Whether you have just had a baby or are just looking to increase sexual comfort and pleasure, help is at hand. Kari Bo, a world expert in exercise science and physiotherapy has spent 20 years researching and treating women with pelvic floor problems. She has found that the failure to exercise these muscles is due to a lack of knowledge and guidance of how. In a rare opportunity, she joins us today to demonstrate some simple steps to strengthen your inner core, from her brand new DVD- PELVICORE Technique. So clear a space in your living room, grab a yoga mat and learn from the expert.

There are seven main exercises that Kari has pioneered and developed that will help women of all ages restore balance and regain control of their body. By following her brilliantly simple exercise programme you can improve your tummy tone, posture and even your sex life.

The pelvic floor specifically helps control posture, movement, control and tummy tone. Childbirth, age and loss of tone can all contribute to a loss of control, which can be unexpected and unnerving for any woman. The great thing is that by regularly doing these very simple exercises, you can strengthen the muscles to their former glory. Whether you have back pain, bladder weaknesses, stress incontinence, or are merely looking to enhance your sex life, Kari Bo is here to help you regain control and demonstrate her simple exercises.

Kari Bo joins us live online on 11th September at 16:30 to demonstrate how by following some simple exercises we can improve the tone and control of our pelvic floor muscles.

For your free Pelvicore DVD go to www.corewellness.co.uk

H: Lis Speight, host
K: Kari Bo, Professor exercise, science and physiotherapy

H: Hello and welcome to the Healthcare Show. I'm Lis Speight and today we're going to be talking about pelvic floor exercises. Did you know that by undertaking a simple program of exercises you could improve your posture, your tummy tone and maybe even your sex life? So if you've recently had a baby, or you're just looking to improve your sexual comfort and pleasure, stick around because we have somebody in the studio who can give you some really top tips on how to improve your pelvic floor. Professor Kari Bo is a world expert in exercise, science and physiotherapy and for the last 20 years she's been working with and researching women with problems in their pelvic floor area, and I'm delighted to say that Kari has come all the way from Norway to be in the studio with us today, welcome along Kari. Now remember this is an interactive show and we'd love you to get involved, so if you have a question for Kari about pelvic floor problems, then all you have to do is type your name and your question in the box that's on the screen, press submit and it'll come through to us here in the studio and we'll try to get through as many as we can. But Kari first of all, tell us a little bit how you got involved with this program, you set up a special program to help women with pelvic floor problems haven't you? Tell us how you got involved with that?

C: Yes it started many years ago when I was going to do my Phd and I was going to do it on peripheral muscle training, and looking into the literature I was really amazed about how they didn't really use exercise science when they were making the program, it's just this small, tiny exercises that didn't really fit into the strength training program that I knew.

H: Right

C: And setting up a program I wanted also to treat women with other things, not only the pelvic floor because if you're going to do an exercise class you want to train other muscles as well. So then I thought it was ok that we could combine pelvic floor muscle training with abdominal training, back training some ergonomics, some stretching and some exercises for the upper body –

H: So you can get a bit fit as well –

C: Yes

H: Whilst exercising your pelvic floor at the same time?

C: Yes, it's not only the pelvic floor, it's the whole thing is the posture, it's everything there

H: Every time you say posture it makes me want to sit up straight

C: Yes

H: Now you have obviously had a lot of success in this and we have a couple of case studies to look at actually. Take a little look at this and it will give you an idea what this program is all about

Video footage

“I first started having bladder problems when I had 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, I didn't really worry too much about it, but it's 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 – it 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 and 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.”

“Well somebody told me a bout Tenna pads so I thought I'll try these, rushed out, 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 experience 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 some really interesting case studies there and some real success stories as well. Kari, tell us for the uninitiated, what exactly is the pelvic floor muscles or are the pelvic floor muscles, and why is it so important for women?

