For women generally, health and wellbeing is of increasing importance. From step-ups to squats, we know the exercises we need to be doing to keep our body in shape. But one group of muscles often overlooked are our pelvic floor muscles. 

Your pelvic floor is a complex network of muscles and ligaments reaching from your pubic bone to your spine, providing essential support for your bladder, womb and bowel. These muscles can stretch and weaken through pregnancy and childbirth, age or lack of exercise. A common side-effect of weakened pelvic floor muscles is bladder weakness – something which affects one in four women over the age of 35 in the UK.

Fortunately almost three-quarters of bladder weakness cases triggered by a weakened pelvic floor can be remedied with simple exercises. The exercises improve core muscle strength, contributing to better posture and a flatter tummy.

Joining us on this live webTV show will be Nell McAndrew who will demonstrate a few of the simple exercises that could make a world of difference to your figure and quality of life. She's joined by Gill Brook, a women's health physiotherapist who has worked in the specialty for over 20 years.

Nell McAndrew joins us live online at www.webchats.tv on Wednesday 24th February at 2pm to discuss pelvic floor strength and demonstrate some simple exercises.

Chat spokesperson's biog:
Nell McAndrew is no stranger to a tough workout regime. The model and TV star and mum of one, has released four of her own fitness videos and makes it her priority to keep fit and healthy.

For more information visit www.corewellness.co.uk

Hi Gill, I've been hearing loads about this 'pelvic floor'? What is this?!

Patsy

Your pelvic floor is made up of muscles and other tissues, and runs from your pubic bone at the front between your legs to the base of your spine at the back. It forms the floor of your pelvis, hence the name. I'm glad you've been hearing loads about it - it's a very important part of your body! It holds your pelvic organs in place, helps you control your bladder and bowels, and contributes to the enjoyment of sex

Hi there, surely this is only a problem for old women?

Anon

Bladder weakness can affect women at any age, though it is more common in later life. 1 in 4 women over the age of 35 will experience bladder weakness at some point in their life

Hi Nell and Gill, I thought this might be a good thing for my mother to take part in, but she's not very mobile - how easy is it to do at home?

Harriet Allen

That's a really good question. Pelvic floor and core muscle exercises are not just for young, fit people. They can be done in any position - standing, sitting or lying - so are suitable even if you are not very mobile. And they are very easy to do at home

My wife has had two children so I'm keen for her to work on her core but I don't know what is scarier, suggesting she do some exercise or her wetting herself with laughter. How do you suggest I approach the subject?

Dan H

People - even married couples - can find it a difficult topic to discuss but you seem to be aware that your wife does have some form of bladder weakness, Dan, so perhaps she has told you about it. If she is keen to improve her core muscles, and improve any bladder weakness she has, then it would be great if you could tell her about pelvic floor muscle exercises and the Pelvicore DVD if she doesn't know about them already. You can always join in! Men can benefit from the exercises, too.

I've had three kids and experience some of the problems you're talking about here. It's very embarrassing to have them and I don't really know who to talk to or what to do about it. Any advice you can give me would be so good. Thank you

Mel

Many people do find it an embarrassing subject to discuss which is a shame, as it affects so many. If you want to talk to someone about it, then how about your GP or practice nurse? They may test your urine to check you don't have an infection, and may also ask if they can examine you to check for things like a prolapse, and to see if you can tighten your pelvic floor muscles correctly. Quite a lot of women don't.

Pelvic floor muscle exercises are a good starting point but don't expect instant results. If your muscles are weak, then it can take 3-6 months to strengthen them, just like any other muscle.

I don't intend to have children but I go running quite a lot. Will bladder weakness still affect me?

- Jennifer Pheby

If you don't have any children then you are less at risk, but could still develop bladder weakness. There are other things that can trigger bladder weakness, some which are unavoidable - such as ageing and the menopause - and others that we can try to avoid like constipation, obesity, heavy lifting, or a chronic cough. So, pelvic floor muscles exercises are still a good idea for you

Hi there, I have heard that strengthening your pelvic floor muscles improves your sex life..is this true and how so?

