Pelvic Floor Muscle Training for Women in Maltese

What are the pelvic floor muscles?

The floor of the pelvis is made up of layers of muscle and other tissues. These layers stretch like a hammock from the tailbone at the back, to the pubic bone in front.

A woman’s pelvic floor muscles support her bladder, womb (uterus) and bowel (colon). The urine tube (front passage), the vagina and the back passage all pass through the pelvic floor muscles. Your pelvic floor muscles help you to control your bladder and bowel. They also help sexual function. It is vital to keep your pelvic floor muscles strong.

X’inhuma l-muskoli tal-qiegħ tal-pelvi?

Il-qiegħ tal-pelvi hu magħmul minn saffi ta’ muskoli u tessuti oħra. Dawn is-saffi jiġġebdu bħal branda, mid-denb tas-sinsla fid-dahar sal-għadma pubika fuq quddiem.

Il-muskoli tal-qiegħ tal-pelvi tal-mara jissapportjaw il-bużżieqa tal-awrina, il-ġuf (utru) u l-musrana (kolon) tagħha. It-tubu tal-awrina (l-passaġġ ta’ quddiem), il-vaġina u l-passaġġ ta’ wara jgħaddu kollha mill-muskoli tal-qiegħ tal-pelvi. Il-muskoli tiegħek tal-qiegħ tal-pelvi jgħinuk tikkontrolla l-bużżieqa tal-awrina tiegħek u msarnek. Jgħinu wkoll fil-funzjoni sesswali. Hu importanti li żżomm il-muskoli tiegħek tal-qiegħ tal-pelvi b’saħħithom.

Why should i do pelvic floor muscle training?

Women of all ages need to have strong pelvic floor muscles.

Pelvic floor muscles can be made weaker by:

• not keeping them active;
• being pregnant and having babies;
• constipation;
• being overweight;
• heavy lifting;
• coughing that goes on for a long time (such as smoker’s cough, bronchitis or asthma); and
• growing older.

Women with stress incontinence – that is, women who wet themselves when they cough, sneeze or are active – will find pelvic floor muscle training can help in getting over this problem.

For pregnant women, pelvic floor muscle training will help the body cope with the growing weight of the baby. Healthy, fit muscles before the baby is born will mend more easily after the birth.

After the birth of your baby, you should begin pelvic floor muscle training as soon as you can. Always try to “brace” your pelvic floor muscles (squeeze up and hold) each time before you cough, sneeze or lift the baby. This is called having “the knack”.

As women grow older, the pelvic floor muscles need to stay strong because hormone changes after menopause can affect bladder control. As well  as this, the pelvic floor muscles change and may get weak. A pelvic floor muscle training plan can help to lessen the effects of menopause on pelvic support and bladder control.

Pelvic floor muscle training may also help women who have the urgent need to pass urine more often (called urge incontinence).

Għax għandi nagħmel eżerċizzju tal-muskolu tal-qiegħ tal-pelvi?

Hemm bżonn li nisa ta’kull età jkollhom muskoli tal-qiegħ tal-pelvi b’saħħithom.

Il-muskoli tal-qiegħ tal-pelvi jistgħu jiddgħajfu minħabba:

• li ma żżommhomx attivi;
• tkun tqila u jkollok it-trabi;
• kostipazzjoni;
• ikollok piż żejjed;
• irfigħ ta’ affarijiet tqal;
• tisgħol għal ħin twil (bħal ngħidu aħna sogħla bħal ta’ min ipejjep, bronkite jew ażma); u
• tibda tikber fl-età.

Nisa li jbatu minn inkontinenza kaġun tal-istress - jiġifieri, li jagħmlu pipì taħthom meta jisgħolu, jgħatsu jew huma attivi - ser isubu li l-eżerċizzju tal-muskolu tal-qiegħ tal-pelvi ser jgħin biex din il-problem tingħeleb.

Għal nisa tqal, l-eżerċizzju tal-muskolu tal-qiegħ tal-pelvi ser jgħin il-ġisem ilaħħaq maż-żieda fil-piż tat-tarbija. Muskoli b’saħħithom u f’kundizzjoni tajba ta’ saħħa qabel ma titwieled it-tarbija ser jissewwew aktar faċilment wara t-twelid.

