Keira W. B. calls 2008 her "dark year." That's when her pelvic organs slipped out of place.She was diagnosed with a minor bladder prolapse after delivering her first child, but the bladder fell further and the rectum also dropped after her second child was born. "It was tediously uncomfortable," says Brown, 41. "Inside I felt shredded."


Hoping to delay surgery as long as possible, she found a physiotherapist who helped her strengthen her pelvic muscles to keep the organs from falling further, and she discovered Pfilates, a pelvic floor exercise routine, that she does at home.But she regrets that she didn't strengthen those muscles before pregnancy - and that no medical professionals encouraged it. "Maybe I could have staved off the prolapse," she wonders. "We need to be proactive about the pelvic floor."It's not an area of the body that gets much attention - until a person leaks or organs shift. "You should be working your pelvic floor muscles all your life, just like you work your biceps," says Toronto physiotherapist Julia DiPaolo. Some doctors tell patients to do Kegel exercises, an up-and-in squeeze motion, but rarely offer instruction or follow-up.


Patients tend to do them incorrectly -if at all, says DiPaolo, owner of Physio Excellence.The pelvic floor is a bowl-shaped area of muscles and connective tissues that keep the bladder, bowel, and uterus in place. Nearly 24 per cent of adult women struggle with at least one pelvic floor disorder - urinary incontinence, fecal leakage or organ prolapse - according to a national health survey in the U.S. The major risk factors are pregnancy, hysterectomy, obesity, genetics and age.



Men can also develop pelvic floor disorders, such as incontinence after prostate surgery. Rather than admit to a problem, some men just use their wives' liners and pads, says DiPaolo. "I'm blown away by what people live with," says Trista Zinn, a personal trainer who works with pre- and postnatal women and adults over 60. "Mothers have told me they can't laugh or run after their children without leaking." Some women pee when they cough, or even stand up. "It's absolutely not an inevitable consequence of childbirth and aging," says urogynecologist Bruce Crawford, who designed the Pfilates exercise program. "That's one of the major barriers to care - hopelessness."Medication or surgery can help many cases. But after performing 2,500 surgical repairs for urinary incontinence, Crawford was frustrated. "Clearly the problem was the strength of the pelvic floor muscles," says the Nevada surgeon. Some common exercises, such as heavy weight lifting, could make a pelvic floor disorder worse, says Toronto trainer Zinn. "Some of us are trying to get gyms to include questions about pelvic floor dysfunction," she says. "If there's a red flag, the person would be sent for assessment before starting a program."


Of pelvic floor disorders, the most common is urinary incontinence, with 15.7 per cent of women reporting it, according to the U.S. national health survey. Nine per cent had fecal incontinence and 2.9 per cent experienced pelvic organ prolapse. Stunned by her prolapse diagnosis, Brown has become an advocate for women and started a website, Her message: Strengthen those pelvic floor muscles. "Any women who are pregnant I start telling them about it," she says.



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