The Floor is Yours

Emily Burmester of Project Physio never set out to be a pelvic health physio. In fact she’d never even thought about it for the first nine years of her career. But like a lot of her clients, her pelvic floor — or rather the failings of it — was something that became top of mind after the birth of her first child.

As an avid long-distance runner, competing in trail ultra-marathons and on-road half-marathons, Emily’s main area of focus had always been fellow runners and other athletes. Although whether that was simply natural interest or the lack of pelvic health education in musculoskeletal degrees, could be up for debate. “The word pelvic floor wasn’t even mentioned in the physio master’s degree I did
in the UK,” says Emily, who points out that even now, if you want to learn about the pelvic floor, you need to seek out specialised education. Her own search took her to Australia for a course.

This lack of information isn’t just in tertiary education. It’s just as hard for your average person to
find any clear guidelines on how to help their pelvic floor, or even how to know if there’s anything wrong. This was something Emily struggled with postpartum when looking for ways to get back
to running without leakage.

“My pelvic health was having a massive, massive effect on my life. And as a physio, I know what
I’m doing and am really ‘body aware’ — there must be so many women that have just absolutely no idea what to do. The information is so conflicting and hard to understand, not to mention when you start Googling, it comes up with all the scary stuff, like prolapse!”

It’s no wonder that for many of us, pelvic health feels like an unknown, and something that can
seem overwhelming. And that’s without even starting to delve into the stigma that comes with it.

Emily started researching and testing techniques and ideas on herself, until she was back to being able to run without the worry or anxiety about her pelvic floor being able to withstand the movement. This made her appreciate the importance of this area of physiotherapy because the ability to do things we enjoy, along with our mental health, confidence and even the way we see ourselves, is all impacted when pelvic health isn’t good.

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Despite the huge impact it can have on our lives, it’s usually one of those things you don’t think
about until you have a problem with it. And even then it’s not something that you really want
to talk about! “Nobody wants to talk about wetting themselves. Nobody wants to talk about uncomfortable sex. Nobody wants to talk about constipation,” Emily says, referring to symptoms
of pelvic health that need help.

But talking really is part of the solution. The more people that open up about their pelvic health journey, the more others around them feel comfortable to share too. This approach is really where Emily’s pelvic health service started — talking to the mums at her own Space group (a postpartum programme run through Playcentre) about how she wanted to get back into exercise and the issues she’d been having along the way. To her surprise, almost all of the mums were in the same boat and wanted to join her as she worked her way back into movement, kicking off the first of her Project Mum groups, which now include pregnancy and postnatal classes that cover off exercise and education.

Four years and another child later, Emily has now had more than 400 women go through her classes (some twice, with second babies). “It’s pretty cool to see that many women gain this knowledge and empowerment on their exercise journey,” she says.

She still visits Space to educate mums around the importance of considering their pelvic floor as the first step to getting back into exercise. Compared to when she first talked about her own issues, she’s found the mums are increasingly aware that it’s a topic they need to think about, and that the things prior generations accepted as ‘normal’ postpartum challenges (like not being able to sneeze without leaking), no longer have to be that way.

“My pelvic health was having a massive, massive effect on my life. And as a physio, I know what I’m doing and am really ‘body aware’ — there must be so many women that have just absolutely no idea what to do.”

You might have also seen this progress in your social feeds, with more posts around pelvic health, memes around trampolines being off limits for mums and an increase in raw postpartum sharing.
But is it enough? Emily doesn’t think so. “It’s definitely more talked about in recent years, and I think social media has helped people become better at talking about it, but there’s still nowhere near as much information available as there should be. And there’s still an embarrassment that comes with admitting to having some of these issues.”

This extends to the words we use, with clients visiting Emily to ask about ‘pain down there’ and discomfort in their ‘lady bits’. “We wouldn’t make up a silly word for shoulder, why do we do it for
our vagina?” Emily laughs. By normalising conversations around our bodies, we take a step closer
to making a visit to a physio for pelvic troubles as normal as any other injury.

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Another point that’s (so far) been missed in the increased conversations is that pelvic health isn’t
just a topic for mums. Everyone has a pelvic floor; there are people of all ages and genders who
have trouble with their pelvic health and need support to get it working properly again. Things
like painful periods, erectile dysfunction, issues post prostate surgery, urgency to use the loo, unexplained abdominal pain, painful sex, and vaginal dryness from perimenopause onwards are
all symptoms that could be related to your pelvic health.

One of Emily’s clients put up with (many!) years of symptoms and eventually got to the stage
where she didn’t feel able to leave the house as she was scared of her urgency to wee during social outings. As someone whose coffee group catch-ups formed a big part of their social calendar,
this really impacted her life and mental health. For another client, it was wearing a pad every single time they ran for eight years postpartum. When she realised leaking while running was something
she could actually do something about, she was horrified that all those years could’ve been free
of pads and anxiety.

Emily is driven to keep sharing, keep educating and keep normalising these kinds of experiences
in the hope that it’ll stop anyone — postpartum, teenage, menopausal or other — from keeping their own issues hidden in shame. Because it doesn’t need to be shameful. Pelvic floors are just part of
our body, another muscle to be worked on so that we can all keep doing the things we love.

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TIPS FOR BETTER PELVIC HEALTH

Do pelvic floor exercises Also known as Kegels (named after Arnold Kegel, a gynaecologist who invented them), this is an exercise where you squeeze your pelvic floor on exhale (as if you’re holding in a fart), then fully relax. This is the only way to directly work those pelvic floor muscles. Specialist physios, like Emily, can help ensure you’re doing the ones right for you. Pelvic floor exercises are for life, not just for the short time after babies, and not just for those who have given birth.

Engage your floor When you’re lifting something (a box, a child, a crate of beer), engage the pelvic floor before you lift to add support while you do the movement. This also applies to things like sneezing, jumping and coughing. This is more essential for those with a weak pelvic floor.

Strengthen supporting muscles Your core and glutes help support your pelvis, so strength work,
such as Pilates, can be a good way to target these areas.

Breathe well Your diaphragm and pelvic floor work together, so it’s important you take deep
breaths with your diaphragm rather than breathe with your upper chest, as we tend to do when
busy and stressed.

Keep your bowels healthy Constipation and straining puts huge pressure on your pelvic floor, but
you can reduce this by going as soon as you have the urge and using a stool also helps (if you’re unaware, there are special stools — kind of footrests — that put you in an ideal squatting position). Keep an eye on your bowel movements — we want the middle ground between Malteser consistency and McFlurry. Good bowel habits start from an early age so ensure kids are going about it correctly.

For more information and to seek help, see a pelvic health physio or GP. Every person is different so having individual management is ideal. projectphysio.co.nz @projectmumnz

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Story by Megan Raynor

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