Pelvic Floor Gadgets (Vadgets) - Episode Transcript

Helen

Hi, I'm Helen, and this is Why Mums Don't Jump - busting taboos about leaks and lumps after childbirth. All the stuff that happens to your pelvic floor that no one ever talks about. Incontinence, prolapse, pelvic pain - problems that affect millions of women, one in three. I'm one of them. I have a prolapse. My pelvic organs fell out of place after the birth of my second child five years ago. And if you'd told me then I'd be speaking about this stuff out loud, I would have told you to give your head a wobble.

Hi, welcome back. If you heard last week's episode, you'll know that I fell off the wagon a bit on pelvic floor exercises. And, well, just exercise in general. It happens, doesn't it? It's not easy to keep it up all the time, but I'm back on it. So if that's you, don't beat yourself up. Just start again, do what you can. It's all good. It's all heading in the right direction. This week's episode is hopefully helpful. It's one that I've wanted to make for a while. Gadgets and gizmos for your pelvic floor. I mean, who knew, right? I had never, of course, heard of any of these things. The wands, the apps, the shorts, the weights, the cones. I don't know about you, but I have found the choice completely overwhelming and confusing.

I mean, who are they for? How do they work? Do they work? Are they safe? Should I get one? I haven't so far, but I really wanted to understand more about what's out there, and I wanted to do it in a way that gives a sort of unbiased overview, if you like. And I finally found the perfect person to do that. Amanda Savage is a specialist pelvic, obstetric and gynaecological physiotherapist who's carried out a review of a huge range of pelvic floor devices to help inform other physios. You can find that work online and I'll link to Amanda's website in the show notes. She's previously done some educational videos with Kegel8, but she's absolutely not about any particular brands or devices. She's also very kindly written a blog post for me, which you can find at whymumsdontjump.com.

So here's your guide to Vadgets. Can I call them that, please? Does it work? I think so. Here's Amanda...and also Tilly...

Amanda

...Yes she's my dog and I thought that being here, she might be more peaceful. Yeah, she's nine, but she thinks she's two.

So the first bit of kit that comes in, that is the one that most people have heard of, is when we find that a muscle really isn't working very well at all by itself, and especially if you've already been trying to improve it through pelvic floor exercises. Now, our first tack, when we find one of those sets of muscles that's really just doing a little flicker or a baby, baby squeeze, like you knew, if you try to whistle and all you get is a sort of phhhhhh one of those. So you knew you wanted a wolf whistle and all you got was a phhhhhh.

So when we find a pelvic floor like that, our first tack is going to be to try to make sure that you did know where it was. So sometimes it's only when somebody touches it for the first time, your brain goes, 'Oh, I see what you mean there. I wasn't thinking of there, I was thinking of over there.' So touch can be really powerful and so can just giving the muscle a bit of a massage, like you would with any other muscle in the body. Massaging it gives it a bit of extra blood flow, gets the nerves woken up. And we'll use lots of cues, lots of visual cues and tricks to try to get your brain to send the right message to the right place. But if we've tried all of that and it's still not working, or we know that the squeezes you can do are so baby that you're going to have to do hundreds of them to get even onto the next level, then your physiotherapist is going to probably suggest that you try something called neuromuscular electrical stimulation, which is a bit of a mouthful.

Helen

It's a bit of a mouthful.

Amanda

It's a bit of a mouthful. But what it means is we can make your muscles work for you. We can fake it with a bit of electrical kit or we'll talk about just now, there's a magnetic version of the same thing. So for years and years, like 30 years...more probably, it's been possible to make any muscle in the body work by getting an electrical stimulation to the muscle belly. And traditionally that's done by putting a surface electrode over the muscle belly, and then you can make the muscle contract. So in your first term of physio school, you do that a lot with arms. You have a pad and you put it on your friend's arm or a little button electrode on your friend's arm, and you make their fingers twitch for them. And it's quite entertaining.

Helen

It sounds like quite a lot of fun.

Amanda

Yeah. And you can do this for legs, and they use it for thigh strengthening. It's used all around the body. And when you get the electrical impulses at the right frequency and the right milliamps, it's the right settings to make your pelvic floor muscles contract.

