There's a secret that could save the sex lives of millions of women. Daily Mail 31 Oct 2013
So why aren't we being told about it?
Estimated 7m women in the UK suffer from stress incontinence
Health experts aren't giving prescriptions for simple device that can help
The PelvicToner can work muscles deeper than those worked by pelvic floor exercises
Ann Marie Yates tried it and it's given her new lease of life
After Ann Marie Yates gave birth to her first baby in the late Eighties, she received plenty of advice from midwives about how to take care of her newborn, whether it was how to change a nappy or the best way to breastfeed.
But it was a throwaway line by one midwife about how a new mum could best take care of her own body which stands out now.
'She told me to do my "pelvic floor exercises" - and that was it,' recalls Ann Marie. 'I was never told how to do them or why I must do them, just to do them.
'Of course, when I left hospital I was so busy as a new mother that I completely forgot. No one ever told me how vitally important they were and how they could have saved me from so many problems in the future,' says Ann Marie, now 57 and a divorced mother-of-two.
For the first few weeks, new mums are lucky if they have time to brush their hair, let alone do exercise, pelvic or otherwise.
Even if they've been reminded to do them by their midwife or health visitor, it’s unlikely they will have been instructed as to the best technique. At best, they might be given a leaflet with a few diagrams at the hospital.
Now, a new book claims that even when medical staff do instruct mothers in how to strengthen their pelvic floor, they are a pale imitation of the original treatment that gynaecologist Dr Arnold Kegel devised in the Forties.
Mums get told simply to squeeze their internal muscles as if they are trying to hold back a wee. But this only works superficial pelvic floor muscles, not the deeper ones that make a real difference, author Barry Fowler insists.
What's more, health experts are failing to recommend a simple device - available on prescription - that can prevent embarrassing problems later in life, such as stress incontinence, where urine leaks when a woman runs, coughs or sneezes.
'Though well-meaning, the exercises recommended by doctors and physiotherapists as a first line of treatment bear little resemblance to the pioneering work done by Dr Arnold Kegel, even though modern pelvic floor exercises bear his name,' says Mr Fowler, author of The Kegel Legacy, 65 Years Of Denial.
Simple solution: The PelvicToner device helped Ann Marie
I felt so isolated. I thought: "I'll never be able to have sex again"
'The one thing your doctor or midwife will probably not offer you is an effective post-natal floor rehabilitation programme. This helps restore your pelvic floor muscle, prevent the onset of urinary stress incontinence and restore muscle tone to prevent prolapses.'
An estimated seven million women in the UK suffer in silence from stress incontinence.
While such problems can afflict new mums, even those who show no signs of weak pelvic floor muscles can develop difficulties decades later. And any woman is susceptible post-menopause because a lack of oestrogen slackens muscles.
Furthermore, around 30 to 40 per cent of women will suffer a prolapse in their lifetime, where the uterus or other pelvic organs begin to fall from their normal position.
Ann Marie, a therapist from Nantwich, Cheshire, had one last October. 'It was horrendous,' she says. 'I'd suffered from some stress incontinence for several years. But I'd resisted buying pads, as I didn't want to admit it was a problem.'
Ann Marie suffered frequent attacks of cystitis, particularly after sex. Her doctor prescribed antibiotics, but Ann Marie knew something else was wrong; it was, she says, as if everything was 'dropping', making even walking difficult.
Until then, she had enjoyed an active sex life with her boyfriend.
'But I started pushing my partner away because I wondered if sex was making my problem worse, and the pain was excruciating,' she says.
After several weeks of this, Ann Marie requested an internal examination and her GP diagnosed a prolapse. She had recently been through the menopause, and the resulting decrease in oestrogen had led to weakness in the vaginal muscles.
She says: 'I didn’t want my sex life to be over. I was only 56. But the only option at that stage seemed to be surgery. I felt so isolated. I thought: "I'll never be able to have sex again." I refused to go out and I pushed my partner away. It was difficult for him, but luckily we could talk about it.
