By: 1 March 2009


Many women, when jogging or exercising, playing tennis, bouncing on the kids’ trampoline, lifting something, even just laughing, coughing or sneezing, can experience a sudden, unexpected leakage into their underwear. It’s not pleasant, it’s often highly embarrassing, but because it is a taboo subject that people rarely discuss, it happens to far more people than many realise. The problem is stress incontinence and, perhaps unfairly, it is far more prevalent amongst women than men, with up to 1 in 4 suffering symptoms, partly for physiological reasons and partly due to factors like childbirth, menstruation and the menopause. Such is the hidden concern that British women spend upwards of £24 million annually on disposable incontinence pads, merely masking the problem rather than addressing the cause, while many sufferers will not use public transport or even go out at all, in case of unwanted leaks.

Yet there is an effective and highly accessible means of combating stress incontinence, which is pelvic floor exercise. That’s according to leading UK pelvic health specialist Neen, a division of medical and sports healthcare group Mobilis Healthcare, which produces a comprehensive range of diagnostic and remedial products that are widely recommended and prescribed by women’s health physiotherapists, continence advisors, urogyneocology nurses, midwives and local GPs within the NHS.

Over the years, Neen has developed highly regarded patient self-help devices, like its Educator biofeedback trainer and Aquaflex weighted vaginal cones, and supplied clinicians with innovative probes for muscle stimulation and EMG feedback, notably the award-winning Periform intra-vaginal probe, which has just been updated and improved (see separate news story).

Pelvic floor exercise relates to the hammock of muscles and other tissue that stretches from the pubic bone at the front, to the coccyx at the base of the spine, supporting the bladder, uterus and bowel. These muscles are composed of two different types of fibre, the majority having properties of endurance and the rest fast-acting fibres that react quickly to sudden rises in abdominal pressure, such as when sneezing or coughing. The supportive role of these pelvic floor muscles assist with closing the bladder outlet tube, or urethra, and any failure in this activity results in urine leakage. The same muscles also play an important role in maintaining good sexual function, actually contributing toward women reaching orgasm.

The female pelvic floor muscles are inherently more prone to developing problems, since women’s muscles have further to span and the support structure can be affected by fluctuating hormones during pregnancy, the menstrual cycle and, later, the menopause. Carrying a baby puts extra stress on the pelvic floor muscles and damage can occur during childbirth, although even those giving birth by caesarean section are at risk of muscle dysfunction. Other factors contributing to pelvic floor weakness and stress incontinence include persistent coughing due to smoking, being overweight, a lack of overall fitness and general ageing, yet even girls as young as 18 can suffer from symptoms.

There is considerable evidence that pelvic floor exercise is effective, helping to increase muscle strength and decrease urine loss, and the National Institute for Health & Clinical Excellence (NICE) suggests regimens of eight pelvic floor muscle contractions, three times a day. However, hard-pressed midwives are often unable to provide proper tuition and clinical studies suggest that half of women are performing exercises ineffectively, with a quarter doing possible harm by bearing down, when they believe they’re pulling up. That’s where inexpensive devices like Neen’s Educator and Aquaflex cones really contribute, by helping to develop proper technique and actively strengthen pelvic floor muscles.

Biofeedback is a means of demonstrating how well pelvic muscles are performing and, whilst Neen offers highly sophisticated electronic devices for healthcare professionals, its Educator provides biofeedback in the simplest possible form for patients. Consisting of a smoothly-contoured vaginal insert and an attached, external indicator wand, it detects and signals whether exercises are being performed correctly. If the pelvic muscles are pulled upwards in the proper manner, the tip of the wand moves downwards; when the wrong technique is being used, the indicator moves up, toward the stomach. Developed from Neen’s Periform probe, which is used by continence care advisors around the world, the Educator is washable and can be used daily to help strengthen the pelvic floor muscles, although not during pregnancy, and over the longer term to check exercises now and then.

Aquaflex is a clinically-proven product comprising weighted cones, one of the most widely used pelvic floor exercise systems in the UK, with success rates of up to 70%. Discreet in use, the weighted cone is inserted in the same way as a tampon and causes the pelvic floor muscles to automatically contract around it, a reflex action that actively tones the muscular fibres. Worn for up to 20 minutes a day while going about normal activities, the Aquaflex allows different weights to be added progressively, building up the pelvic muscles until the smallest, heaviest cone can be worn comfortably. For best results, it should be worn daily for up to 12 weeks, then occasionally thereafter.

Further enquiries to Neen at Mobilis Healthcare, 100 Shaw Road, Oldham OL1 4AY, tel 0161 925 3180 or visit: