BY DEFINITION, it happens at the most inopportune of times. Urinary incontinence, the unexpected, uncontrolled passing of urine, can be annoying and embarrassing in equal measure. Stress urinary incontinence (SUI) occurs when sneezing, laughing, coughing, exercising, lifting or doing other similar activities.
These activities pressurise the bladder, causing unexpected leaks. It is estimated that up to one-third of women can suffer from SUI at some point in their lives. Old age, pregnancy and after childbirth are periods when women are more at risk of SUI.
Pelvic floor exercises have been increasingly popular in treating SUI. Dr Arnold Kergel is credited with first popularising the idea in 1948.
The best technique to follow is one recommended by a continence adviser or physiotherapist. Briefly, it involves tightening and lifting up the muscles around the vagina and back passage, as if trying to not urinate or pass wind, in a set pattern.
Hips, stomach and upper legs should be stable, and a recommended routine involving both fast and slow contractions followed. The movement is an upward and inward contraction, not a bearing-down effort.
In 1998, a team of Norwegian researchers conducted a six-month trial of the various treatment options for SUI. These included pelvic floor exercises, electrical stimulation, vaginal cones and no treatment. Of these, women who did pelvic floor exercises showed the most significant improvement.
More studies have backed up this finding since, including a recent publication by Dumoulin (et al 2011), which describes pelvic floor muscle training as having a “level-A evidence” rating.
Prof Fionnuala McAuliffe of the Royal College of Physicians of Ireland says: “Pelvic floor exercises are one of the main treatments for female stress incontinence and are very effective in providing symptom relief. Success with pelvic floor exercises is very high in cases with mild to moderate stress incontinence.”
For many people, when they think of pelvic floor muscles they think of Pilates. Pilates is an exercise regime practised by millions worldwide, which involves a series of low-impact, flexibility and muscle-toning exercises.
First taught by Joe Pilates in the 1920s in New York as “Contrology”, the practice centres on developing core strength which includes the pelvic floor, but also the upper abdominals, hip flexor origins, and glutei muscles.
So is Pilates an acceptable alternative to pelvic floor muscle exercises? “Pilates which addresses pelvic floor exercises would be as successful as pelvic floor exercises alone. Essentially exercise that aims to strengthen the pelvic floor will reduce the symptoms of genuine stress incontinence.
“Other treatment options include surgery. However, the patient would be advised to continue with pelvic floor exercises to allow muscles to continue to strengthen,” says McAuliffe.
When asked if Pilates might actually be slightly better than just doing pelvic floor exercises, McAuliffe says further research needs to be done in this area.
While there is a growing body of research that points to the standout success of Pilates in treating lower back pain, there is still something of a lacunae when it comes to research on Pilates and SUI.
There are, it seems, two arguments to be made in favour of Pilates in this regard. The first is how it actually works on the body – connecting up the parts that connect to the pelvic floor. The second, intriguingly, is more a sociological than physiological consideration – other people.
Patrick Culligan, MD, wrote a 2009 study on the superior effectiveness of Pilates over other pelvic floor muscle training. He argued: “Even among women who are diligent with pelvic muscle rehabilitation, long-term follow-up reveals that benefits are lost in the absence of maintenance exercises.
“Given its mainstream popularity, Pilates would be . . . appealing as a therapeutic modality for women experiencing pelvic muscle weakness.”
Research also points to the superiority of follow-ups when it comes to SUI and, in these cases, pelvic floor exercises: “Women who had regular and repeated contact with the person who taught them to do the exercises and monitored their progress were more likely to report they were improved after treatment,” according to Hay-Smith’s Cochrane survey of the research in 2011.
There are many styles of Pilates available, from generic adapted classes with a Pilates component – Pilates was reclassified as an exercise that could not be copyrighted in 2000 – to one-to-one classical Pilates sessions.
While most people may try out Pilates in a large group in the local gym, there is also a purer strand to the regimen.
Nóirín McCarthy falls into the latter camp. She trained in classical Pilates at the Romana Kryzanowska School in New York, doing the fully immersive one-year teacher training apprenticeship, before further studies in the Netherlands. This is considered the most direct line of learning from the originator of the discipline as Romana Kryzanowska was taught by Joe Pilates and his wife.
Over the years, some of McCarthy's clients have been post-natal. Recently, she opened a new clinic in Fitzwilliam Street, Dublin ( truepilatesdublin.com).
McCarthy says: “Pilates is excellent for post-natal recovery. It not only targets pelvic floor tone, but also the abdominals and deep stabilisers in the back and hips, in one movement programme. Pilates works from the inside out, the deeper muscles work to support the bigger more superficial muscles.”
McCarthy says: “It’s important to understand the physical changes in pregnancy, and that previous strength and stability is not present after childbirth, a period of physical recovery is necessary. Pilates training can begin six to eight weeks after pregnancy.”
What’s different about this one-to-one approach? In many ways, it is more like a physiotherapy session, in that it is targeted directly and specifically to you. There is also special kit.
“People think Pilates is just sitting on a ball, doing core stabilisation, or mat work. That’s part of it, but Pilates can involve studio equipment – apparatus like reformers, chairs and barrels – which give the correct positions to work the correct muscles.”
Doing one-to-one classes is more expensive than a group class: like physiotherapy, sessions are usually about €60 at a time. However, there are advantages.
“At a group class, it’s one size fits all,” McCarthy says. “So you could be doing the moves incorrectly, unsure if you are working the right muscles, and ending up sore.”
Pilates, done correctly, has numerous advantages over other options: once you know how to do it, it can be cheap, simple and effective. You can engage the muscles yourself, waiting for the bus or queuing in the bank, as it were. That’s empowering.