Helen

Okay

Amanda

The problem is, if you try to do this through the surface of the skin, there's a lot of interference between where the pad is on the surface and the muscle and its nerve supply are, deep inside you. Fortunately, 25...more years ago, they invented a much nicer, neater vaginal electrode that can go inside the vagina and you can now get those electrical impulses almost bang on the muscle belly, which is where we need to get the stimulation to make the muscle work.

And those devices used to be big units and you used to have to go to the physio department and plug in at the physio department, and you'd have to go a couple of times a week. But over the last 15 years, those devices have got smaller and smaller. So you can now buy those little devices or your physio department can lend you one, and they basically look like tens machines. So did you use a tens machine?

Helen

I didn't but I know what you mean.

Amanda

No, but you know what they are. So a tens machine is very, very similar to the devices that we use, and it sends electrical impulses just to your skin, whereas the devices that we use for pelvic floor sends it to an internal electrode. And you put that in and the electrodes, they're called electrodes, but because that's a bit of a scary word, electrode, we tend to say probe. And the probes come in lots of different shapes and sizes and they've developed a lot over the last 5-10 years as well.

Helen

And you and I have had a conversation, and obviously we're not about any particular brands or products, but just to give people an idea of the bracket that we're talking about, this is like a Kegel8 would be one of these. And what are some other examples?

Amanda

Well, I just counted my list that I made a year ago. There are 25 different ones that you could buy, but the ones that most people have heard of, that you see advertised direct to the public are: Kegel8 are a brand that had several different types of electrical stimulation. And then you might have heard of SensaTONE, and there's one called New Tech and Neen Pericalm. They all provide the same activity, but their price point varies depending on how many programmes they're offering you, preset, and usually also depending on what kind of probe it comes with.

Helen

Right.

Amanda

But they're all in a similar price bracket of around £100 to £150. And they're very simple to use, but they don't tend to come with terribly good instruction booklets.

My suggestion would always be that if you were thinking of buying a device and hadn't really bought one, you would be best first to find out if you need one and then let your physiotherapist help you learn how to use it the most effectively.

And the idea is that you would then plug into your electrical stimulation for about 15 minutes, and I would suggest every other day, and the electrical impulses will create an artificial contraction of the pelvic floor muscles. So that...what you know you're supposed to do in your head - squeeze your muscles and release your muscles, and squeeze your muscles and release your muscles in a nice rhythmic fashion with good rests in between - the machine does that for you. And it is a little disconcerting because you lie there and you think, 'That wasn't me. I didn't do that' and you feel your muscles contract and then you feel them release. But if you couldn't do that any other way yourself, then that's really helpful.

And the idea is that we're going to teach your brain how to do that by yourself. So in the past we used to say, read your book, but if you're reading your book while this is happening, you're not learning anything. So what we would encourage you to do is to really notice what's happening, feel the contraction from the device, join in with it if you can, and then when it relaxes, you need to relax as well. Because one of the other common problems is that people are just gripping and they don't realise they've got to relax too.

Helen

And am I right in thinking that if you are one of those people who have - we've talked about it on the podcast before, about having an overly tight pelvic floor, then using one of these machines, that would obviously improve your muscle...could that make it worse? That would tighten it even more, right?

Amanda

I think if you didn't think about what you were trying to achieve. So if you understand that what you need to do is both tighten and relax, the machine could be helpful because it would let you really tune in to when you're in the tightening up phase and when you're in the relaxing phase. And it can be very helpful for people to think, 'Okay, I know how to tighten. But now the machines stop tingling, I need to stop tightening as well and need to let go.' You can also set the machines to be more for pain control and for relaxation. As in, it's more about blood flow and being a sensory input, but learning to relax around it and not grip. But generally, yes, you've got to be careful that you're not just focused in on the tighten, tighten, tighten. Not all pelvic floors need to tighten. Everybody's Pelvic floor needs to be able to relax as well.

So the ones that look like tens machines, there are lots of those around. And then one of your podcasts before, you talked about Pelviva...and Pelviva is a newer version of that old technology. It's a foam sponge that you put inside. You pull off a little tab and it does its electrical impulses within you. And you don't fiddle with any buttons, it does it for you. And those you use for up to half an hour every other day. They're disposable, so they're single person use only. So you wouldn't be loaned a device. You'd buy your own of those.

