus was on what our muscles needed to be able to DO in an emergency situation – when we cough, sneeze, pick up something heavy. This is not wrong. If you struggle with stress incontinence (leaks when there is high pressure on the bladder) then the best thing you can learn is The Knack of getting the pelvic floor to co-ordinate with perfect timing.
However, we now know how our muscles should be doing when we are not thinking about them. The resting pattern of your muscles has an impact on common problems like urgency, bladder frequency, vaginal heaviness and pelvic pain.
#1 New thing we know
Firstly, our breathing pattern and our pelvic floor muscle movement pattern are similar and interconnected. Breathing is easier to understand, feel and control than the hidden away pelvic floor. So if you want to better connect to your pelvic floor – start by noticing how you breathe.
#2 Weird thing to notice
However, most of the day we don’t think about our breathing AT ALL. You wouldn’t have been thinking about yours a few minutes ago until I brought the topic up. Your brain operates your breathing system all day, all night, 24/7 without any conscious input from you. A gentle in and out, muscles contracting and releasing, a continuum of movement like a swinging pendulum, you are only completely full of air or completely released for a moment in time.
#3 Amazing thing we can do
Yet, you can also have incredible control over this system. For example, you could take a deep breath right now to blow out an imaginary candle; you could whistle a little tune; you could shout (or yodel) or pant like a dog. With training, you could develop sophisticated breath control as well – as a singer, long distance runner, athlete, deep sea diver, bird impressionist. Did you know that you need enormous breath control to accurately shoot a pistol or throw a dart?
And then, when you stop panting or wolf-whistling or humming a ditty, your brain just automatically puts you back into gentle breathing mode, no questions asked. A-MAZ-ING.
#4 Pelvic floor muscles should be super-skilled too
We want our pelvic floor muscles to have similar super powers. When we are NOT thinking about them we want them to gently (gently!) contract and relax, very low key, very little. Just enough to keep blood flowing through them, to nourish their feeder nerves. We want movement to keep the tissues stretchy and flexible. We want to be on standby for whatever we decide to do next.
Then, when you decide to pick up your toddler or dash up the stairs, we need them to move up a gear or two to help carry that load from below, preventing pelvic organ descent or a sudden urge to wee.
Similarly, if you want to push shut a heavy door, or hit a tennis serve, or do one of your room shattering sneezes, we want them to go into full tension mode to prevent leaks. And most important of all, if you want to empty your bladder or bowel, or get sexy with your partner you want them to relax and release to allow things out or in.
#5 Best thing to work on
In contrast, if your muscles are always tense they become “crampy” with painful sensations associated with a build up of lactic acid or the soreness to be touched or if stretched. Then if your muscles are always “in gear” you can’t choose to have “more” or “less” for the activity you are doing.
So take moments through the day to tune in to your breathing and from there to your pelvic floor muscles. Find time to reset your background, automatic, movement pattern to line yourself up for a day with super-powers.
Video: How to improve pelvic floor control by simply breathing
https://youtu.be/k8V5NTkAEmM
Firstly, tune into your breathing pattern. Feel your rib cage lift and raise as you breathe in, drop and shrink as you breathe out. Play with it. Breathe deep, blow out an imaginary candle. Do this a couple of times. Then stop. Can you feel your body revert to your base breathing pattern?
Then, notice how your BELLY breathes. Yes it does!! Drop your hands to abdomen. Channel your inner frog. Notice that your belly mimics your breath. As you breathe in your belly lifts as you breathe out it falls.
Finally, lower your consciousness to your pelvic floor. It is the lowest moving set of muscles. Can you feel how these move to, in time with your breathing, ever so gently contracting & letting go. Or gathering & releasing, or lifting & lowering – whichever words work best for you.
Have you improved your pelvic floor skills by practicing breathing? Please let me know if this video and explanation was helpful and how you are getting on?
natural tone and tension in it.
to restore abdominal muscle tone and strength. 
If you tighten your pelvic floor muscles, in the exact moment before you cough, it is like two friends pulling your trampette tight for you just for that moment that you want to jump.
