(APPLAUSE)
So as Barry just told you,
I'm a continence and women's health physiotherapist.
And I like to think about us as your trainers for your pelvic floor.
And one of the things that we like to do
as continence and women's health physiotherapists
is help you to do what you'd like to do,
not just tell you what you can't do.
So we can work together.
So, what I'm going to talk about today
is a little bit of an overview
of your pelvic floor,
a bit of an overview of the anatomy,
and looking at the importance
of the function of the pelvic floor
in all different parts
of continence, prolapse,
and also in exercise,
and also discuss a little bit about some of the risk factors
or people that may be at risk of dysfunction.
So I'm sure you've all seen these pictures.
They're a very simplistic view of what your pelvic floor is.
As you can see, we've got the woman and the man,
and they basically are the same.
You've got your tailbone, pubic bone, sling of muscle.
The only difference, obviously, is the uterus and the vagina.
But pretty much, they're a very similar sort of structure.
And so men and women both have pelvic floors,
and for the men in the room that didn't know that
or the women that didn't, they do,
and they need them just as much as women do.
The difference with the woman and the man is that...
And I've got a female pelvis here,
which we can have a look at later a bit more, but...
Basically, the width of the pelvis bones in the woman
have to fit a baby's head out.
I had a really interesting thing happen a couple of years ago
when I took my 4-year-old to the museum,
and I don't know if anyone's been to the Melbourne Museum,
but they have this great anatomy and reproduction area there.
And they had the pelvic bones, and he said, "Mum, what's this?"
And I said, "Oh, that's a woman's pelvis bone."
And he said, "Well, what's this one?"
I said, "That's a man." He said, "How do you know?"
And I said, "Well, a baby's not going to fit out there."
Anyway, we then went along into the next section,
where they had a big picture of a woman giving birth.
Didn't realise I was walking into that one.
And he goes, "Look, Mummy! The baby's coming out her pelvis!"
And I went, "Oh, great!"
(LAUGHTER)
So anyway, the pelvic floor in a woman is much more important
because we don't have the bones to hold everything up.
So that's why the soft tissues are much more important
and we're more likely to have problems with support and prolapse
in women.
Just to give you a bit of an idea of
how this is more three-dimensional,
this is looking from underneath,
and, obviously, these muscles aren't just one little sling -
they are, in fact, the whole bowl,
which you can see from that way.
So they actually surround the outlets to your bladder,
the bowel and also the vagina or the uterus.
So these muscles have roles in different ways
in helping to maintain your continence,
and that's both urine and faecal continence,
also preventing prolapse, which we'll talk a little bit about,
and I'm sure that Ian's going to talk a little bit more in detail about.
They also have a big role in sexual function in both men and women
and also in low back and pelvic pain and motor control,
so controlling your pelvis and low back.
And this is something that we don't really know that much about,
or the general public don't necessarily know a lot about.
But it's really important to have the pelvic floor functioning
if you're going to be an exerciser or an athlete,
which is why we're here today.
Thinking about...
I really should say types of incontinence
and also pelvic floor dysfunction,
because it's not just continence that we're talking about here.
So we have stress urinary incontinence,
which is the type of incontinence
where you cough and sneeze and lose a bit of urine,
or urgency - when you feel that you absolutely need to go to the toilet
and you can't stop the urine from coming.
And then mixed incontinence, which is a bit of both.
And I'm sure Ian will go through this a little bit more as well.
Then we have urgency/frequency, or an overactive bladder.
So it's not necessarily leaking, but you might be
one of those people that has to go to the toilet every 10 minutes,
and it mightn't be very much that you're going for.
And then you've also got faecal incontinence,
or the inability to hold wind.
So all of these things, and faecal urgency,
they can be signs that your pelvic floor muscles
or the area are not working as well as they could be.
So thinking about the pelvic floor muscles in...
..their role in continence,
if the muscles then tighten to close the bladder and the bowel,
obviously, if these muscles are not strong,
there's going to be problems with continence.
So if your pelvic floor has a lack of bulk...
So if you think about a bicep muscle,
it actually is nice and bulky when you're strong,
so if your muscles aren't bulky,
they're not going to have the strength to close off.
They might have the strength,
but they mightn't come on at the right time.
So if you cough and sneeze
and your muscles aren't coming on
at the time that you're coughing and sneezing,
then you're also likely to leak or not be able to hold wind.
Then also, if your muscles are actually working too hard...
So we know that a lot of people actually have what we call -
I call it overachieving - muscles that don't relax.
We see a lot of...
In our private practice, we see a lot of solicitors
and they've often got very overachieving pelvic floors.
(LAUGHTER)
And often they'll get urgency and frequency,
because if you think about a normal muscle,
it should turn on and off,
and if it's just held on the whole time,
where is it then when you need it?
