(APPLAUSE)
So the pelvic floor.
We've talked a lot about pelvic floors,
and now we need to think about how we get our pelvic floors working.
So...really need to think about...
Well, we've talked a little bit about why already,
why we need to do them -
how we do them, when and where,
because if we don't fit these into a bit of a schedule,
you're never actually going to do it.
One of the things that I hope you get out of tonight
is it's not a "one size fits all"
for a pelvic floor training program,
and it's not just about strength.
It can be about how quickly you can turn the muscles on.
It can be about being able to relax the muscles.
So if you are having some problems,
you actually need to go and see someone to have a chat with them
and get them to actually assess your muscles.
And pelvic floor physiotherapists,
we actually do a master's level training
in assessing people's muscles
so we can internally assess women and men,
and there's also some perineal ultrasound measures with men
that we use as well,
to see what your muscles can do,
because it is not a "one size fits all" approach.
Everybody...it's the same as if someone tears a hamstring -
you can't just do the same thing for every person.
So, how do we do this?
We need to be able to contract and relax. So...
First of all, you've got to get a bit of an awareness of the area.
Now, I always joke around with the guys that I see
that have prostate surgery
that, "You guys are really good at knowing what that area's about,
"because from the time you're able to have a nappy off,
"you basically have your hand there,
"whereas women..."
Anyone who's had a son knows that.
..but whereas women, we actually don't think about that area.
We're not encouraged to know about that area.
So sometimes your sensation of that area
is only very little until you have a problem,
and then you have to think about it,
until we go to have babies.
So if you think about
when you use your muscles to stop the flow of urine,
that can be one way, as a woman and a man,
of how these muscles work.
And it's like a squeezing and a lifting underneath.
If men think about
when you're trying to squeeze that last few drops of urine out,
that's your pelvic floor muscles doing that as well.
What you do need to do is have them come on at the right time.
We are going to practise in a minute.
But strength training is really important,
so the same as with an injured hamstring -
you need to do some sets.
Now, for example, an optimum strength training regime
may be to get to 6- to 10-second holds,
10 times, 3 sets a day.
But if you can only hold it for one or two seconds,
that's where you start, and you'll gradually build up.
We know that once you get to 6 or 10 seconds,
then we're getting some building of muscles.
You need to use these functional, as we talked about -
before you cough, before you sneeze,
when you're changing position.
I'm going to get everybody to do something now,
is to sit down in your chair
and think about relaxing your muscles
and then just stand up.
So everybody stand up.
And now sit down again.
This is what I always do with my pelvic floor patients.
Now let's think about where these muscles are inside.
And I want you to engage your pelvic floor muscles
and then push through your legs as you stand up.
So, as you come down, I want you to squeeze your pelvic floor
and then push through your heels to stand up.
I don't know whether it feels any different to you,
but I know that you actually feel like
everything's a little bit more together.
Yeah? No?
(LAUGHTER)
Maybe you're all just so together that you don't feel it.
When someone comes in with prolapse symptoms, continence symptoms,
and I know that they can actually
correctly contract their pelvic floor,
when I teach them to do that, it's like a 'Aha' moment.
"This is what I'm meant to be doing."
Instead of every time you're standing up... (GRUNTS)
..and pushing down.
And it's the one exercise that I routinely give a man
before he has prostate surgery,
because every single time they come in after their surgery,
they'll say, "I stand up, and that's when I leak."
And you're like, "Well..."
Often they'll go like this... (GROANS AND SIGHS)
..after they stand up, and that's when they all leak.
So, got to teach them to... everything in moderation
and to gently, gently engage as needed.
Then you've got your sports-specific training.
It's all very well and good
to be able to hold your pelvic floor 10 seconds, 10 times,
to do your strength program,
but if it doesn't come on when you jump,
you're going to wet yourself.
So it's about training it to come on at the right time
at the right amount.
I train people doing jumps and skips and things like that,
especially if they've had babies
and they're having some pelvic floor issues
and we're training them to get back to running
or to whatever sport they do.
You actually train them up to do what they need to do.
It's the same as any sport, rehabilitating.
So where, how can you remember to do it?
We always remember to brush our teeth.
Well, I know I do. Most people do.
And if you've got children, you try and get them to.
(LAUGHS)
So at least twice a day, hopefully, you brush your teeth.
So I always say do two sets in the morning when you brush your teeth,
do one set at night, or breakfast, lunch and dinner.
Use an app on your phone. There are lots of apps.
There's one, I think, called myKegel.
There's a pregnancy app that the Continence Foundation have
that you can use for remembering to do your exercises.
Or just set a reminder.
We're so digital these days, so if you've got a phone
that you can put a reminder on at...
..you know, at 4:00 every afternoon, it gives you a "ding, ding".
And you can ignore it, but it's there and it's keeping it in your mind.
'Cause unless we do things in a diary type of way,
you don't remember to do it.
So we're going to practise.
So sitting there, I want everybody to just gently relax
and lean a little bit forward
so you can feel the chair underneath your perineum
and your elbows...almost like a guy sitting on the toilet,
you know, with a newspaper.
You're nice and relaxed.
