Kegel Exercises for Women - what do women really know?

What do women really know about the problems caused by childbirth?

The manufacturers of the PelvicToner™ have an ongoing programme of research designed to improve their communication process and to help educate and inform new mothers in particular, and women in general, about the benefits of effective pelvic floor exercise for all women of all ages.

It has been very apparent over the years that there is a complete lack of reliable and accurate information about the physiological and physical impact of childbirth and of the problems associated with the long term damage inflicted on the pelvic floor by childbirth. The problems are compounded because the UK NHS does not offer adequate post natal support and advice to new mothers and there is no structured, pro-active post natal programme for pelvic floor rehabilitation.

Too any women live with the health and relationship consequences that arise despite the fact that there are simple, effective solutions to the problem of which PelvicToner exercises are, without doubt, the simplest, cheapest and most effective.

Mumsnet Discussion Thread July – Aug 2012

The Mumsnet organisation (www.mumsnet.com) offers a service to sponsor ‘discussion threads’ and the manufacturers of the PelvicToner availed themselves of this opportunity to add to the knowledge base and understanding of the issues from a ‘new mother’ perspective.

It must be hoped that Mumsnetters are not typical!

There were 156 posts over the 8 days that the thread ran. There were a huge number of negative and cynical comments but that may be due to frustration with the lack of help offered and the disbelief that anything may actually help when the advice that they do get clearly doesn’t help.

Overall conclusions from the Mumsnet thread

The thread confirmed several key issues:

New mothers are generally ill-informed.
They don’t know what to expect, so bladder and pelvic floor problems come as something of a shock.
Embarrassment is a key problem as is the belief that pelvic floor problems are unusual.

New mothers don’t receive or absorb the information they need.
When they do seek medical advice they are often fobbed off.
There were few positive comments about GPs but a huge number of negative ones.

Clearly the media that new mothers rely on are not providing the honest and truthful information that is required and the regular, ongoing repetition of key facts is necessary.
Given that each segment of the pregnant/new mum/toddler age population of mothers is in a constant state of flux, the message to get through to editors is than these messages need to be put out their constantly and honestly. Not a once every two year mention.

Verbatim comments by Mumsnet contributors

The following statements are the verbatim comments of Mumsnet contributors. To read the full transcript of the entire discussion thread click Post-natal pelvic floor and bladder problems - transcript

Lack of information and relevant advice

My hospital gave me a leaflet about postnatal exercises and incontinence but as it was badly photocopied and looked very boring I imagine most women would have thrown it away among all the Bounty and other bumf you get on leaving hospital.

women just aren't given a lot (any ?) medical followup after birth,

women often expect to have a weak pelvic floor after birth and think not much can be done for them.

anything that encourages women to exercise their pelvic floors and realise the importance of them is a good thing. My motherin-law's friends used to laugh at her for religiously doing her PF exercises every day - now she's the only one who doesn't need tena lady!!

I think the problem is women not being told either when pregnant or shortly after that help is available,

If women aren't aware there is help, they aren't going to go to the GP or phone the hospital physios in the first place

more in general needs to be done to raise awareness of the issue of post natal pelvic floor and bladder problems.

I got a leaflet that told me to do pevlic floor exercises - but not how to do them, or what issues could arise if I didn't.

Nobody really admits to it. We all make jokes about weeing on trampolines but nothing more.

at my 6 week check, I was asked if I was doing my PFEs, of course I was. I answered yes, that's it.
They didn't ask me what I was doing specifically, they didn't ask me how they were going, they didn't give me a leaflet showing me how to do them properly (so I still don't know), but most importantly, they didn't tell me that if I was worried about the progress within a certain period of time, that I could go back and discuss it.

I thought pelvic floor exercises were an optional extra to labour and delivery but this particular midwife made it quite clear they really need to be done to avoid possible serious complications later in life.
I think to market a product in this market, a similar information-giving approach would be needed, pointing out what can go wrong.

Lack of a sympathetic ear

There needs to be a broader focus generally on what a mother may expect in terms of physical and emotional changes after she leaves hospital.

