By Birgit Nakamhela International Pilates Instructor/Personal Trainer, ISSA, IST, HFPA

It's a known fact: More than 13 million Americans have problems with the pelvic floor, but only a third of them talk to a doctor about it. Not surprisingly, more than half of them are women.

What is the pelvic floor? Sometimes called the pelvic diaphragm, it is composed of muscle fibers of the levator ani, the coccyges and associated connective tissue, which span the area underneath the pelvis. The pelvic floor is often ignored or misunderstood and for that reason, often mistreated.

As one of the youngest muscles in your body, we generally don't care for that muscle group as we should. We hope that it will continue to operate by itself until suddenly something happens. Either we cough, sneeze or can't control the bladder or suddenly have bladder infections. A tight pelvic floor muscle can cause pain during intercourse and extreme pain during childbirth, which will then lead to an episiotomy or even to a tearing of the perineum. The healing process will then take long - often women will have pain when they sit, and some women also refer to a feeling of "everything is just falling out of me," which usually happens after birth and often after some years.

It is not a condition to live with - we can do something about it. Having a strong pelvic floor muscle group is very important for good bladder control. Pelvic floor muscles need to have good tone, (greater than the skeletal muscles) because they hinder the uncontrolled loss of body wastes during sleep.

All three layers are three centimeters thick. In pregnancy they have to stretch up to 12 centimeters in length and throughout the whole width. The male pelvic floor is stronger because they have less estrogen (which makes the pelvic floor tissue softer and looser) and of course they will never have to deliver a baby.

The tasks of the pelvic floor are to lift, to carry, support, close, open, release and to hold. But what happens when the pelvic floor is too weak?

• Stress-and Urge-incontinence
• Constipation
• Bladder infection
• Lower back pain
• Problems during intercourse
• Withdrawal from sports and social activies (traveling, movies, etc.)
• Depression and sleep deprivation

What are the benefits of a strong and good functioning pelvic floor?

• Better posture, more stability when walking, sitting and standing
• Better muscle awareness
• More self-confidence
• Better sexual life

What can you do to improve your pelvic floor? It's simple. Exercise!

There are many things that can influence that muscle group such as medicines, foods, etc. So it's important to do some effective training of the pelvic floor muscles. The traditional exercises include Kegels. In 1948, Dr. Kegel discovered that the pelvic floor muscles could also contract like the skeletal muscles. He recommended contracting the muscles around 300 times a day.

Before starting:

1. Bladder should be empty.
2. Do what makes you feel good, but listen to your body.
3. Concentrate and don't see it as a duty!
4. If you have problems in the beginning, focus on the effort and relaxation. Always remind yourself to relax in between.
5. Integrate the exercises every time you think of it. When you walk, stand, sit, wait, drive, etc.

Kegel Exercises

• Squeeze for a count of three those muscles that you use to stop the flow of urine. Take a short break, and then squeeze these muscles once more. Try to increase the length that you hold the contraction until you can hold each one for a full count of 10. Try to complete five sets three times a day.
• Tighten the muscle around the back and front passages and lift up inside as if trying to stop passing gas and urine at the same time. The feeling should be one of lifting up and inwards. Try not to use the buttock muscles - try to breathe out while doing those exercises.

Try to hold the pelvic floor contractions for longer periods of time - increasing endurance of those muscle groups. Here are some other exercises for the pelvic floor:

• Be continuously conscious about the pelvic floor muscles.
• Coordinate pelvic floor muscle exercises and breathing.
• Train the muscle fibers in all directions, fast- and slow-twitch muscles and also during functional activities.
• Remind new mothers of importance of pelvic floor exercises and good posture during breastfeeding, lifting, carrying, etc.
• Training can be done everywhere - it should be performed regularly three times a day for at least six weeks.

These clear, easy-to-use tools focus on the anatomy and physiology of the pelvic floor, providing exercises, treatment options and evaluation forms for female and male patients. Men, women or children suffering from stress or urge incontinence can use the exercises demonstrated in this DVD to strengthen the muscles in the pelvic floor.* Only when the entire abdominal compartment including the diaphragm becomes part of the re-training can the function of the pelvic floor be restored. The exercises in this DVD are based on the teaching of European therapists, Renate Tanzberger and Susanne Klein-Vogelbach. Developed by Beate Carriere, PT, CIFK. DVD format. 20 minutes.

*Consult your physician before beginning this, or any, exercise program

You won't find a higher-quality therapy ball! The Gymnic ball is perfectly round and offers dynamic elasticity-it's never rigid, always flexible and is ribbed for maximum grip. All ability levels can use the Gymnic ball to improve balance, coordination, flexibility and strength. The Gymnic Therapy Ball is used as one of the training tools in the FitBALL Exercises for the Pelvic Floor DVD spotlighted above. The Gymnic ball is weight tested to over 600 lb. and is color-coded by size. Made in Italy.

FitBALL Body Therapy Balls offer optimum support and comfort while providing steady counter-pressure. Three balls of decreasing size are offered for increasing challenge. Needle pump required to inflate/adjust.

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