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1. Reflection

2. Role of Women's Health Physiotherapy

3. Pelvic Floor Muscles

4. Pelvic Floor Exercises

5. Pelvic Floor Exercises & Socioeconomic Status

6. Women's Knowledge of Pelvic Floor Dysfunction

7. Urinary Incontinence & Exercise

8. Pelvic Health Podcast

9. Pilates

10. Pilates & Pregnancy

11. Pilates & Pelvic Floor

12. Physical Activity Guidelines in Pregnancy (UK & Canada)

13. References

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Womens Health Weekly Ep1: Physiotherapy at The Coombe

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This resource helped me to visualise the layers of the pelvic floor muscles in both males and females.

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Understanding the Layers of the Pelvic Floor Muscles

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I found this resource useful for explaining the pelvic floor and what exercises can be done to strengthen these muscles.

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13. Physical Activity in Pregnancy - Canadian Guidelines

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13. Physical Activity in Pregnancy - Canadian Guidelines

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12. Physical Activity in Pregnancy - UK Guidelines

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12. Physical Activity in Pregnancy - UK Guidelines

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Infographic taken from Lori Forner's (Women's Health Physiotherapist, Brisbane) Instagram page highlighting problematic exercises for urinary leakage - skipping, running, heavy lifting

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Pilates focuses on core stability, including pelvic stabilisation, neutral alignment and breathing. During the exercises, the pelvic floor muscles are used in their role as natural muscular support for the movement.

The Pilates method is recommended in pregnancy due to its intensity and low physical load. The programme also contains adaptations of the exercises to suit the changes in the body and women can therefore begin at any stage of the pregnancy, regardless of whether they have been trained in the method before.

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5. Pelvic Floor Exercises & Socioeconomic Status

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5. Pelvic Floor Exercises & Socioeconomic Status

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A link between pelvic floor exercises and socioeconomic status was mentioned by CSP Ciara Ryan in the lecture.

This study outlined how women living in an urban area presented more chance of having knowledge about UI and that women with a higher education level had significantly higher rates of willingness to receiving information.

It also showed that whilst discussion about Pelvic Floor Dysfunction (PFD) at schools was also low, 29.4% of the adolescents would want to know more about the topic.

Based on this lack of discussion on PFD in schools, I think its inclusion as part of the Sex Education programme should be considered.

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6. Women's Knowledge of Pelvic Floor Dysfunction 

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6. Women's Knowledge of Pelvic Floor Dysfunction 

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Following on from the previous study attached (Fante et al, 2019), when investigating the reasons why women do not seek treatment for UI, common themes were:

- Shame
- Belief that incontinence is part of the normal ageing process
- Sensation that they can handle the problem on their own
- Low expectations of benefits with treatment

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Dr Monika Leitner on slogans such as "How to exercise without wetting yourself" for The Pelvic Health Podcast

"Traditionally, a physiotherapist may want to avoid any exercises that may trigger leakage and be embarrassing for the patient during the treatment programme but in the principles of effective muscle training, a stimulus needs to have an overload, which means the muscle needs to perform more work than usual and fatigue occurs.

Our instruction to the patient therefore needs to be different - we need to integrate little jumps, little running steps and prepare the patient for leakage. This doesn't mean the pelvic floor is weak, but that the threshold for effective training has been reached."

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10. Effectiveness of physical activity program using Pilates method in pregnancy and labour

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10. Effectiveness of physical activity program using Pilates method in pregnancy and labour

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The results of this study showed how the use of Pilates in the intervention group lead to improvements in various parameters (grip strength, ischial flexibility, dorsal lumbar curvature), what I found most interesting was that it seemed to have a significant contribution to the birthing process, with a reduction in number of caesarean sections and difficult births in the intervention group.

Although this could be biased due to the fact that  more of the control group  (78.2%) were first time mothers compared to intervention (48%) which could lead to more difficult births, it shows promising results in the use of Pilates during pregnancy.

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11. RCT comparing Pelvic Floor Muscle Training (PFMT) to Pilates for improving muscle strength

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11. RCT comparing Pelvic Floor Muscle Training (PFMT) to Pilates for improving muscle strength

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The element of this study which I found particularly interesting was that of the Pilates group, 2 participants dropped out due to unforeseen circumstances, whereas 7 of the 8 participants who dropped out of the PFMT group did so because they found the treatment unpleasant in some way.

I believe that this is because with the Pilates programme, the whole experience seems less intrusive, more acceptable and enjoyable for participants than PFMT. Another added benefit of Pilates is that it not just focusing on levator ani muscles but providing greater strength, flexibility and posture for the whole body which adds to the positive feedback for participants.