You want to relax your breathing.
One of the biggest problems with exercise
and with doing pelvic floor exercises
is people use too much of their tummy.
You might have seen some of those ads a couple of years ago for Tena
where everybody was doing this
when they did their pelvic floor exercises.
It was like they had to have their eyebrows go up.
Well, you don't.
I could be doing pelvic floor exercise now and you don't know.
You might see a tiny drawing-in of tummy.
But you shouldn't be seeing any... (INHALES LOUDLY)
You shouldn't be holding everything up,
'cause as soon as you let your breath go,
everything's going to go.
So you've got to be able to isolate this muscle.
When you're actually contracting your pelvic floor,
it is just those muscles working.
So if you close your eyes
and imagine that you've got your perineum sitting on...
..so that's the underneath part, sitting on the chair,
and I want you to imagine that all of that is drawing up inside you
and then releasing.
Nothing should be happening here. (MICROPHONE BUMPS SOFTLY)
Sorry for the microphone there.
Your upper tummy muscles actually are nice and relaxed,
'cause as soon as you pull them in,
you're actually increasing your pressure down.
So it's squeezing underneath.
Some of the ways that I... like to tell...tell guys
is to lift your scrotum as if you're walking into really icy-cold water.
Often they go, "Oh, yeah, I know exactly what to do."
And one of the other things they've found actually recently
from doing some research
is that if you tell a man to retract his penis,
originally they said 'shorten',
but as one of the guys in the audience said,
"You can never tell a man to shorten the penis.
"Just tell him to retract it.
"'Cause they'll never do it otherwise."
So if you can't get the sensation of what your bladder is...
..and stopping urine,
maybe you've got some sort of sensation of what your bowel area is
and you can think about squeezing your anus.
And, obviously, that's not going to be optimal for around your urethra,
but at least it gives you a little bit of sensation of what's happening.
And they should all work together.
It's not like you can go, "One, two, three."
It all works as one lift.
OK - one of the things I like to do with patients
is to give them some sort of visual cues.
One of them is the reverse of the drop of water.
So your muscles, it's like everything's coming up
in reverse of the drop,
and then when they relax, everything's coming back out
and the ripples are coming back out into the ocean.
Don't know if that makes any sense.
The other one is a clock face.
So I imagine...with your pelvis
that your six o'clock is your pubic bone, midnight is your tailbone,
and then your nine and three are your side walls of your pelvis.
So when you do a pelvic floor contraction,
it's not just a lift,
it's a squeeze together front to back and lift up.
So it's a squeeze and lift.
Because we're trying to narrow the gap
which the bladder can come down
and you're trying to lift everything up.
So it's a squeeze and lift.
OK.
So, we probably should think about
having a little practice again.
I want everybody to think about totally relaxing
and thinking about either your clock or your reverse drop of water.
I want everybody to think about squeeze and lift as fast as you can,
if you can hold it again, and squeeze again.
And I keep saying to you, squeeze until you can't anymore
and then release.
But as you're doing that, you should still be able to talk,
so one of the ways you can make sure that you can do that is count,
so I would tell people to squeeze and lift, two, three,
squeeze a bit more, then a bit more and a bit more,
and then fully relax.
Then there's different type of exercises.
That's your strengthening.
Then you might think about, "Well, when I cough and sneeze,
"it has to come on really quickly,
"so it needs to be a quick squeeze and lift."
So one of the other exercises we get people to do,
and this is the only one you can do at the traffic lights,
is your quick on/off.
On/off.
And that's to get it coming on all at once really quickly.
Then you can think about more of your endurance-type holds,
so a longer hold,
and this might be, as Ian was saying before,
when you've got the key in the lock,
you might gently just need to hold it on,
think about what you're going to cook for dinner,
distract yourself from the fact that you need to go to the toilet,
and then gently go on.
So the muscle is the same as any other muscle -
it needs to have endurance, strength, bulk
and be able to function at the right time.
If you're unsure, get yourself assessed,
'cause a lot of people come to me and they say,
"I've got a weak pelvic floor. I'm wetting myself."
And, actually, no, they don't have a weak pelvic floor,
it's just that it's not relaxing.
You've got to make sure you can relax as well.
It's really important, and Ian was saying this as well,
you don't put up with symptoms.
You don't have to. There is lots of help out there.
And it can be as simple as someone saying to you,
"Actually, you're just using your tummy too much,"
or, "You're not totally relaxing,"
or, "The muscle just needs to be a bit quicker."
And it's something that you can practise
the same as any other skill that you need to learn.
So...I hope that's given you a little bit of an idea
about how to do exercises
and that you really need to think about it
as one size doesn't fit all,
but there are some guidelines around strength,
three sets of the strengthening a day,
which I put in here before...
..which was your 6- to 10-second holds,
10 reps three times a day for strengthening,
making sure you're fully relaxing in between.
Using your muscles - the most important thing
is using them as you do things.
As you stand up, like we did before,
as you're lifting up your children, grandchildren, boxes at work.
As you're rolling over in bed.
As you're coughing and sneezing.
OK.
Thank you.
(APPLAUSE)