Exercise is a vital part of healthy living; however, one size doesn’t fit all when it comes to exercise. If someone has, or is at risk of pelvic floor problems, it is important they take care to protect their pelvic floor while exercising to avoid risking further damage and incontinence.

Who is at risk of pelvic floor problems?

Anyone who:

• is overweight, obese or has a body mass index (BMI) over 25,
• regularly lifts heavy weights,
• strains on the toilet because of constipation,
• has a chronic cough or sneeze, including those linked to asthma, smoking or hay fever,
• has a history of back pain,
• has suffered trauma or injury to the pelvic area (e.g. a fall or pelvic radiotherapy), or
• has had abdominal surgery.

A woman who:

• has ever had a baby,
• is post-menopausal,
• has had a prolapse (a sagging down of pelvic organs, commonly after childbirth), or
• has had a hysterectomy or other gynaecological surgery.

A man who:

• has a prostate problem (where the prostate gland disrupts the urine flow), or
• has had a prostate operation (and where urinary incontinence followed).

The pelvic floor

The pelvic floor is a trampoline-shaped group of muscles and ligaments stretching from our pubic bone to our coccyx and between our sitting bones. It holds up our pelvic organs and has an important role in opening and closing off our urinary and anal sphincters. Stretching and weakening the pelvic floor can increase the risk of bladder and bowel control problems, and prolapse in women.

High-impact aerobic and/or resistance exercises are more likely to place a strong downward strain on the pelvic floor and, over time, stretch and weaken the pelvic floor muscles, leading to bladder or bowel control problems.

There are many ways to become strong and aerobically fit without harming your pelvic floor.

Aerobic exercises

Unless you have a strong pelvic floor, avoid high-impact exercises such as skipping, running and jumping, or sports where you change direction suddenly. These activities will cause a much greater downward force on the bladder than the closure force of the urinary sphincter, risking leakage and the further damage to the pelvic floor.

Instead try swimming, cycling, walking, water aerobics or sign up for any of the many low-impact exercise classes now available.

Resistance training and core strength

Excessive weights or intense abdominal exercises such as crunches and lunges can exert so much downward force on the pelvic floor, they can also cause damage over time.

No matter how strong your pelvic floor is, before doing in any resistance activity, lift and “contract” your pelvic floor muscles. (This technique can also be applied before sneezing, coughing or any other activity that can cause urinary leakage.)

Don’t lift weights or do exercises that cause you to strain or hold your breath, and always ensure you are supporting your pelvic floor while doing them. A good way to do this is by using a Swiss ball, or sitting or lying down to exercise. When doing standing or squatting exercises, keep your legs no further apart than shoulder width, and avoid deep lunges.

Is leaking normal?

Leaking should never be considered normal. It should never be accepted as inevitable with ageing or childbirth, and can be prevented or cured in the majority of cases – often by adopting a few simple habits.  Go to continence.org.au for more information.

If you notice leaking when you exercise, it may indicate a weak pelvic floor, and it is recommended you speak to one of the continence nurse advisors on the free, confidential National Continence Helpline (1800 33 00 66) as a first step.

More help and information

The pelvicfloorfirst.org.au website has a list of pelvic floor-friendly exercises and a free pelvic floor safe exercises app.

The continence.org.au website has an excellent demonstration video by women’s health physiotherapist Shira Kramer on doing pelvic floor exercises correctly.

For confidential advice, free resources and information on local continence services, phone the National Continence Helpline (1800 33 00 66), which is staffed by continence nurses advisors 8am-8pm Monday to Friday AEST.