And you asked me before about the magnetic chairs and that's another technology that also does the same thing to get your muscles to work for you without you having to do it yourself. But that works on a different physics that runs electricity through a magnetic coil and that produces magnetic fields, like around a magnet, into your body and then that stimulates the electrical impulse to the muscles. So we get to the same place. But the advantage of the magnetic system, which is why they're trying to develop it, is that it can be from the outside, but it can go through clothing and it can go through skin and it can go through your tissues. So it gets rid of this problem that you've got to be right up close to the muscle to get the effect. And that's why these chairs are something you can sit on with your fully clothed, but the technology is still very big and this isn't something you can take home and do at home.

Helen

Right, that's what I was going to say. So this is not an armchair to buy for the sitting room. This is...some professionals have started buying these and you can go and use them. It's mad, isn't it? It sort of blows my mind. I would never have even imagined all this stuff was possible. It's kind of a bit scary as well, the idea of electric and magnetic forces internally manipulating your body. But I suppose um...

Amanda

I think if you can remember that, that's what your brain does. That's what nature does. Nature sends an electrical impulse from your brain to your pelvic floor. And what we're doing with these devices is we're kind of skipping the brain out and trying to do a more direct route.

Helen

We've looked at the electric stimulation and about the magnetic stimulation, and then....biofeedback? That's a different sort of thing, isn't it? I've never used any of these devices, but the only one I was given at one point was something called - it made me laugh actually - it's called an Educator, which I presume is a biofeedback thing, which is like a plastic egg that goes into the vagina, with a plastic stick on it, which rises and falls as you squeeze and relax your pelvic floor. And that's the category called biofeedback, right?

Amanda

Yes, and they get much more exciting than that as well! So biofeedback works the other way around. So up until now, we've been giving electrical impulses to the muscles, and that tells the muscles what to do. Now, the next phase of rehab, once you've found your muscles and you can feel them, you don't really need something to give you a passive treatment. You need now to teach your brain how to use your muscles in everyday life.

But again, because you can't see where they are, so it's hard to know what they're doing. It's really useful if you've got a visual cue of whether you're doing it right. And that's what so many people say, is, 'But how do I know if I'm doing it right?' And also because it's very easy to wander off and do something else when you're supposed to be doing your pelvic floor. Having something to look at that tells you what you're doing can be a really useful skill. And that's why all those machines in the gym have got like readings of how many calories you've burned and what speed you're going. It's all about motivating the brain to keep going a bit longer, isn't it?

So the simplest and cheapest thing you can buy, and often you get given it from an NHS physio department, is an Educator. Slight problem with them is that you've got to be able to look over your tummy and find your stick and they can be a little bit disappointing because the stick doesn't really move terribly far...and you were expecting great things and then it doesn't go that far. But it's a very basic, cheap and easy tool to just check that you're doing it right.

Now, a bit more sophisticated, is there are devices that you can squeeze on and you get a reading on a machine, like a little handheld computer, or there are some that give you a reading on a phone app now. And in our clinics and hospitals, we tend to have quite basic versions because it means we can connect lots of different customers up to the same machine. So the patient only has to buy the bit that goes inside, or the hospital only has to give you the bit that goes inside. And then we can have one machine that everybody can use.

If you're buying your own one at home, then you could buy one of the ones that works with your phone. So the ones that you'll see now are the Elvie and the PeriCoach and the Pelvifly Kegel and they give you a visual picture of what you're doing. So when you squeeze your muscles on the Elvie pebble, a little bubble goes up in the air and it's a bit like playing a computer game with your pelvic floor...and it's rewarding because you think, 'Oh, that was me, I moved that.'

Helen

I had a little look before we started speaking, actually, and I saw - one of them, I think you can drive cars around. I love that.

Amanda

And the PelviFly has an octopus that collects things! And I can't decide if I think it's crazy to have birds catching things and octopuses and rockets or really, actually it's quite motivating. You do find yourself thinking, 'I'm going to get that octopus to get that thing.' And I think we are very visual by nature and having something to see that's also quite entertaining is amazing. And these products are fairly new. They're stealing technology from other areas of fitness and I hope they're going to continue to drive forward, getting that balance for women of more sophisticated, maybe more tasteful, but still fun, but not infantile. There is a balance to be had.

Helen

I guess with those things...I think you've said it really, but it's about you understanding the correct way to do your pelvic floor exercises. So you are still doing all of the work, it's just that you have this like visual reminder of how to do it properly.

