NatraTone

What is NatraTone?

What is the Natratone Exercise Programme?

Are the Natratone Exercises different from Kegel pelvic floor exercises?

How long before I will begin to see results from using NatraTone?

When should I NOT choose NatraTone? Can I use a lubricant to help with insertion?

Can I use NatraTone if I am pregnant?

How soon after giving birth can I begin to use the NatraToner?

What is a prolapse and how can you prevent it?

Can I prevent a prolapse or reverse an existing prolapse with the NatraTone programme?

I've got a prolapse - should I use NatraTone?

Can the NatraTone program help me if I decide to have surgery?

What should I do if I have my period?

I have an anterverted uterus, what does this mean?

Can I use the NatraTone for longer than 6 weeks?

I have some post delivery trauma—is NatraTone ok to use?

Can I use Natratone if I have an IUD? 

What is NatraTone?

NatraTone is a clinically proven exercise device and programme that has been designed by women, for women, as a treatment choice for Stress Urinary Incontinence (SUI) or light to moderate bladder weakness.

SUI is the involuntary loss of urine with activity such as laughing, coughing, sneezing, running and even sex.

NatraTone teaches women how to correctly train and strengthen their pelvic floor and inner core muscles in a minimum 6 week programme incorporating exercise (5 minutes, twice a day, 3 x week) with NatraTone’s NatraToner (the small white bone shaped device). The Natratoner is inserted a small way in the vaginal opening and the pelvic floor muscles are squeezed around the device, following the simple exercises-as shown on the DVD.

Natratone can be used by women of all ages and life stages and we recommend for women who have POP (pelvic organ prolapse), are considering surgery for incontinence issues and for pregnant women.

What is the NatraTone exercise programme?

The Natratone Exercise Program is a sequence of specific exercise movements along with breathing that are simple and quick to do. As you follow the program outlined in the instruction booklet and follow along with the DVD you will see gentle progressions to challenge your muscles and increase their performance. With the NatraTone programme you will do 10 exercise cycles, 2 times a day, 3 days a week (i.e. every other day) for a minimum of 6 weeks. Each cycle takes around 5 minutes.

Women facing more challenging issues such as pelvic organ prolapse, or 'POP', or who are pregnant are recommended to use it for a longer period of time.

You can follow the NatraTone programme daily if you wish provided you allow at least 4 hours between each exercise set.

Are the Natratone exercises different from Kegel pelvic floor exercises?

Recent studies have shown that pelvic floor muscles alone are not sufficient to thoroughly support the long term relief of SUI or bladder weakness in women.* A combined exercise programme of pelvic floor and inner core (lower abdominal) muscles is required.

The NatraToner training dvice supports the pelvic floor exercises making it a very effective and natural solution for SUI/bladder weakness.

*Sapsford, R., Hodges, P., Richardson, C., Cooper, D., Markwell, S. and Jull, G. (2001), Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourology and Urodynamics, 20: 31–42. doi: 10.1002/1520-6777(2001)20:1<31::AID-NAU5>3.0.CO;2-P

How long before I will begin to see results from the Natratone Exercise Programme?

Some women will feel results within days, others a few weeks and for other women it will take longer than 12 weeks. It depends upon the current strength and tone of your pelvic floor and inner core muscles.

If you are an active person, results can also vary depending on the type of exercise you do e.g. running versus walking. It may take longer to gain control with high intensity exercise. The most important thing is to the complete programme—don’t give up if it seems hard, it will become easier and remember, it took a long time to bring on the problem, so 6 weeks or more of just 5 minutes twice a day, 3 times a week is not that difficult. Persevere and you will have success (unless your leakage problem is due to something other than weak PF/Inner Core muscles, and in that case, you need to see your health provider).

We encourage pregnant women use the NatraTone throughout the pregnancy provided you have approval from your lead maternity carer. Allow 6 weeks post birth to allow for a full recovery, then commence using your NatraTone again. This will ensure that recovery from trauma to the pelvic floor and inner core muscles is quick and any bladder weakness issues can be resolved.

When should I NOT choose NatraTone

NatraTone supports regular examinations and check ups for good health.

Pelvic pain needs to be diagnosed correctly and it is managed most effectively when a combined approach is adopted to address the physical, pharmacological, emotional and sexual aspects related to it.

Faecal incontinence must also be correctly diagnosed. If pelvic floor strengthening and toning is recommended, then NatraTone would be beneficial.

Where there is NO voluntary control over the muscles in the pelvic floor due to nerve damage then NatraTone is not recommended. Electrical stimulators are generally used to stimulate muscles or nerves that are not able to respond optimally without help. They are often recommended for use by women who are unable to contract their pelvic floor muscles at all. 

Can I use a lubricant to help with insertion?

We recommend you first try wetting the NatraToner just with water if you are too dry. If that does not make insertion easier, then you can use a minimal amount of water-based lubricant just on the insertion tip. Note: too much lubricant may cause the NatraToner, when inserted, to twist and turn or to move up too high, therefore not being in the correct position to achieve desired results.