C: First of all they are regular skeletal muscles, so the only problem is we can't see them because they are inside the pelvis, so they go from the pubic synthesis, from the front and back to the tail bone, and they actually form the floor of the whole pelvis, so everything we are doing – laughing, we are sneezing, we are jumping, everything will affect the pelvic floor muscles, so they are actually going to counteract all the rises in the abdominal pressure, and that's why they need to be strong and in place to be able to resist that movement, really pressing them downwards, and in every standing position when we are not from – the animals are on all fours but we are in upright position, and every pressure is going to affect the pelvic floor muscles, so they need to be really in good shapes to answer to that

H: And when are they not in good shape, when do we start getting problems with our pelvic floor muscles?

C: Well the funny thing is really that women who have not had any children like young, sport women also have problems with the pelvic floor –

H: Oh right so it's not just pregnancy –

C: It's not only pregnancy and especially childbirth is the main risk factors because –

H: A lot of stress in that area

C: Yes because then you have some injuries, but injuries can heal and I think because I'm coming from sport medicine and sport physiotherapy, I know that if you have an injury you can heal that by exercises and do things with it, so it's not really the end of the world if you have a trauma during birth, but of course this is a risk if you having problems, and the problems can be faecal incontinence, and the most common problem is urinary incontinence, and for women stress urine incontinence and that's when you are coughing or sneezing or doing exercise then you will have small drops of leakage

H: It's very distressing for people isn't it?

C: Yes and it makes them stop exercising and that's a big concern because exercise and regular exercise throughout your life span is really important for your health

H: Ok

C: So that's, I think that's really bad thing about having this problem because you stop exercising

H: Right, but your program then combines the two so you can't go wrong

C: Yes it's true because then we are doing regular strength training, using knowledge from science and apply that on the peripheral muscles and I think that's why it works so well because we are really doing strong, maximum contractions

H: Ok. Well it's interesting stuff isn't it? Now we already have some questions in actually and one comes in from Sarah and she wants to know “can I still do pelvic floor exercises while swimming?” She wants it all doesn't she?

C: Yes. You can do it in every occasion or in every position or whenever, but I strongly recommend that we are doing this exercises as exercises for their own and not combine them with all other things, because if you put a lot of things all together the effect will be very low on both the swimming and the training

H: Right. So you need to concentrate really on one or the other really –

C: Yes to build up the strength you really need to concentrate, like when you're strengthening your biceps you're not doing that while you're doing three or four other exercises. So you should to build it up you should really go into positions with legs apart, concentrate on the muscles and then try to strengthen them as you do with other muscles groups. But if you have done that and your muscles are strong enough or in shape then of course you can do it in all situations if you want to

H: Right. Well Sarah at least you're thinking about doing your pelvic floor exercises so that's a start isn't it?

C: That' very good

H: Now Lucinda from London has written in and she wants to know “I'm considering having a c-section, a caesarean to deliver my baby and I'm worried about my pelvic floor being affected for the rest of my life, am I being drastic?” Actually I think what she's saying is she's thinking of having a caesarean section because she's worried about natural childbirth affecting her pelvic floor. It's a difficult one that actually isn't it?

C: It is because every woman should choose that herself but I think that still a vaginal birth is the natural way of giving birth and in most cases this is going very well with no problems and if you have a problem then you can train the pelvic floor muscles, and we mustn't forget that with caesarean section there are also problems for instance like you would have adherences inside your tummy and also because you are pregnant you will have the pressure on the pelvic floor so you are not totally protected by doing a caesarean section, so I mean every surgery is a risk so –

H: It's major surgery having a caesarean, I had a caesarean – it's not fun

C: No, no if you have a vaginal birth it's much easier afterwards, I can say that because I had that myself and I mean for most women this is not a problem at all

H: No and it's never too late either is it to do your pelvic floor exercises, so if you are having problems after birth then as long as you do your pelvic floor exercises then you should be able to correct that

C: Yes and even in old women in their 90s starting to do pelvic floor muscle exercises, they will feel better, so it's never too late, it's really correct what you're saying

H: There we are. So I hope that's been some help to you. Now we have a question in from Selina in Wapping, and she wants to know “should I get my husband involved with pelvic floor exercises?”

C: If you should do it – is that the question?

