By Cheryl Binning

KELLI BERZUK has a mission.
She wants women to know that they have a muscle just as important as those in their abs, thighs and arms.

It's called the pelvic floor muscle. And it needs exercise, too.

"We all need to become more aware of this muscle," says Berzuk, a Winnipeg physiotherapist who has spent the last eight years working with patients experiencing problems relating to the pelvic floor muscle. "And exercising it should become part of our regular fitness routine."

This seldom talked about and often neglected muscle holds the responsibility of supporting our internal organs. Like any other muscle, when it is weak, problems can occur.

But because people are often unaware that the pelvic floor muscle even exists, they ignore the tell tale signs that something is wrong, until matters get a lot worse.

The pelvic floor muscle assists in bladder control and elimination, support of the uterus, bladder, rectum and small intestines, and sexual sensation.

When the muscle is weak or damaged it can cause a range of conditions, including: incontinence -- defined as the involuntary loss of urine or the inability to control when and where emptying of the bladder occurs; prolapse -- where the internal organs literally fall due to lack of support; a decrease in sexual satisfaction due to the inability of the pelvic muscle to contract sufficiently; and chronic pelvic pain if the muscle is unable to fully relax.

Pregnancy and childbirth, hysterectomies, abdominal surgeries, hormonal changes during menopause, diet, and certain medications can all cause the above problems.

But by strengthening the pelvic floor muscle these conditions can not only be treated, many of them can actually be prevented, says Berzuk.

The exercises involve isolating and contracting the pelvic floor muscle, while keeping other muscles, such as the stomach, the glutes and inner thighs relaxed. The exercises are varied between short contractions and contractions that are held for a longer period of time. To do the exercise correctly, it is important to pull the muscle up and in and never bear down and out, explains Berzuk. "This is a common error."

Most recently, studies have shown that it's not just adult and elderly women who are at risk of having a weakened pelvic floor.

A study of female athletes aged 18 to 21 found that 28 per cent suffered from incontinence because of injured pelvic floor muscles. Of these girls, 17 per cent began experiencing problems while in junior high.

"It is an eye-opener that all women are at risk," says Berzuk. "This shows that we have to remember to strengthen the pelvic floor muscle."

To help spread the work, Berzuk recently self-published the book I Laughed So Hard I Peed My Pants!, a guide to the importance of the pelvic floor muscle which specifically zones in on incontinence, and everything women need to know for improved bladder control.

Of all the conditions associated with a weak pelvic floor muscle, incontinence is one of the most prevalent and least discussed problems.

More than 1.9 million Canadian women suffer from urinary incontinence -- and Berzuk says that researchers in the field believe that the actual numbers are a lot higher. The Mayo Clinic reports that 50 per cent of all women will experience urinary incontinence at some point in their lives.

And many of these women suffer needlessly in silence, too embarrassed to discuss the problem with their doctor, some assuming it is a natural part of having children and growing older or under the false impression that nothing can be done about it anyway.

"The scariest thing to me is that they think it's normal," says Berzuk. "It isn't normal. You should be able to laugh a hard as you can, you shouldn't be afraid to sneeze."

Untreated, the problem gets worse over time, and many women begin to isolate themselves socially to avoid embarrassing accidents or being "found out."

"One woman told me her husband for years thought she loved a certain fast-food restaurant because they always stopped there every time they went out in the car," says Berzuk. "But it was really because she knew they had a washroom she could use."

Only by openly discussing incontinence will women become aware that help is available, says Berzuk.

"It is amazing to see women who have been hiding their problem for years, finally find out that they are not alone, and especially when they learn that there is something that can be done."

For many, pelvic muscle exercises cure them of the problem entirely, or at least lead to a significant increase in bladder control.

"It is very rare that a women doesn't improve after doing the exercises," says Berzuk. Even women in their 60s and 70s who have suffered with incontinence for years make noticeable improvements.

cheryl.binning@freepress.mb.ca