Can I use the NatraTone if I am pregnant?

Natratone can be used during pregnancy by most women. Please check with your lead maternity carer about using the NatraTone programme while pregnant as it uses an intra-vaginal (inside the vagina) training aid called the NatraToner.

This program is more comprehensive than traditional pelvic floor exercises alone, and there is a lot of evidence that pelvic floor exercise during the first half of pregnancy can substantially reduce incontinence symptoms in later pregnancy and after birth.

If your maternity carer does not recommend you use the NatraToner while pregnant you may want to consider doing the the NatraTone exercises on their own.

The Natratone is made of medical grade materials, is long lasting and can easily be cleaned with hot soapy water. You do not need to use lubricant with the Natratone.

How soon after giving birth can I begin to use the NatraToner?

We recommend that you wait until you have had your 6 week post-natal check, have been cleared by your health professional and that you are feeling healthy and well before using the NatraToner.

However, you may be able to do the NatraTone exercises without the NatraToner a lot sooner, if you are healthy and well, but it is important that you check with your health professional first. A pelvic floor muscle strength training program can add significantly to physical recovery after childbirth.

What is a prolapse and how can you prevent it?

A pelvic organ prolapse (POP) occurs when a pelvic organ, such as your bladder, drops (“prolapses”) from its normal position and pushes against the walls of your vagina. This can happen if the muscles that hold your pelvic organs in place become weak or stretched from childbirth or surgery. More than one pelvic organ can drop at the same time. Organs that can be involved in a pelvic organ prolapse include the bladder, the uterus, the bowel and the rectum. Pelvic organ prolapse can cause pain or problems with bowel and bladder functions or interfere with sexual activity.

An exercise scientist and physiotherapist and leading expert in pelvic floor muscle training Kari Bo says: “The most important factor influencing the success of pelvic floor exercises is your ability to contract your muscles, increase muscle force and adhere to the prescribed program”. 

The training regime for the pelvic floor muscles (PFM) with POP is exactly the same as for SUI (Stress Urinary Incontinence)/bladder weakness. When you perform a pelvic floor contraction, the pelvic floor muscles should be able to pull the tail-bone forward and lift about 1cm internally, “squeeze and lift”.

NatraTone is ideally suited for prevention of POP by helping to identify the correct “squeeze and lift” action of the pelvic floor muscles - gripping the NatraToner training aid strongly/contracting your pelvic floor muscles.  When you perform the pelvic floor contraction, the pelvic floor muscles should be able to pull the tail-bone forward and lift about 1cm internally.
NOTE: 2-3 sessions per week of strong contractions using NatraTone maintains strong pelvic floor muscle tone and require less effort than to try to develop strong muscles.

It is highly recommended to incorporate correct pelvic floor muscle and inner core exercise into a regular exercise regime and not wait until these muscles are weak before you try and strengthen them.

It is important to begin lying on your back or side to learn and achieve the correct squeeze and lift action. Do not alter your position to sitting or standing until you have mastered the pelvic floor contraction both in its quick and long form and you can feel it strongly.

We do not recommend high impact physical activity while doing the NatraTone programme as it may undo all your good work.

• If you have recently had a baby and feel you are still tender in your birth canal – use the NatraTone Programme to gently restore your vaginal and pelvic floor tone.
  
• Repeat the complete NatraTone exercise sequence two to three times per week using the NatraToner training aid. Do this up to 12 weeks to intensify your training regime
• Use the NatraToner in the shower – alternating with grip and squeeze and grip and hold.
• Aim to NatraTone in the morning when less tired, and if you have POP, when it is least evident (check this over a one month cycle).
• Inner core training should be on-going throughout your life and will help you stay on top of aging and estrogen depletion (which can weaken your pelvic floor muscle tone).

Can I prevent a prolapse or reverse an existing prolapse with the NatraTone programme?

Medical opinion is divided on the role of pelvic floor exercises in treating an existing prolapse or preventing a prolapse.

For some time, pelvic floor exercises were generally considered only appropriate for mild prolapse cases. However, a research review in 2006 suggested that pelvic floor muscle training may be also be useful in cases where the prolapse is severe. After reviewing current evidence, Expert Committee 12 "Adult Conservative Management" of the Fourth International Consultation on Incontinence (ICI), Paris, July 2008, stated that:

• Pelvic floor exercises may reduce pelvic organ prolapse severity
• Pelvic floor exercises may help prevent pelvic organ prolapse
• Pelvic floor exercises before surgery may improve lower urinary tract symptoms and quality of life for women with a prolapse .

Note: NatraTone has not clinically trialed prolapse control. However independent research states a bio-sensory feedback exerciser (such as the NatraToner) can be very useful for women who have a prolapse.

I've got a prolapse of the urethra—should I use NatraTone?

There are 3 grades of Prolapse of the urethra (cyctocele): mild/moderate/severe.

It is extremely common and some statistics are as high as 80% of women will have mild to moderate prolapse especially of the urethra. In mild to moderate cases Pelvic Floor exercises are always recommended +/- ovestin cream to support the vaginal walls.