H: Or whether he wants to be involved in her pelvic floor exercises, maybe that's what it is. I'm not sure about that one

C: Well first of all men have the same muscles so they can train the muscles as well, but it doesn't seem to be a big problem for men, it's only after they prostectamy when maybe they have an injury to the pelvic floor muscles, but in most men this will heal without the exercises, so the evidence is not very strong for men to do pelvic floor muscle training, as it is for women because after childbirth we have evidence that it really helps women. If it's about sexual pleasure and that she could exercise for instance during intercourse, that's totally fine to do that but it's much more difficult, so I think you will be a skilled exerciser to be able to do that during intercourse but it's – I mean it's a good thing, whenever you can train that's fine

H: It's worth having a go isn't it, you never know? Now we have another question in and this lady said “I've been told I have a prolapse. Now that I have given birth what should I be doing to sort things out. I'm finding it painful to do pelvic floor exercises as I have a bartholen cyst.” Do you know what that is? I don't

C: Yes it's a cyst inside the vagina that you feel when you have intercourse

H: Oh I see

C: And you can feel it also during exercise and elsewhere. We have very little knowledge about the affect of peripheral muscle training and prolapse, there are only actually two studies available for the moment and we are doing one in Norway now. It's a huge problem because we think that about 50% of the vaginal birth they have some prolapse, some small prolapse so none of us really are without any problems at all after vaginal birth. Theoretically I think it's the really – if it may be very effective to try to do peripheral muscle training and try to stop and reverse the prolapse, but we have no evidence yet for that

H: Right that it will actually work?

C: Yes

H: But it does no harm to have a go?

C: No because it's really what we are trying to do is to close the pelvic floor because during childbirth or after childbirth it's really opening up and what we are doing with exercise is try to close it and lift it up and back in place and then you will lift the prolapse, but if the prolapse has come too far then of course you can't do exercises, so this should really start at an early stage, so I really would recommend her to do peripheral muscle training. If she has a problem with pain I think she needs to go to her gynaecologist and maybe in collaboration with the physiotherapist to try to sort out what is this pain about

H: So there is hope then, she can sort it out?

C: Absolutely

H: And don't just grin and bear it actually, to try and get something done about it

C: This is really some sort of problem that women think they have to live with, but I think there's a lot you can do in this area, so don't sit there and have the problems, try to put it forward and you can be helped

H: Lovely, now we're about halfway through the show now, this is a live show, the Healthcare Show and if you want to get involved then all you have to do is type your name and your question on the screen and send it through here to Kari and we'll try to answer as many of your questions as we can. Now we spoke a little bit earlier about how Kari has put together this Core Wellness program to try to help women with pelvic floor problems and she's put together a DVD, a free DVD to help women to do these exercises. So let's have a little sneak preview of what that DVD entails

DVD footage

“So let's start the class with some breathing, some posture and stretching exercises. Breathe in and out – and roll your shoulders – and again stretch, breathe in, and out. And shoulders. Stretch up, breathe out – and stretch – and shoulders. And just breathe – bend your knees, and stretch up – hip and knees, flat back – “

H: Well that all looks very relaxing – I hope that's given you a bit of a taste of what the DVD is all about. Now we still have some questions coming in actually so we're trying to get through as many as we can, Lisa has written in and she wants to know “hi, my baby is almost 5 months old now” – congratulations Lisa – “and my pelvic floor still seems to be weaker than before. I do hold pee exercises 10 times” – I'm making a mess of this aren't I? “I do hold pee exercises 10 times, three times a day but don't seem to be benefiting so is there anything else I can do?”

C: I'm not sure about the English here –

H: Trying to stop the urine flow, I think this is her words not mine – trying to stop the flow of urine, I think that's basically what she's saying, so she's doing basic pelvic floor exercises – 10 times, 3 times a day. Is that not enough do you think?