Amanda

And I think one of the reasons that gadgets and devices can work is because they make you stop still and actually do it properly. Because if you've gone to all the effort to take your kit off and put something inside and plug into a machine, you're not going to just drift off and put a wash on, are you? Whereas if you stand in the kitchen thinking, 'I must do my pelvic floor exercises', you could, but there's always other things to distract you. And I think sometimes when we have somebody a device to work with, often for just a short amount of time, I'll often say, you've got it for three weeks, then I want it back because I want to make them do it. If I said you've got it for three months, you'll take three months without even getting it out of its packet. If I tell you've only got three weeks, then you're going to get a shuffle on, aren't you?

Helen

That makes total sense because I find when I'm doing my pelvic floor exercises, before you know it, the kids are asking you for something and you've sort of half done it, you've only really half done it. You've reminded me of the first time someone told me that the hospital was lending them a biofeedback machine. I was kind of horrified at the idea of borrowing it, that you could share that with all the women.

Amanda

You're not borrowing the bit that goes inside. I always say to people, I'm really sorry you have to pay for this bit that goes inside - because I'm in private practice - and it's mainly because I don't want it back and we're not sharing it.

Helen

Okay, that's good. Just to be clear about that. Brilliant. Okay.

Amanda

And that's why I think something like Squeezy App works really well. Now, Squeezy App isn't giving you anything. It's not telling you what you're doing, but it's a timer. The little bubble is going to squeeze and let go and it's going to squeeze and hold for 10 seconds. And the machine can't count quickly like we do. We go 12345678910, but the Squeezy App counts properly. It goes one, two, three....so if you actually watch the bubble and you do what you see in front of your eyes, actually to do the proper ten squeezes for ten second holds, then you can look yourself in the eye and say, I did do my three sets of pelvic floor properly today, and I didn't wander off in the middle. And maybe I didn't actually do as many as I thought I did. And I think that's why that works so well for people.

Helen

Yeah. Let's talk about weights. Another one that when you first hear it is just like what vagina weights? How is that a thing? How does that work?

Amanda

And that is not just a thing. That has been a thing for about 2000 years. So the original thing that they come from is something called ming balls, which were little metal weights that women would put inside mainly to improve their bedroom skills.

Helen

That's when I first heard of it. It was an Ann Summer's type thing.

Amanda

Yeah. The principle is that your pelvic floor muscles are a muscle and once you can tighten them just with your head, that might not be enough of a stimulus to keep them growing. How do you get that muscle to grow a bit more? So what we can do is we can add weight from the outside so your physio will get you up against gravity, doing your lunges, doing squats, using your own body weight to make exercising more challenging. But what the vagina weights do is put the weight right on the muscle itself.

So they come in different shapes. The original one that's been around for about 30 years are called Aquaflex Cones. So that's why you sometimes hear them called cones. And this was like a little...it looks like a white plastic tampon. And you unscrew it and you can put weights inside it, little ones, and getting bigger. And then you hold that inside. And what your pelvic floor muscles have to do now is what we call a postural hold. So it's not so much that your muscles have to squeeze on and off, they just have to hold all the time. And if you think about yourself at playgroup with a baby on your hip, talking to a friend, that's a weight coming down on your muscles constantly. It's not coming and going. So your pelvic floor has got to know how to do that job, of holding up against a weight for a long period of time, but not a massive grip because if you just grip your hardest, you're going to run out of oxygen in the muscle, run out of blood flow and get cramp, which is lactic acid build up, and you'll get pain.

Helen

And to be clear, you don't wear the weights while you're doing the shopping or going for a run. Or do you?

Amanda

Well, I do know that some of the advertising that goes with the weights...and there are lots of different styles that you can get because they've had to devise different styles to get around the different patents...they do infer that you could wear your weights to Sainsbury's. I never really thought that was a terribly good idea. I'm not really for like ultimate risk. Personally, I'd always advise that you make it a focused task...in your own home. And I usually suggest something like when you wash your hair in the shower, because the nice thing is they're not electrical. And when you're going to wash your hair in the shower, it's not something you do every day, but you do it often enough that you would never forget to wash your hair. And I like the fact you're going to be naked anyway, so you know...

Helen

That'S a great idea.

Amanda

...It's much more natural, and it's clean...Sainsbury's, the gym? I'm not so sure.

Helen

Shall we talk about shorts? I've seen various shorts. Some have wires sticking out of them, which look kind of scary, and some don't. Presumably the wired ones are back to that electro stimulation thing?