Thanks, anon

Yes. Because of where they lie, your pelvic floor muscles can have an effect on your sex life. It doesn't mean that you necessarily need strong muscles to enjoy sex, but if the muscles are well toned then this may enhance what both you and your partner feel during intercourse, and improve your orgasm

Hi Nell. I'm aware of pelvic floor muscles, but was just wondering how important it actually is to keep these muscles fit, just like any others?

Just like any other muscle in the body, if you don't exercise the pelvic floor regularly, it will lose tone and strength and therefore won't be fit to do its job properly. The good news is that you can tone this muscle and regain strength just by doing certain exercises.

The Pelvicore Technique DVD guides you through exactly how to find these muscles and how to exercise them. The exercises are easy to follow and I'm feeling the benefits already: I have a firmer tummy, my posture has improved and I no longer have bladder weakness. Visit corewellness.co.uk to sign up to the Core Wellness programme and request your free DVD.

The TENA website also has plenty of advice and information for people wanting to find out more information on bladder weakness and the products available.

Hi Nell, I know that bladder weakness is more common than people think apparently? Do you have any general tips or advice for women who are wanting to combat this issue?

You're right. Bladder weakness affects 1 in 4 women over the age of 35, but the great thing is that pelvic floor exercises can be done just about anywhere. I try and remember to do mine when I'm on the phone, watching TV, doing emails, driving, etc. Just any time I can remember really.

H: Lis Speight, host

A: Nell McAndrew

B: Gill Brook, women's health physiotherapist

H: Hello I'm Lis Speight and welcome to the Healthcare Show. With one aged 35 and over being affected by bladder weakness, it might interest you to know that undertaking some simple exercises can prove an effective remedy for this troublesome condition. These exercises, which are part of the Core Wellness program supported by Tena, if they're practiced alongside others can also contribute towards better posture and a flatter tummy. Makes you want to sit up a little bit! Well joining me to discuss this and guide us through it is women's health physiotherapist Gill Brook, welcome Gill, and very busy and very fit mum of one, Nell McAndrew, welcome Nell.

A: Thanks

H: Really nice to see you today. Now we are live today, so if you want to get your questions or comments into Nell or Gill then please use the box on your screen, press submit and it'll come through to us here and we'll try and get through as many as we can during the course of the show. Now Nell, you've got a little boy now haven't you?

A: Yes

H: He's 3 ½

A: Yes

H: So you're obviously very busy, but you still hopefully find time to exercise. We don't all do as much exercise as maybe we should

A: No it is really hard and I struggle just like everybody else, but I'll tend to just sort of you know, go to the park a lot with him and we'll be chasing, I'm the gingerbread man or whatever you know I'll be chasing around, and sort of – I do it like that, and now he's at nursery obviously it makes it a little bit easier where I can drop him off, do a quick run and get back, do a bit of housework and then it's time to pick him up again. But I thin kit's about thinking of it as little and often, you know and don't beat yourself up if you don't get a chance to do it one day or two days, you know it's – just think about maybe what you could do the next day, and it's –

H: It's not just about muscle tone is it, we're talking about other muscles that we can't see as well

A: That's it, everybody's obsessed with, you know, what you can see and the muscles that you can really feel, and they want to lose weight, but it's really, really important to focus on the internal muscles which are the most important ones to work, the pelvic floor muscles, and it's so easy to forget, once you've had a baby, it's the last thing on your mind to do any sort of exercise. You know just getting a shower is a mission accomplished in a day, but it's so important, and speaking from experience, you know, it is – you know – of having a baby, it does really affect you, and I'm 36 now

H: Looking good on it, I have to say!

A: It's something that you think of as affecting older women

H: Yes

A: But it has affected me, so – and I can guarantee that if you do the exercises regular, and properly then it does make a massive difference

H: Ok Nell. So Gill just talk us through a little bit about what the pelvic floor muscles are, because I think most women know they've got them but not everybody really know what they're for or how to find them

B: No. I've got a model here which will –

H: Oh that will help.