C: Well that's a good thing, 10 times 3 times a day, that's really what we recommend in general exercise science for strength training, but I'm not so sure about the hold pee because we're not sure if this can really disturb the bladder, so I don't think she should do it during the peeing, so she should rather get into the positions with legs apart and try to do it outside the toilet I think

H: Right so concentrate on pulling up those inner muscles rather than try –

C: Yes and try to hold the contraction and really work on that and if she has a problem, because a lot of women are not able to do correct contractions, and some are even straining so they are pressing down and making it worse, so if she is not sure about if it's working, I think she should really try to get a physiotherapist to take a look at her and help her and really guide her through the exercises and to make her sure if she's doing correct contractions

H: Doing it correctly? Now there is an exercise you can show us actually isn't there, in the studio here if it helps to give people an idea as to what they should be doing, the strength of it etc, so could you just show us now?

C: Yes, it really goes after you have seen a physiotherapist and be sure that you are doing it correctly, but if you are able to contract then just to sit in a sitting position with legs apart and lean forward, and then try to have no action on the other muscle but think about the muscle inside the pelvis and then squeeze around the urethra, vagina and rectum and lift up and hold it there and stay on the top, really hold, hold, hold and then relax, and to try to really go on and hold like that, to make a maximum contraction, that's important, so I usually tell my parents that they should – it's better to do 4 proper contractions instead of 20 like you try to train your biceps and it's not going to work, you have to really work hard

H: Right, so concentrate on that inner area

C: Yes

H: And how often should you be doing that then?

C: Well what she's said is correct, it's like 8-12 contractions, 3 sets per day, that's what we recommend in that area, but it's better to do 4 really strong contractions, than doing more and really no effect from that

H: So you could do that whilst watching the telly at night couldn't you?

C: Yes you can do it –

H: There's no excuse

C: No, it's true

H: And should you start these very young? I mean is there any point getting into it when you're in your teens maybe so that you're prepared for later life?

C: Yes we think that that we have no primary prevention studies in this area, so I think practical or pragmatically we could think that the easiest time to start is during pregnancy. I would recommend to do it during pregnancy and not start after childbirth because you know you've just had a baby yourself

H: There's enough else to do isn't there?

C: There is and it's quite difficult just after childbirth because we have injuries, we have pain – it's difficult to find the muscles, so everyone should actually try to get them going during pregnancy

H: So you know what you're doing?

C: Yes

H: then afterwards it's much easier –

C: It's much easier

H: Then it's much more instinctive then isn't it, you know that you've hit the right spot as it were

C: Yes

H: Ok well we have a question in from Shelley and she wants to know “are there any pelvic floor clubs that I can join?” In this country maybe not

C: I'm not sure but you have a very strong women's health physiotherapy group in England and they are excellent so I think if you try to approach a physiotherapy group they would recommend you some places that you can go. I hope there will be in the future because I think it's very, very nice to have this group training because they can train all the other muscles and you can meet others and you can chat and you can meet other people who have just had their babies, it's a fantastic period actually to work together

H: I know that my hospital actually where I live in Surrey did training on – what's the word I'm looking for? Gym classes for people who've just had babies and you can take your babies along in car seats and sit them all along the side

C: Wonderful, yes

H: It was great actually because at least then you've not got to worry about childcare, but after you've had a baby you're not feeling great particularly but how do these pelvic floor exercises help you take control of your life, how do you think they're going to make you feel more in control really?

C: Well it's that you have been opened in the pelvic floor during the childbirth so it's really trying to close it again and then you will feel much more control and you can avoid urinary incontinence and faecal incontinence and prolapse, so that's what you will gain and I always say well if there's a side effect that you also have a better sex life I think that's an acceptable side effect so that's a good thing

H: An added bonus

C: Yes yes it is

H: Can't go wrong with that can you?

C: No

H: Well that's all we‘ve got time for today so thanks to everyone who sent questions in, I'm sorry we haven't got time for all of them and thanks very much to Professor Kari Bo for coming in and talking to us about that, coming all the way from Norway. Well have a really good trip back and thanks to all of you who've sent in questions as well, I'm sorry we couldn't get through all of them but we hope we've been of some help to you, and if you want any more information about these pelvic floor exercises that Kari's put together and you'd like a free DVD yes free no less, then all you have to do is to log onto the website which is www.corewellness.co.uk, that's corewellness.co.uk and you can claim your free DVD that contains all of those exercises that Kari was talking about. So that's it from the Healthcare Show for today and we'll see you next time, bye bye

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