Wara t-twelid tat-tarbija, int għandek tibda l-eżerċizzju tal-muskolu tal-qiegħ tal-pelvi malajr kemm jista’ jkun. Dejjem ipprova “lesti” il-muskoli tal-qiegħ tal-pelvi (agħfas ‘il fuq u żomm) kuldarba qabel ma tisgħol, tagħtas jew terfa’ t-tarbija. Dan hu magħruf bħala li għandek “il-ħila”.

Hekk kif in-nisa jikbru fl-età, il-muskoli tal-qiegħ tal-pelvi jkollhom bżonn jibqgħu b’saħħithom għax il-kambjamenti ormonali wara l-menopawsa jistgħu jaffettwaw il-kontroll tal-bużżieqa tal-awrina. Barra minn dan il-muskoli tal-qiegħ tal-pelvi jinbidlu u għandhom mnejn jiddgħajfu. Pjan ta’ eżerċizzju tal-muskolu tal-qiegħ tal-pelvi jista’ jgħin biex inaqqas l-effetti tal-menopawsa fuq is-sapport tal-pelvi u l-kontroll tal-bużżieqa tal-awrina.

L-eżerċizzju tal-muskolu tal-qiegħ tal-pelvi jista’ jgħin lin-nisa li jkollhom bżonn urġenti biex jagħmlu awrina aktar ta’ spiss (magħrufa bħala inkontinenza f’daqqa (urge incontinence).

Where are my pelvic floor muscles?

The first thing to do is to find out which muscles you need to train.

1. Sit or lie down with the muscles of your thighs, buttocks and stomach relaxed.
2. Squeeze the ring of muscle around the back passage as if you are trying to stop passing wind. Now relax this muscle. Squeeze and let go a couple of times until you are sure you have found the right muscles. Try not to squeeze your buttocks.
3. When sitting on the toilet to empty your bladder, try to stop the stream of urine, then start it again. Do this to learn which muscles are the right ones to use – but only once a week. Your bladder may not empty the way it should if you stop and start your stream more often than that.

If you don’t feel a distinct “squeeze and lift” of your pelvic floor muscles, or if you can’t slow your stream of urine as talked about in Point 3, ask for help from your doctor, physiotherapist, or continence nurse. They will help you to get your pelvic floor muscles working right.

Women with very weak pelvic floor muscles can benefit from pelvic floor muscle training.

Fejn huma l-muskoli tiegħi tal-qiegħ tal-pelvi?

L-ewwel ħaġa li trid tagħmel hu li ssib liema muskoli li trid teżerċita.

1. Poġġi bilqegħda jew imtedd bil-muskoli ta’ kuxtejk, tal-warrani u tal-istonku tiegħek mitluqin.
2. Agħfas iċ-ċirku tal-muskolu madwar il-passaġġ ta’ wara qisek qed tipprova twaqqaf il-ħruġ tar-riħ. Issa irrilassa dan il-muskolu. Agħfas u erħi darbtejn sakemm tkun żgur li sibt il-muskoli t-tajba. Ipprova tagħfasx il-warrani tiegћek.
3. Meta tkun bilqiegħda fuq it-tojlit biex tbattal il-bużżieqa tal-awrina tiegħek, ipprova waqqaf il-fluss tal-awrina, imbagħad erġa’ ibda. Agħmel hekk biex titgħallem tagħraf liema huma l-muskoli t-tajbin li għandek tuża - imma agћmel dan darba fil-ġimgħa biss. Jista’ jkun li l-bużżieqa tal-awrina tiegħek ma titbattalx kif suppost jekk tieqaf u terġa’ tibda l-fluss tiegħek aktar ta’ spiss minn hekk.

Jekk ma tħossx b’mod distint “għafsa u refgħa” tal-muskoli tal-qiegħ tal-pelvi tiegħek, jew jekk int ma tistax tagħmel il-fluss tal-awrina tiegħek joħroġ aktar bil-mod hekk kif tkellimna f’Punt 3, iltob l-għajnuna tat-tabib, il-fiżjoterapista, jew in-ners tiegħek tal-kontinenza. Dawn ser jgħinuk tagħmel l-muskoli tiegħek tal-qiegħ tal-pelvi jaħdmu kif suppost.