So that can cause problems.
You might think you've got a weak pelvic floor,
but it might be that it just stopped relaxing.
So, pelvic organ prolapse.
I'm not going to go into detail on this, 'cause I know Ian will.
One of the things I like to think about prolapse
is that prolapse is a problem when it's a problem
and that a lot of women will be out there
with very mild prolapses,
a lot of people that have had a baby
that don't necessarily have symptoms of a prolapse,
and it's only an issue if you have a symptom,
but we want to prevent you from having symptoms,
which is why, if you've had a baby or if you've gone through menopause,
very likely to not have as strong supports as you used to have.
Another thing - not just being...having babies,
but also having constipation and straining,
and that's why men can also have rectal prolapses.
And this can be...
And also if you lift too-heavy things
that you can't actually control your muscles for as well.
So weightlifters can have prolapse problems.
They used to say that nurses, from pushing the beds,
or airline hostesses, for pushing the trolleys up the plane,
used to have problems with this as well.
OK. (LAUGHS)
Now comes Pelvic Floor Chicken.
So, what does the pelvic floor do?
It actually helps to close the gap by which everything can fall down.
It's lifting the level of all the organs
so that there's a higher level for things to...
..from which things are actually pushed down.
It counteracts what we call our intra-abdominal pressure.
So if we cough, if we sneeze, if we do a sit-up,
if we lift something heavy, you're going to get a downward force.
And we always talk about Prolapse Chook,
that if you don't have the upward equal force,
you're going to lay an egg,
and that could be wetting yourself, could be...
Everyone crosses their legs when I do that.
(LAUGHTER)
It's the best tool when you're in an exercise class
and you're trying to say to the girls,
"Well, when you're doing this exercise,
"you should be able to feel your pelvic floor turning on
"as you use your tummy,
"and if you don't, you need to come back to this level."
And it's amazing - everyone in the room comes back to the first level,
because they want to be making sure
that they're actually using their pelvic floor
to meet their tummy pressure.
Chicken's not that bad, but I always have it in my office.
It gives everyone a giggle.
There's also the theory of 'boat'.
So if you think about the water level being your pelvic floor muscles.
So if you have a really nice high-water level,
the supports that hold up, for example, your uterus or bladder,
they're nice and... it's nice and buoyant, you know.
There's not a lot of strain put on those supports.
Whereas if your pelvic floor muscles,
the bulk and the tension that they're able to produce underneath
and the gap that they're able to close,
if they're not there,
then the boat's going to sink down further
and you're more likely to have issues.
It means your bladder might be more likely to leak
or you could have problems with prolapse.
Then there's also our role
in sexual function.
Now, this is for both men and women.
If you have a weak pelvic floor,
with poor muscle bulk,
obviously, you're going to have
poor sensation.
If you have a weak pelvic floor,
you might actually have incontinence when you orgasm or some other time.
With men, we know that 50% of men who have their prostates out
have incontinence during intercourse for the first year,
and they know that pelvic floor training helps that,
so it's actually got a role with continence in men as well.
Also, men that have weak pelvic floors
have poor erectile function, so...
And also, they can have overactive bladders,
which I'm sure Ian may talk about later as well.
OK.
So then you've got your non-relaxing pelvic floor,
so people might have heard of sexual pain
or people who are unable to have sex or even unable to use tampons,
and also general pelvic pain, so people that have...
..maybe have had painful periods, etc,
they can often have muscles that then get very tight and overactive
and makes everything more sensitive in that area.
And then we've got the pelvic floor
with low back pain and pelvis control,
which I talked about before.
This is really important for exercise.
So it's all very well and good to have strong abdominals
and strong back
and be able to breathe nicely,
but there's the other end.
So we need to have our...
We're only as strong as our weakest link,
so if your pelvic floor isn't controlling with the other links,
you're going to get back pain, you're going to get incontinence,
and you might have prolapse as well.
The core is not something that should be locked on.
I don't know if anyone's heard this...the term of "Lock on your core
"and then hold it on the whole time you're exercising."
It actually should be "Engage your muscles
"to meet the resistance that's needed."
So if you're doing a sit-up, you need to engage them
to meet the tummy muscle pressure.
So, what can potentially
damage our pelvic floor?
We know pregnancy and childbirth,
and that's something that we as women
are very likely to go through,
and it's not going to stop you from doing it,
but it may put you at risk.
The other thing is menopause, when we lose our oestrogen.
And then also, repetitive lifting for men and women,
incorrect exercises, and constipation.
So with pregnancy and childbirth,
there's hormonal changes that happen.
People ask me, "When should I stop running?"
I say to them, "As soon as you pee on the stick,"
because at that point, you've got the hormonal changes.