B: Help me explain. This is just a model, life-size model of a woman's pelvis, so these bits here at the top of your hips, pubic bone at the front and the base of your spine. And all that red area in there sort of demonstrates where your pelvic floor muscles lie, so they have some really important jobs in that they hold your pelvic organs up in place, they contribute to your bladder and your bowel control and they can also contribute to your enjoyment of sex as well, just because of where the muscles lie

H: Ok and how are your pelvic floor muscles affected then, as you get older and as you have a baby or whatever?

B: Particularly when you're pregnant - I mean the real high risks are pregnancy and having babies, and if you think about the increasing weight of the baby and the womb growing and just that pressure down, and then when you give birth as well, the muscles have to stretch to let the baby come out

H: Right

B: So that's risk factors as well, and just generally they are affected by ageing too, particularly by hormone changes of the menopause

H: Right

B: But people can be troubled you know by weakness in their pelvic floor or bladder symptoms at any time in their life as well

H: Ok so the affects of having a weak pelvic floor then are what?

B: Probably the most noticeable one, the commonest one is a form of bladder weakness that we call stress urinary incontinence, where women in particular find that if they sneeze, cough, laugh, anything that puts a bit of e xtra pressure on their bladder and they leak a bit of urine. You can also have other problems like it might be that you get a desperate urge to go to the toilet and leak before you get there, or a mixture of those symptoms

H: Right

B: But that's the commonest symptoms that you would tend to get

H: Ok. And how do you actually find your pelvic floor then, if we can't see them, how do we know –

B: That you're doing it right

H: Yes

B: It's a very good point, and some research has suggested maybe for 30% of women, even if they're told how to contract the muscles, aren't doing it properly, so it is a very good point. I mean you can think of where they lie to start with, so if you're just tightening your pelvic floor, it is the muscles underneath, so if you just tighten them and nothing else, there should be nothing that anybody can see that you're doing, and some women find it quite useful to imagine that they're trying to stop themselves breaking wind

H: Right

B: And just – and men find that very easy as well

H: Pull everything up. Pull everything up sort of thing

B: Yes and just pulling it up and pulling it in as if you're stopping yourself breaking wind, or as if you were trying to stop yourself passing urine. But we don't suggest that women practice stopping and starting while they are passing urine

H: Right because then you end up with an infection and all sorts of other problems. So how often should you be doing your exercises, when should you start? I mean should you start when you're a teenager?

B: I think it would be a great idea if people could start at a very young age, and certainly sort of government guidance now is certainly that if women aren't doing pelvic floor exercises before they get pregnant, that they start doing them during their pregnancy because that's been proved to reduce your risk of having bladder weakness during your pregnancy or after you've had your baby, so that's a good time to start if you're not doing it already. Basically the sooner the better, but it's never too late to start, so if you know you're watching or you think about it now, or whatever age you are, you can start doing them

H: Yes. So Nell, I know that when I had my little girl the midwife sort of talks to you about pelvic floor exercises – was that when you first started doing yours?

A: Yes yes really, I suppose because I did a lot of fitness beforehand, you know my muscles, I was working them probably without even realising it a lot of the time. But it did affect me afterwards and it's not really talked about in great depth though, it's kind of – it's very brief, and I wish that somebody would have baby, a constant reminder whether it's from your health visitor, your midwife, your doctor – every check-up that you have, if every one of those, it's like on a tick list that they remind you, then it's – it's always on your mind to do that, because you should be doing them daily, definitely

H: I know my midwife said do your pelvic floor exercises when you're cleaning your teeth, because then at least – you're not doing anything else when you're cleaning your teeth, so you might as well be doing your pelvic floor exercises, and you need something in your life that reminds you to do them don't you?