Nisa li għandhom muskoli tal-qiegħ tal-pelvi dgħajfin ħafna jistgħu jibbenefikaw mill-eżerċizzju tal-muskolu tal-qiegħ tal-pelvi.

How do i do pelvic floor muscle training?

Now that you can feel the muscles working, you can:

• Squeeze and draw in the muscles around your back passage and your vagina at the same time. Lift them UP inside. You should have a sense of “lift” each time you squeeze your pelvic floor muscles. Try to hold them strong and tight as you count to 8. Now, let them go and relax. You should have a distinct feeling of “letting go”.
• Repeat “squeeze and lift” and let go. It is best to rest for about 8 seconds in between each lift up of the muscles. If you can’t hold for 8, just hold for as long as you can.
• Repeat this “squeeze and lift” as many times as you can, up to a limit of 8 to 12 squeezes.
• Try to do three sets of 8 to 12 squeezes each, with a rest in between.
• Do this whole training plan (three sets of 8 to 12 squeezes) each day while lying down, sitting or standing.

While doing pelvic floor muscle training:

• keep breathing;
• only squeeze and lift;
• do NOT tighten your buttocks; and
• keep your thighs relaxed.

Kif nagħmel l-eżerċizzji tal-muskoli tal-qiegħ tal-pelvi?

Issa li qed tħoss il-muskoli jaħdmu, int tista’:

• Tagħfas u tiġbed ‘il ġewwa l-muskoli madwar il-passaġġ ta’ wara u l-vaġina tiegħek fl-istess ħin. Ogħllihom ‘IL FUQ ġewwa. Għandek tћoss sens ta’ “telgħa ‘l fuq” kull darba li tagħfas il-muskoli tiegħek tal-qiegħ tal-pelvi. Ipprova żommhom qawwija u magħfusin hekk kif tgħodd sa 8. Issa, erħihom u strieħ. Gћandek tћossok fi-żgur li “qed terħi għal kollox”.
• Irrepeti “agħfas u ogħlli” u ntelaq. Ikun aħjar li tistrieħ għal xi 8 sekondi bejn kull darba li terfa’ ‘l fuq il-muskoli. Jekk ma tistax iżżomm għal 8, ipprova żomm sakemm tista’.
• Irrepeti dan “agħfas u ogħlli” għal kemm-il darba tista’, sa limitu ta’ minn 8 sa 12-il għafsa.
• Ipprova agħmel tliet settijiet ta’ minn 8 sa 12-il għafsa, b’perjodu ta’ serħan bejniethom.
• Agħmel dan il-pjan sħiħ ta’ eżerċizzju (tlett settijiet ta’ minn 8 sa12-il għafsa) kuljum waqt li tkun mimdud, bilqiegħda jew bilwieqfa.

Waqt li tkun qed tagħmel l-eżerċizzju tal-muskolu tal-qiegħ tal-pelvi:

• ibqa’ ħu n-nifs;
• agħfas u ogħlli biss;
• TAGĦFASX il-warrani tiegħek; u
• żomm kuxtejk irrillasti.

Do your pelvic floor muscle training well

Fewer good squeezes are better than a lot of half hearted ones! If you are not sure that you are doing the squeezes right, or if you do not see a change in symptoms after 3 months, ask for help from your doctor, physiotherapist, or continence nurse.

Agħmel sewwa l-eżerċizzju tal-muskolu tal-qiegħ tal-pelvi

Inqas għafsiet tajba huma aħjar minn ħafna nofs qalb! Jekk m’intix ċert li qed tagħfas kif suppost, jew ma tara l-ebda bidla fis-sintomi wara 3 xhur, itlob l-għajnuna tat-tabib, fizjoterapista, jew in-ners tal-kontinenza tiegħek.

Make the training part of your daily life

Once you have learnt how to do pelvic floor muscle squeezes, you should do them often. Every day is best. You should give each set of squeezes your full focus. Make a regular time to do your pelvic floor muscle squeezes. This might be after going to the toilet, when having a drink, or when lying in bed.

