The Embarrassing TRUTH about Sit-ups!

AFTER losing 20kg and competing in a 15km adventure obstacle course in under 2 hours, Sarah Jones* appeared to be a postnatal fitness success story.

About a year after the birth of her first child, Jones had signed up at a gym and engaged a personal trainer to help her lose her post-baby excess weight and regain her former high level of fitness.

Within six months she'd achieved her goal.

"I was so strong, fit and healthy, but then my insides let me down," said Jones, now 36.  “I realise that something wasn’t quite right one morning when I was in the shower and felt a heavy drag between my legs.” After visiting a Women’s Health Physiotherapist, Jones learnt she'd been building her fitness while leaving behind her pelvic floor, the platform of muscles, ligaments, connective tissue and sphincters that combine to support and close the bladder, vagina, uterus and bowel.

"I first started experiencing urinary stress incontinence [leaking urine when under stress, such as coughing, running or sneezing] about three months into my fitness kick. There were some exercises I just couldn't do, because I would wet myself, exercises such as skipping, star jumps, sit ups and crunches. But I pushed on thinking I simply had a weak bladder and ended up being unable to walk or run without having to go to the loo all the time or wear pads to prevent my shorts from getting wet."

Sixteen per cent of the Australian female adult population participate in fitness centre activities, compared with 9.4 per cent of adult male, according to the Australian Bureau of Statistics 2005-06 Multi-Purpose Household Survey. One in three Australian women experience urinary stress incontinence, which can be induced by incorrect exercise methods, as reported by the Continence Foundation of Australia. These are disturbing statistics, especially when many fitness programs and popular training regimes are written by men for men. 

Had Jones been screened before starting her initial fitness training it would have been obvious that she was at high risk. Jones recalls: "I'd experienced a difficult birth [one long forceps delivery] and, after inquiring, I discovered I had a family history of pelvic floor weakness. I often wonder if my story would have been different if my initial trainer had required me to complete a pelvic floor screening tool."

Jones, like many women, was looking to take care of herself and her body but didn’t realise that fitness starts from the inside and although the pelvic floor is a group of muscles which are hidden from view, they are a very important  to every woman. As Jones explains, "I'm an educated health promotion professional, but I simply didn't know about what I needed to know about my pelvic floor."

The pelvic floor muscles attach to the pubic bone in front and run underneath the body like a muscular hammock, inserting into the tailbone and stretching from the sit bones on either side of the body. Heavy lifting, excessive abdominal training (sit ups and crunches) and classes such as combat, balance, pump and step, can cause serious damage to this structure.

Lifting a heavy weight increases pressure inside the abdomen, which in turn pushes down on to the pelvic floor. Sit-ups, crunches and double leg lifts, traditionally recommended as abdominal strengthening exercises, also raise internal abdominal pressure. If the pelvic floor isn't strong and co-ordinated enough to quickly lift and hold to counter this internal pressure during exercise, then pelvic organ prolapse, or misalignment, is promoted.

Leaking when running, lifting or jumping in high-impact classes indicates the pelvic floor isn't coping with the effect of the feet hitting the ground, and persisting is likely to weaken the pelvic floor even more.

While certain exercises can cause or aggravate pelvic floor problems, others can cure them. Pelvic floor muscle training is effective in treating stress incontinence, with cure rates of up to about 85 per cent, according to Pauline Chiarelli, a women’s health physiotherapist and associate professor at the University of Newcastle.

Chiarelli says tailored pelvic floor exercises and tailored exercise programs or fitness regimes that are pelvic floor friendly, work best.  

"Initially, my pelvic floor muscles were so weak that I couldn't isolate or contract them at all," Jones recalls. "It took me two to three months to build up enough strength to be able to activate the correct muscles. I'd been compensating for my weakness by using my stomach, back and thigh muscles instead. I had to unlearn those strategies so they wouldn't be the first to kick in."

Poor instruction also doesn't help. Chiarelli said: "There are some very highly regarded Pilates instructors teaching pelvic floor exercises on the in-breath, but you need to do them on the out-breath as when you cough or sneeze.”

After about several months of dedicated pelvic floor strengthening exercises three times a day, Jones can now run 5km and stay dry. "I've changed my gym routine completely: no high risk ab work, meaning no sit ups, crunches or exercises with double leg lifts, no wide leg squats or side lunges and low impact classes only. It's about gradually bringing my pelvic floor strength up to my body's fitness level," says Jones. “I also changed personal trainers and now train with Krysia Child. Krysia’s understanding of the female body allows her to ensure that all of my sessions are pelvic-floor safe.” 

The best way to prevent urinary stress incontinence and prolapse is to find out that you are not at risk by taking 5 minutes to complete a Pelvic Floor Screening before you commence any form of exercise. Attached is the Pelvic Floor Screening Tool that all DASH Spot on Fitness Trainers require our female clients to complete before commencing training. If you answer yes to any of the questions we recommend that you make an appointment to see a Women’s Health Physiotherapist to prevent any injury to your pelvic floor muscles. 

For more information on Pelvic Floor safe exercise visit the Pelvic Floor First website: http://www.pelvicfloorfirst.org.au

• Name has been changed to maintain client confidentiality. 

DASH Spot on Fitness - Pelvic Floor Screening

Women are at higher risk of bladder and bowel control problems because of pregnancy, childbirth and menopause. Certain exercises can cause or worsen these problems. 

This survey has been designed to see if you are at risk of pelvic floor problems, and if so, to make sure your exercise program is pelvic floor safe. The survey will take 5 minutes to complete and your answers will be confidential.

ABOUT YOU…	YES	NO
Are you currently pregnant?
Have you recently (or ever) had a baby? Did you have a diastasis of the Rectus Abdominis?
Are you going through or have been through menopause?
Have you ever undergone gynecological surgery (e.g. a hysterectomy)?
Are you an elite athlete (e.g. a runner, gymnast or trampolinist)?
Do you have a history of lower back pain?
Have you ever injured your pelvic region (e.g. through a fall or pelvic radiotherapy)?
Do you suffer from constipation or regularly strain on the toilet?
Do you have a chronic cough or sneeze (e.g. because of asthma, smoking or hayfever)?
Are you overweight, obese or have a BMI over 25?
Do you frequently lift heavy weights (e.g. at work or at the gym)?

DO YOU…	YES	NO
Accidentally leak urine when you exercise, play sport, laugh, cough or sneeze?
Need to get to the toilet in a hurry – or not make it there in time?
Constantly need to go to the toilet?
Find it difficult to empty your bladder or bowel?
Accidentally lose control of your bowel – or accidentally pass wind?
Have a prolapse (e.g. a bulge or feeling of heaviness, discomfort, pulling, dragging or dropping in the vagina)?
Suffer from pelvic pain or experience pain during or after intercourse?

NOTES/ COMMENTS
If you have answered YES to any of the above questions please provide a brief explanation of your current condition in relation to the identified issue/s.

• If you have answered YES to any of the above questions it is recommended that you visit a Women’s Health Physiotherapist.