I have been to the doctors regarding this issue and been fobbed off by them,

GPs tend not to be useful for minor complaints.

I hate going to the doctor, I find them patronising,

I don't think I would go to the GP. My GP is very insensitive,

I think GPs forget its an issue as women don't talk about it freely enough.

I think GP/ health visitors should do more to discuss the problem more openly, like at the 6 week check-up, as mine didn't. I was too embarrassed to mention, & it just got forgotten about, hence I'm having to deal with it on my own.

I think there should be routine follow up of mothers by GPs to discuss issues like this that you wouldn't have time to notice by the 6-8 week check, because that may be the only time you see a doctor for years.

I wouldn’t talk to my GP because I would expect to be told to wait/exercise/lose weight/fobbed off

make (GPs) see that the Pelvic Floor problem is a real problem, and that it's not just as simple as a few squeezes here every day.

I tried talking to the midwives during my second pregnancy and was pretty much dismissed.

In my experience GPs are very set in their ways and that's sad.

I certainly wouldn't talk to my current gp about an 'embarressing' condition as she is a judgemental, arrogant witch.

Turn them all (GPs) into post-baby women? Then they'd understand.
I'd be embarrassed to talk to my GP, mostly because I'd feel my problem wasn't serious enough

health visitors who run these things.... specific meetings about post natal health and fitness that included mention of the pelvic floor might be a good idea.

I think half the problem is that the 6-8 week check is supposed to be for mums and babies but just ends up being for babies, nobody checks you, nobody checks your tummy for a separation, nobody asks about leaks, nobody asks if you have trouble with bowl movements.

Would the PelvicToner be relevant?

wish I had known about this product as when trying to do pelvic floor exercises a few weeks post birth, I couldn't even isolate my muscles

It's a nice idea, but I haven't got the time, haven't got the money and isn't a bit of stress incontinence something everyone has. It's not like I want to go trampolining or anything.'

I know I should do something but ….

most of my friends in their 40s and 50s say that their PF has never returned to normal

I tried doing exercises, but it wasn't very easy to make progress, at the beginning I couldn't find the muscles to do anything!

It is later once life has settled and you want your sex life back that you might do something about it.

(Physio) said no leakage is normal at our age and even said friends who have to concentrate when they sneeze should seek help.

The main issue for me - and this has been briefly mentioned - is sex after having 2 big babies. Although 'leakage' too as I do have to wear a panty liner for when I sneeze... Frankly, orgasms are just plain rubbish without the strong muscles inside to carry you over and combined with a decreased sex drive anyway, I'd rather have a cup of tea and an early night these days...as you can probably imagine, my marriage is a little bit stale at present.

I think at the moment the main problem is that we just aren't given a lot if any medical followup after birth, concerning urine leakage.

It has affected my confidence though and my self-esteem may never recover properly

no-one told me that I would have trouble with tampons.

I have some damage to my pelvic floor but ironically it didn't manifest itself as "ordinary" incontinence but in my inability to keep in a tampon.

Conclusions

The Mumsnet community may or may not be typical of mothers at large. If it is then there is cause for great concern.

Small companies, such as the manufacturers of pelvic toning devices, can do their utmost to improve the education and awareness of new mothers but they may lack the credibility and authority of those organisations that should take responsibility for that education process.

In short, the NHS at large, GPs in particular, and the editors of women’s magazines and newspapers must assume a more active role.

A survey of GP surgeries conducted at the same time as this discussion thread discovered that in 62% of cases the only support given to new mothers was a leaflet on pelvic floor exercises. There are no clinical trials to confirm the efficacy of this ‘treatment’ which falls far short of NICE Guidelines. The fact that there are estimated to be between 4 and 7 million women with health problems directly caused by weak or damaged pelvic floor muscles following childbirth and/or menopause confirms that this approach is inadequate.

It is essential that something must be done about the problem because every week there are approximately 15000 new births in the UK. The most conservative estimates suggest that a third of new mothers (5000 each week) will suffer long term from urinary stress incontinence and a similar number will suffer prolapse.

If you would like to read the full transcript of the Mumsnet Discussion Thread on the link: Post-natal pelvic floor and bladder problems - transcript