Amanda

You've so got this. You've got this.

Helen

I am all over this now

Amanda

Yeah, you can join me on my nerdy outings now. You're on it! So, yes, the ones with the wires coming out, they are effectively the surface electrodes - like you get with a tens machine - embedded into a pair of shorts, so that when you put the shorts on, the surface electrodes end up in the right place. Which is quite a clever concept, especially for somebody who can't use an internal electrode, but maybe doesn't have the dexterity or the understanding to put the external electrodes in the right place. They're quite an expensive option considering what they do could be done with surface electrodes an awful lot cheaper, but a clever concept to stick them inside the shorts so that they'll stay in the right place. So that's kind of how they work.

And then could we get anything to give us some support from the outside when we're doing the activities that we know we're going to be really vulnerable for? So obviously your ideal would be to get your own muscles to do that work. So that's your abs and your glutes. And that's why you'll find physios who work in women's health are often Pilates instructors and yoga instructors as well. Because we know that if you can get your whole body stronger, then that's going to help support your organs as well from the outside.

And then you know from your own clothes that there are certain trousers and the way they're made that just make you feel slimmer and stronger. And they're the ones that get you a nice support on your lower belly. And so that's your tummy support tights and tummy support panelled pants. But you've just got to watch that the elastic round the waist doesn't get too tight and actually then reverse the effect.

Helen

Okay.

Amanda

And so the sports shorts, there's a lovely brand called EVB and Spanks also do a sports short. And I think Jojo Mamon Bebe's postnatal knickers do this quite well. And actually yoga trousers that you can roll back down. They create a nice tummy lift, mimicking your own muscles. What the EVB shorts have tried to do, and this is such a holy grail, it would be great if it works for you, is get some gusset support. So, you know, on a bad day with a prolapse, you want to hold your perineum with your own hand because you think, if I could just push it all back up, it would feel so much better. So by reinforcing the gusset, they're trying to get that uplift and again, I hope this technology is going to grow and grow in the years to come to give us more options.

Helen

It's really helpful, this. I think one of the things that we're saying is that all of these things can work to some extent for someone, and not all of them will work for everyone. But it's really encouraging to know, because I think I tend to come at things from a slightly cynical point of view. And my first sort of thought is, 'Hang on a minute. What is this device that's promising the world to me?'

Amanda

And I think it's worth remembering that a lot of these gadgets should be part of a package of care. So just sitting at home, stimulating your pelvic floor with a device will not be enough. You've also got to get your core working, you've got to look at your bladder habits, you've got to think about your lifting and carrying, and you've got to teach your brain to be able to do that job when you're not plugged into a machine.

So that's my kind of...it needs to be part of what you're doing, not the only thing you're doing. And then my other thing would be to say that if you're thinking about spending some money on a device, maybe just think before you spend the money on the device. Might that same amount of money be better spent having one appointment with a specialist, postgraduate trained physiotherapist whose job it is to really help you understand what you're dealing with, the extent of the problem, and give you some real pointers - what you personally need to work on and which devices would be worth the right thing for you, and how to get the most out of them. Or take your little pile of gadgets that are sitting in your drawer at home gathering dust to a physiotherapist and she'll take you through how to use them all, so that they're not a waste of the money you've already spent.

Helen

Brilliant! All right, well, thank you, I've kept you for so long. I really appreciate your time.

Amanda

I hope that was helpful?

Helen

Yeah massively. And is it Tilly?

Amanda

Oh she's been very good, actually now, yeah

Helen

I hope that's made it all a bit clearer. It certainly has for me. And as I mentioned, Amanda, who is @propelvic on Instagram, has also written a guest blog about Pelvic four gadgets, or Vadgets - I'm claiming it - which you can find on the website, you can now support Why Mums Don't Jump at buymeacoffee.com/whymumsdontjump. It can be completely anonymous, if you prefer. Thanks so much for the donations so far, and thanks to anyone who has shared, recommended or reviewed the podcast. It really helps to spread the word. Next week, POP Club is back. I've had a bit of a catch up with the two women who keep me going, and who have inspired unofficial friendship groups all over the place. Love that.

I am not a medical professional, so please don't take anything you hear as many medical advice. You've been listening to Why Mums Don't Jump with me, Helen Ledwick. You can find me on social media @whymumsdontjump or online at whymumsdontjump.com. Bye for now.