A: Yes or one the phone or watching TV or –

H: Yes that's a good idea

A: Just any time at all where, stood at the bus stop – anything you know, just try and remind yourself constantly to do just do a little bit, little and often and before you know it you will actually notice a massive difference and fell stronger and tighter

H: But the Core Wellness program which is what we're here to talk about today is all about improving your posture and your tummy tone as well as your pelvic floor muscles, and Nell's going to be showing us some of those exercises a little bit later on before we go, but Gill just tell us a little bit about the effects of bladder weakness on women, and the sort of – the effects it might have on your partner, and your relationship with you and your partner because women who haven't got kind of instant control of their urine, it's very distressing isn't it?

B: It is, absolutely. A lot of people find that they can't talk about it, working as a physiotherapist sort of dealing with people with pelvic floor weakness and bladder problems, you know I'm used to women talking to me about it, but quite a lot of women wait a very long time before they seek any help and maybe feel they can't talk to people around them about it, or they feel they can't go and speak to a professional about it as well, so it does have an impact on it. And you know if we're saying that one in four women can experience bladder weakness at some point in their life – we also know that of those women, probably one in four of them can leak during sexual activity

H: Oh that's embarrassing isn't it, yes

B: So – so that's – you know that's a major concern to them and might affect their sort of relationships that they have with other people. You mentioned instant control, and on the DVD there's a section that talks about instant control

H: The DVD you can get from the website, we'll tell you about it at the end

B: Yes

H: All to do with the Core Wellness program

B: Because apart from doing a whole structured sort of set of exercises which Nell's going to demonstrate a couple, it also talks about the importance and we know this is important, of using your pelvic floor muscles when you need them,

H: Right

B: If you have a weakness problem, so for instance if you're a woman that finds you might leak urine when you cough or sneeze, what were saying is you know as you sort of take that breath in, or your hand goes up to cough or sneeze, pull up your pelvic floor muscles as well, keep them pulled up, keep them pulled in until you've finished coughing or sneezing and let go, and it demonstrates on the DVD how to do that, or for instance if you're picking up a chair or another item, because that will make some women leak urine, how to pull up your pelvic floor muscles at that time too

H: Ok, well let's move onto some of your questions now, we've had quite a few coming in, we've had one in which is anonymous actually which says quite a lot doesn't it? "I've heard that strengthening your pelvic floor muscles improves your sex life. Is this true?" Nell, could you comment on that one?

A: I think you know you're lucky if you have one really if you've got a baby!

H: Yes that's true

A: Even a toddler, so – but I think it just affects your whole life, and it can actually affect your whole confidence, like Gill said you know with everything, you know with everyday life activities as well as your sex life, so you know it's – it will improve everything

H: Yes. There's can't be many exercises that we do in life that improve your sex life can there, so it's worth giving them a go isn't it! We've had one in from Harriet Allan, "Hi Nell and Gill" she says. "I thought this might be a good thing for my mother to take part in, but she's not very mobile. How easy is it to do it at home?" Nell, how easy -

A: Well you can be sat in a chair, so it's really – very straightforward. And I always think – in one particular class that I used to go to, the instructor, who was male actually, he used to actually say think of being in a lift and you're going up different levels, and so you pull your pelvic floor in, and one once you've lifted up, squeeze and hold, and then think about lifting and going to the higher floors, and then hold, and then – that's how he used to explain it to all these women in the class, and it was a really good way of trying to – for people to understand, you know in finding the pelvic floor and then thinking about how it must feel to experience you know, holding and squeezing

H: Yes. And I remember when I first started doing those lift exercises, and it was really difficult, but then it does become much easier, so you're obviously strengthening your muscles without – and it's not that difficult is it really so – no excuse

A: Yes. And maybe avoid you know if you know that you've got a problem at the moment, then you know avoid maybe running and things that maybe will affect that. Try and concentrate on cycling or something that's maybe not quite as – you know pounding weights

H: Yes

A: Going to affect you, so that then you don't – or swimming or something where you'll feel more comfortable, until you've strengthened your muscles, and then go back to doing running

H: Ok, yes. But it is quite a difficult subject this isn't it? I mean if you're sort of leaking urine during sex and – you know how – women do find it difficult to talk – even amongst themselves, would you say that's true Gill?

