Most women know the importance of regular exercise, but working out the pelvic for floor muscles can get overlooked. These are the sling-shaped muscles which run from the pubic bone to the base of the spine and which support the pelvic organs – the bowel, bladder, uterus and vagina.
One in three women is thought to experience some form of pelvic floor dysfunction, leading to incontinence, constipation, prolapse and sexual problems. But research shows that keeping these muscles in shape can help to keep such issues at bay. Knowing how to perform the exercises correctly and persevering with them, however, can be a struggle.
Tania Boler, 39, from London, knows this first-hand, and her experience spurred her to design a device to address these issues.
‘After my son was born three years ago, I started doing pelvic floor exercises but soon got bored,’ says Tania, a women’s health expert turned entrepreneur. ‘When I looked into it further, I found that despite strong evidence for the effectiveness of exercise, most women do not stick with the programme. Part of the reason is the lack of feedback – imagine running but never knowing how far or how fast.’
So she began working on a gadget to encourage women to strengthen their pelvic floor muscles. The result was Elvie, a device worn internally that connects wirelessly with a mobile phone app, which guides the wearer through a series of exercises and monitors how well they are doing them. The device, which is shaped like a flattened egg, is worn only during a pelvic floor workout (the manufacturers recommend three five-minute sessions a week).
It is inserted like a tampon and has sensors that detect when the pelvic floor muscles are activated; this is shown on the mobile phone screen in the form of a moving gemstone. When the muscles are contracted, the gemstone moves higher up the screen; when relaxed, the gemstone drops.
The idea is that you can see when you are contracting your muscles and learn to exercise them properly. Afterwards, you are given a score indicating the strength of the contractions.
This translation of a muscle movement into a visual representation is a form of ‘biofeedback’, where electronic monitoring of a body function is used to teach better control of it.
t is not the first device to help women exercise their pelvic floor, however. Vaginal weights – sets of small, tampon-shaped weights, each one heavier than the last – have been available for some time, but they do not give biofeedback. In clinics, physiotherapists use probes to measure a muscle’s electrical output, or the air displaced by a contraction, to give biofeedback.
Katie Mann, a chartered physiotherapist based in Liverpool, who specialises in pelvic obstetric and gynaecological physiotherapy, says these can be unreliable, are not widely available for home use, and without a physiotherapist checking technique, the results can be misinterpreted.
Experts say one issue with pelvic floor exercises is that women may get them wrong. A 1991 study, in the American Journal of Obstetrics and Gynaecology, suggested only half of women contracted muscles correctly after verbal instructions.
‘A quarter were doing nothing at all and a quarter were bearing down, promoting a downward force on their pelvic floor, increasing the chance of leaking,’ says Katie Mann.
That is where the Elvie is said to differ from other gadgets. As well as sensors to measure muscle movement, it contains an ‘accelerometer’ (which measures the acceleration and direction of a moving object), to identify whether the device is moving upwards during muscle contractions or incorrectly moving downwards.
The proportion of people who think their pelvic floor muscles are in their stomach
‘If, after several attempts, you are still not getting it right, the app will suggest you may benefit from visiting a physiotherapist,’ says Tania Boler.
Tania’s background includes a PHD on teenage pregnancy and HIV in South Africa, plus a role at women’s health charity Marie Stopes International. She helped to design the Elvie with guidance from Rufus Cartwright, a urogynaecology specialist at Imperial College London, and Professor Linda McLean, who researches pelvic floor dysfunction at the University of Ottawa. Professor McLean is planning a series of clinical studies on the product.
Katie Mann is not aware of any other home use pelvic training device that gives this feedback but, at £149, Elvie is not cheap. However, it is similarly priced to other fitness tracking devices, such as some FitBit models (worn on the wrist), but at least five times more expensive than a set of vaginal weights.
‘Although the technology seems sound, this is not a medical device and I would want robust clinical trials proving its efficacy before I could recommend Elvie,’ says Katie Mann. ‘However, I can see it having a useful role.’
She applauds anything that encourages women to do pelvic floor exercises: ‘Every woman should do them for life. NICE guidelines recommend at least eight contractions performed three times per day but if you have a problem, such as incontinence, a physiotherapist can give a more tailored programme.’
However, she says internal devices should not be used during pregnancy, and that women who already have pelvic dysfunction should not see such gadgets as an alternative to medical help. ‘Incontinence can be the first symptom of a more serious problem, such as multiple sclerosis,’ she adds. ‘No gadget can diagnose that.’