And if anyone in the room ran during their pregnancy,
don't worry - I'm not going to know!
But what you need to think about is if we...
..we need to know that hormonal changes have taken place
just by getting pregnant.
And then you've got an increase in weight on weakened muscles.
And then we all go and have a baby and then we have to go and lift.
Can you imagine a guy, a footy guy, having his knee reconstructed
and then having to go and look after a child straight afterwards?
They'd lie on their back for six weeks. So...
But we come home from hospital
either having had a caesarean or a vaginal delivery
and we have to manually work.
You can tell I've had two children, can't you?
Then we've got menopause.
Throws up some other things.
So at this stage,
we have a really big decrease
in your muscle function
due to the lack of oestrogen,
but also just age
decreases our muscle function as well.
So it can cause weakness.
It might cause some irritation, some overactive bladder urgency,
or it can be prolapse, due to your lack of oestrogen.
I'm sure Ian will talk a little bit about this.
But we also need to think about how we modify exercise.
It needs to be modified as if the person is pregnant -
you don't want them to be jumping and running.
Because your connective tissue can't cope with that
from any point of view, let alone your pelvic floor.
Another thing at this time
is often people will get muscles that don't relax
and they might need to see the physio
to learn how to contract and relax muscles a bit better.
So heavy lifting.
Don't know if anyone ever saw this picture.
This was a weightlifter in the Sydney Olympics
who, as she was about to...
Don't know if that's clean, jerk, lift,
whatever it was she's about to do, she actually wee'd herself.
And it just shows that even someone who's highly fit,
they might have that imbalance.
So you can potentially injure yourself
by just lifting too much or too repetitively,
especially if muscles are weak
or if they don't come on at the right time
or if they fatigue.
So if you've done however many weightlifting sessions that day,
of course it's not going to be able...
I always talk about marathon runners.
By the end of the marathon... I don't remember...
I don't know if anyone remembers seeing Robert de Castella
at the end of the marathon, and his legs were like jelly.
And it'd be the same as your pelvic floor -
if you're doing over and over again, it can get fatigued.
So even the best pelvic floors can have issues.
Pelvic floor... There's my chicken again.
I love the chicken.
..and incorrect exercise.
So that's one thing that you can do something about.
You can't do anything about going through menopause
except for modifying things a bit.
We can't do anything about whether we've had babies
except for doing the right exercise.
But we can really change how we exercise.
So your pelvic floor needs to meet the abdominal pressure,
so your tummy pressure.
So when you're doing a sit-up,
you need to engage the muscles to meet that.
You need to be able to have your muscles turn on and off
when you're lifting heavy weights.
When you're running or you're jumping,
it needs to have the ability to turn on.
Because if you do these things and you don't have the right function,
that's when you can cause damage.
Or if you have that, "I've had a baby, I've got a slight prolapse,"
and then you go and do all of these things
without the right pelvic floor control,
then you're going to end up with something worse.
So, what is really good for one person mightn't be good for you,
and I think this is the whole...
I'm sure Marietta will talk about CrossFit
and boot camps and things like that.
They're fantastic, if you're someone who doesn't have an issue.
So I go into...
They've set them up in car parks now,
where they have these big tyres
where they've got these 60-year-old women
pulling around a tyre,
and I'm thinking, "Oh, my God! What's going on here?"
There's so many other better ways to exercise.
So boot camp mightn't be for you.
I like to say all is not lost.
And anyone who's spoken to me tonight
realises I've just been on a big cycling holiday over the weekend,
and that is one type of exercise that anyone can do
as long as you've got your seat fitted right for your pelvic floor.
(LAUGHS) You have to be fitted properly.
But all is not lost.
It doesn't mean don't exercise. It doesn't mean you can't do things.
It just means that you've got to think about what is best for you.
So you need to reduce your risks.
You need to think about what exercise you're doing.
You also need to get some help.
So if you have an individual problem,
there are physios like myself out there
who have that special interest in pelvic floor
and how we can then get you back into what you want to do.
Now, whether that's playing golf,
whether that's just walking with friends,
whether that's helping you to get your bladder working better
so that you're not going to the toilet every five minutes,
even just so that when you get out of the chair, you don't wet yourself,
or preventing it from happening in the future.
You've got to use your muscles as they're needed,
so as you cough, as you sneeze.
And we'll talk a lot more about that
when I go through a session of how to use your pelvic floor.
And the main thing is, don't put up with symptoms.
You don't have to suffer when there's so much that can be done,
and we know that the exercises and getting the individual advice,
the same as if you're an athlete training for a marathon.
You don't just go out there and run a marathon.
It's the same with your pelvic floor.
You have to take little steps
and then train specifically for your sport.
(APPLAUSE)