Other things you can do to help your pelvic floor muscles:

• Use “the knack” - that is, always try to “brace” your pelvic floor muscles (by squeezing up and holding) each time before you cough, sneeze or lift anything.
• Share the lifting of heavy loads.
• Eat fruit and vegetables and drink 1.5 - 2 litres of fluid per day.
• Don’t strain when using your bowels.
• Ask your doctor about hay fever, asthma and bronchitis to ease sneezing and coughing.
• Keep your weight within the right range for your height and age.

Agħmel l-eżerċizzju parti mill-ħajja tiegħek ta’ kuljum

Hekk kif titgħallem tagħmel l-għafsiet tal-muskolu tal-qiegħ tal-pelvi, int għandek tagħmilhom ta’ spiss. L-aħjar ta’ kuljum. Int għandek tiffoka kompletament fuq kull sett ta’ għafsiet. Iffissa ħin regolari biex tagħfas il-muskoli tal-qiegħ tal-pelv tiegħek. Dan għandu mnejn ikun wara li tmur it-tojlit, waqt li tkun qed tixrob, jew meta tkun mimdud fuq is-sodda.

Affarijiet oħra li tista’ tagħmel biex tgħin il-muskoli tal-qiegħ tal-pelvi tiegħek:

• Uża “l-ħila” - jiġifieri ipprova li dejjem “tlesti” l-muskoli tal-qiegħ tal-pelvi tiegħek (billi tagħfas ‘l fuq u żżomm) kull darba qabel ma tisgħol, tagħtas jew terfa’ xi ħaġa.
• Aqsam ma’ ħaddieħor l-irfigħ ta’ tagħbijiet tqal.
• Kul frott u ħaxix tal-ikel u ixrob 1.5 – 2 litru fluwidu kuljum.
• Titqanżaħx meta tkun qed tbattal imsarnek.
• Staqsi lit-tabib dwar il-hay fever, ażma u bronkite biex itaffi l-għatis u s-sogħla.
• Żomm il-piż tiegħek fi skala skont it- tul u l-età tiegħek

Seek help

Qualified nurses are available if you call the National Continence Helpline on 1800 33 00 66* (Monday to Friday, between 8.00am to 8.00pm Australian Eastern Standard Time) for free:

• Information;
• Advice; and
• Leaflets.

If you have difficulty speaking or understanding English you can access the Helpline through the free Telephone Interpreter Service on 13 14 50. The phone will be answered in English, so please name the language you speak and wait on the phone. You will be connected to an interpreter who speaks your language. Tell the interpreter you wish to call the National Continence Helpline on 1800 33 00 66. Wait on the phone to be connected and the interpreter will assist you to speak with a continence nurse advisor. All calls are confidential.

* Calls from mobile telephones are charged at applicable rates.

Itlob l-għajnuna

Hemm nersis ikkwalifikati jekk iċċempel lin-National Continence Helpline fuq 1800 33 00 66* (mit-Tnejn sal-Ġimgħa, bejn it-8.00am to 8.00pm AEST (Ħin Standard tal-Lvant tal-Awstralja)) mingħajr ħlas:

• Informazzjoni;
• Pariri; u
• Fuljetti.

Jekk ikollok diffikulta’ biex titkellem jew biex tifhem bl-Ingliż jista’ jkollok aċċess għall-Helpline permezz tat-Telephone Interpreter Service fuq 13 14 50 b’xejn. It-telefon ikun imwieġeb bl-Ingliż, għalhekk għid liema lingwa titkellem u stenna fuq it-telefon. Tkun ikkonnettjat/a ma’ interpretu li jitkellem il-lingwa tiegħek. Għid lill-interpretu li tixtieq li ċċempel lin-National Continence Helpline fuq 1800 33 00 66. Stenna fuq it-telefon biex tkun ikkonnettjat/a u l-interpretu jgħinek biex titkellem ma’ ners li tagħti pariri dwar il-kontinenza. It-telefonati kollha huma konfidenzjali.

* Telefonati minn fuq telefonijiet mowbajl ikunu ċċarġjati r-rati li japplikaw.