The NatraTone program can be recommended for prolapse that is mild to moderate. This would mean no bulging below the vagina entrance, only occassional feelings of heaviness or bulging into the vagina but NO pain. Note:  If intercourse is not painful then NatraTone would be ideal.

We do NOT recommend NatraTone and instead recommend a gynaecological specialist assessment if the prolapse is severe.

This means the bulging is below the vaginal entrance. Coughing or bearing down drags the urethra down and becomes evident, there is pain, dryness, discomfort and intercourse is difficult.

Note: A specialist can assess the severity - often if no surgery is required they will recommend ovestin + PFM exercises (and so refer to mild/moderate prolapse above). Once a surgical solution has been determined, NatraTone can be recommended once healing is completed to provide on-going support the pelvic organs.

Factors to avoid with a prolapse:

• Heavy lifting at the gym or work (if you hold your breathe to lift then it is too heavy)
• Constipation (and straining) 
• A chronic cough or sneeze including those linked to asthma, smoking or uncontrolled hay-fever
• Obesity; or having a body mass index (BMI) of over 25

Seeking pelvic floor friendly exercises are also important while doing the NatraTone programme and will need to be on going.

Pelvic floor safe cardio exercises:

• walking
• swimming
• seated cycling
• cross trainer (low resistance)
• low intensity water aerobics
• walking in the water, and
• low impact exercise classes.

Cardio exercises to avoid

• running
• jumping
• star jumps
• skipping
• boxing
• high impact exercise classes
• sports involving stop start running and rapid direction change (e.g. tennis, netball, basketball, hockey, and touch football).

Can the NatraTone programme help me if I decide to have surgery?

NatraTone has endorsements from medical specialists who state that rehabilitation such as the NatraTone programme can offer support to your surgical repair by as much as 20 – 30%.

What do I do if I have my period?

Continue with the NatraTone exercises without the NatraToner while menstruating, then add an extra week on at the end of the six weeks to complete the full programme.

I have an anterverted uterus, what does this mean?

This term refers to the direction the top of the uterus is pointing (or sitting). An anteverted uterus is a uterus that tilts slightly forward. This is a normal and the most common position for the uterus.

Approximately 20 percent of women have a retroverted or backward-tilting uterus and approximately 20 percent have a mid-position uterus - not tilting forward or backward. The remainder of women have an anteverted uterus, the top of the uterus is pointing forward towards the front of your stomach. This has no negative impact on reproductive or sexual function for women, or using NatraTone or SmartBalls.

Can the NatraTone programme help me if I decide to have surgery?

You can keep using the Natratone for as long as you want to, the 6 weeks is a minimum duration.

Because it is made of long lasting medical grade materials, women can use them continuously or on and off over their lifetime.

The Natratone will tone and strengthen your pelvic floor muscles which will make the vaginal opening stronger and yes your partner will notice the difference. With the improved blood flow to the pelvic region and stronger muscles, your own orgasmic response is stronger as well. Plus you get will feel the benefits of the correction and prevention of bladder weakness.

I have post-partum birthing trauma—can NatraTone help?

Q: I gave birth 4 months ago to a large baby and ended up with a short perineum grade 2 tear to the anus (but was not deep and surgically repaired at the time), but not sewn up completely so there is a gap like a V, actually I am not sure if it is the vaginal or anus side that is incomplete.

It feels as if the pelvic floor muscles get stuck for example when I do a midstream squeeze of the muscles or after sex and is very uncomfortable or painful after a few hours of this.

I am on the list for an episiotomy but am 6 months away from seeing a specialist as apparently it is not urgent. Do you have any suggestions for exercises that might help?

A: You need an assessment from a women's health specialist physiotherapist now especially if she you are unable to see a specialist for 6 months. Also if you can get a referral from your doctor, you may get to see a specialist sooner.

The physiotherapist will give you a vaginal assessment and is an exercise expert in the pelvic floor. This will give you coping strategies for managing your birthing trauma which will include advice for controlling toileting, lifting, reducing risk of SUI, resuming intercourse, etc.

You may very well have a tear (possibly a severe one see grading scale below) or else an avulsion (tearing of the muscle off the bone), both which can make the pelvic floor muscle spasm instead of relax.

Degree of Trauma

1. Vaginal epithelium/skin only
2. Perineal muscle
3. EAS (muscle)
4. Anal Mucosa/Epithelium

I would not use NatraTone until you have had a surgical opinion and possible repair, but you may need specialist individual exercises including pelvic floor relaxation exercises to allow you to feel what is normal again.

You should be able to find women's health specialist physiotherapist in your area by searching in Google or through your local DHB/women’s hospital.

Can I use Natratone if I have an IUD?

Yes, you can use NatraTone if you have an IUD. The IUD is inserted into the uterus through the cervix and sits above the cervix, threads from some IUD’s such as Mirena may extend through the cervix and sit at the top of the vagina.

While being used, the NatraTone sits in the vaginal opening and will not come in to contact with either the IUD or any threads that may be sitting at the top of the vagina.