'I just wish someone had told me the importance of doing pelvic floor exercises, especially before the menopause. But even doctors don’t realise their significance.'
Author Barry Fowler says Ann Marie’s experiences are typical. 'According to a survey of GP practices in 2012, 62 per cent of women seeking help for pelvic floor-related problems were given a leaflet,' he says.
'It doesn't take a genius to see why seven million women still suffer from stress incontinence, and the number is rising dramatically.
'This has created a multi-billion-pound industry to manage the symptoms of embarrassing leaks while the basic cause is left untreated.'
Shelley Perfect, 28, a full-time mum of four from Wyndham in Norfolk, began to realise something was amiss after the birth of her first son when she was 19.
'I'd had a problematic birth,' she says. 'I had an episiotomy where the doctors cut me to let the baby out, and afterwards I felt really heavy in that part of my body.'
When Shelley left hospital, the midwife gave her a leaflet about pelvic floor exercises, but she couldn't work out which muscles she was supposed to be tensing.
'After I had my second son, I began leaking. I was only 22 but had to wear incontinence pads if I was going to the gym or doing anything that involved jumping around.
'Even sneezing or coughing would make me leak. It was so embarrassing and awful. Then, after I had my third son, my husband Duncan mentioned that he couldn't feel the muscles inside me when we made love. He was getting no sensation.
'I felt absolutely mortified. That put me off sex completely and I became very depressed. Duncan's very supportive, but it felt as if he was saying: "You're rubbish in bed." I was worried he'd go off with someone else.’
According to a survey of GP practices in 2012, 62 per cent of women seeking help for pelvic floor-related problems were only given a leaflet.
According to the National Institute for Health and Care Excellence (NICE), 64 per cent of women suffer from sexual problems six months after childbirth. But fewer than two in three actually consult a doctor.
Shelley did, but says: 'The NHS system was rubbish. I asked my doctor about pelvic floor exercises, but he couldn’t explain them properly. So I asked my midwife, who told me to try to pull in the muscles you use when you try to stop weeing.
'I could do that, but I’ve since found out that this does not tighten the correct muscles.'
According to recent clinical research, only a third of women are able to locate the correct muscle, known as the pubococcygeus (PC).
'Many women who believe they are doing their Kegels are, in fact, only engaging their abdominals, buttocks or inner thighs,' says Mr Fowler.
Pelvic floor exercises are often called Kegel exercises after Dr Arnold Kegel, who developed them in 1948.
In 1948, Dr Kegel invented the perineometer to strengthen the PC muscle. One section looked a bit like a rubber squash ball which a woman squeezed internally. It was connected to a pressure gauge, allowing a doctor to advise whether she was working her muscles hard enough.
Several modern, simpler, portable devices are available, but the one Mr Fowler has developed - the PelvicToner - is the only one available on prescription.
It's impossible to exercise properly without such a device, as the resistance they provide is the only way to work the deeper muscles.
It was the PelvicToner that helped Shelley. 'I'd started researching surgery options which was drastic and expensive,' she says. 'But then I saw a television programme where they were testing out these devices.
'I bought one on the internet and noticed a difference within weeks. Duncan could feel a difference within a month.'
The exercises take eight minutes a day. It took a little while for my sex life to take off again, but now it's fantastic.
For Ann Marie, too, the device has provided a new lease of life.
'None of the doctors I saw mentioned I could get one on the NHS,' she says. 'Instead, I bought one.
'Not long after I started using it, I paid to see a private consultant, who said: "Whatever you're doing, keep doing it, because it's working."?'
'The exercises take eight minutes a day. It took a little while for my sex life to take off again, but now it's fantastic. I even went to a gig recently where I was able to jump up and down with no problems.
'Women are told that leaking is just a normal part of growing older, but it doesn't have to be like that.'
By Jill Foster, Femail in The Daily Mail, 31 October 2013