B: That's true, I think although sometimes when I'm seeing a woman whose come in for treatment, and she'll say oh I did happen to mention it to a friend or another woman in the office, it's amazing then how many will turn round and say oh that happens to me too, or gosh what's the physiotherapist told you to do, because I'd be quite interested in that as well

H: Yes. And maybe people don't even realise they've got a problem, do you know what I mean, maybe it's something that just happens and they just think it's one of those things, and they don't actually realise you can do anything about it

B: I think it's important, that's one of the very important messages is it's not uncommon but in the vast majority of cases, something can be done about it, and the exercises are a very good starting point, but at some point you may well want to speak to your practice nurse or your GP About it, and they may well do some tests, they may check your urine because – to make sure you've not got an infection

H: Yes

B: Or any other problem, examine you, because it's important actually at some point probably to check that you are squeezing the muscles correctly, because we've described how to do it and the DVD describes how to do it, but actually sometimes it needs some sort of check to see that you are contracting the correct muscles

H: Right, yes. Ok. Moving on to some more of your questions, we've had one in from Mel, she says "I've had 3 kids and suffer a bit from some of the problems you're talking about here. It's very embarrassing to have them and I don't really know who to talk to or what to do about it. Any advice you could give me would be so good. Thank you." So Mel – what would you suggest Nell, I mean if you have got a problem and it's embarrassing, who do you think you should go to – GP maybe?

A: well I mean ideally, but even you could feel quite embarrassed about going to a GP because you know they could see maybe, I don't know maybe some GPs are better than others

H: Yes

A: And be quite dismissive and you know maybe not think of it as a serious condition as you're feeling, you know and it's – because it's such a personal issue. So you know ideally I suppose a friend is a good person to sort of be really open with, and maybe as you build the confidence go to a GP but I mean if you could go to them straight away then that's brilliant, but that can be a huge step in itself you know, some people really don't like going to a doctors, you know unless they're really, really forced, so yes it's just – and yes I think the more things like this, you know that's actually saying it's ok to have that problem, it is affecting so many other women, and you know you're not the only one, so I think it's just that – they're about getting that message out that it's very, very common so don't feel like you're isolated

H: Yes you're not suffering, you're not the only one that's suffering from it – if you talk to your friends now you'll probably find out that they've all got it as well. Ok well I hope that's of help. Now this is a problem that effects 1 in 4 women over 35 and we've been talking to some women who have had problems with their pelvic floor and had problems with bladder weakness, but they have tried this Core Wellness program and it has really helped, so just have a little look at this video and it'll give you some idea of what we're talking about

Video Footage

Anna 35: I first started having bladder problems when I'd just given birth to my first child, I don't think it's anything out of the ordinary, a few of my friends have had similar problems so I didn't really worry too much about it. But it was a bit embarrassing. But it cleared up quite quickly and now I'm pregnant with my second child I do notice that I'm having quite a few more problems than I had before. It does worry me that the second time around things might not clear up as quickly as they did the first – can be quite worrying really. Well obviously it's really hard to hide it from my husband. But I feel unclean and I worry that he might smell it, and it does get me down, I do feel quite worried about it and a bit less confident than I would normally feel, but I've recently started doing the Core Wellness program. It's an exercise routine that I find really relaxing, and it's quite simple to do and it fits in so well with the way I live my life with my routine, and it's really working already, I can see results already, I feel so much more control and I'm much more confident within myself and I feel great actually, I feel really good about it

Christina 60: When I first started to discover I had bladder weakness it made me feel really old. I didn't like it at all, I'd just been through the menopause, gone through all of that and now there was this, you know – it effected me a lot because I love playing tennis, I love cycling, and it's stopped me from doing those things because I was nervous it was going to happen again. And in fact actually socially I just wanted to stay indoors, I didn't want to see my friends, it stopped me from doing all my usual things. I'm in a new relationship at the moment and obviously this was the last thing I needed, and it was just this feeling of making you feel less feminine, less confident, and I didn't want it to happen when we were intimate, so I was really quite nervous to broach the subject really, but I thought well we have to, I have to talk to him about it, so we had a nice meal, and a few glasses of wine made it much easier. And he was fine, absolutely fine, no problems, he understood absolutely. Well somebody told me about Tena pads, and I thought I'd try these. Rushed out and got a pack, they made me feel much better, fresher, cleaner, and so consequently I felt much more confident. And I also started to try pelvic floor exercises which I'd heard about and they're brilliant. Once you get the hang of them and you get in touch with your body, the more you do the easier it gets, and I was experiencing less leaks, so I just kept going with this and I'm here to say that I've got my old self back again!

H: So moving stories there, I think you'll agree that it just shows that you can actually do something to improve your pelvic floor if you do these exercises, and Nell is here to show us how. So Nell you're going to show us some of these exercises that are on the DVD, the Pelvic Core DVD. So just talk us through what you're doing

A: Yes well there's a couple of really simple examples, really easy to follow, so if you get down onto your hands and knees, and you're going to keep your back nice and straight, nice and relaxed, and if you just place one hand onto your tummy

H: Right

A: So that you can feel where your abdominals are going to be pulling in, and what we want to do is if you concentrate on pulling in your pelvic floor, so you pull your pelvic floor, squeeze up and hold, and then lift your belly button towards your spine, so you really want to concentrate on pulling it up, so you're squeezing up and holding inside, and you're pulling your tummy in

H: Right

A: And hold and then relax, so you can drop your tummy back into the palm of your hand, so you can actually feel it moving

H: Yes

A: And if you keep doing that and obviously try and hold for slightly longer as you get stronger, the DVD does, you know explain this in good detail

H: And how many of those should you be doing then?

A: Well I think just as many as you can. You know if – just start gradually, so if you try and aim to do maybe 10 or even if you can't manage 10 then it's ok to do you know 5. I think it's just about starting to be aware of where your muscles are, and how it feels , so you know concentrate, you squeeze up, and hold inside and then pull in your belly button towards your spine and relax. And then an alternative to that is you do the same thing again, you pull your pelvic floor up, squeeze and hold and then you're going to lift up and alternate arm and leg and just stretch out

H: Ok. I think I'd fall over if I –

A: And hold –

H: Tried that but there we go

A: And – and don't worry if this is an exercise that you feel that you're not comfortable with, or you don't feel you can balance very well. I mean I personally used to do this a lot when I was pregnant

H: Yes

A: So when everybody else in the exercise class was working their abdominals you know this was something that I was given to do as an alternative, so it's something that everybody can do, so you're working your abdominals, your lower back, your pelvic floor, as a whole which is a really good example of working that whole areas

H: And they're quite easy to do at home as well because you could do that on the carpet as well couldn't you while you're watching the telly or whatever. I suppose you need to concentrate don't you on pulling in those muscles

A: Yes that's it, I think it's just a case of, you know just being aware of where your muscles are and squeezing and really holding and you know lifting, and just making sure that you're engaging all the muscles and think about pulling your tummy button into the spine, and that way – just day-to-day even when you're walking around and standing, you know shoulders back, try and always concentrate on pulling your abs in

H: Yes

A: Your abdominals, pulling your belly button into your spine and it will affect your whole posture then as well

H: And it makes you look slimmer when you pull your tummy in, let's face it

A: Yes, you can look a whole dress size slimmer, so it's very good, yes

H: Ok now well thanks so much for coming in and showing us these exercises, and good luck with your little boy

A: Thank you

H: Racing round after him and keeping slim

A: Yes

H: Really nice to see you. Well strengthening your pelvic floor muscles isn't as hard as you might think, as you can see, Nell's just shown you how to do it. So to improve your figure and your quality of life, why not give it a go? For more information about the Core Wellness Program supported by Tena you can visit www.corewellness.co.uk and there's loads of information on there and it tells you how to get your free DVD as well. Well thanks very much for joining us and we'll see you next time. Bye bye

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