In this section:
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Functions of the pelvic floor
About incontinence
About pelvic organ prolapse
Childbirth and the pelvic floor
Sex and the pelvic floor
Menopause and the pelvic floor
Consequences of a weakened pelvic floor
Links
Everybody recognises the importance of physical activity for general health and fitness. Perhaps the most important muscle group in the female body commonly gets ignored due to influences such as lack of knowledge and embarrassment. These muscles are the pelvic floor muscles.
Why is it important to keep these muscles functioning well?
The multiple functions of the pelvic floor muscles play a crucial role in
quality of life - not only on a physical level but also on an emotional level.
For instance, healthy pelvic floor muscles are vital for:
- ensuring continence
- good quality sex & childbirth functions
- supporting the pelvic organs in their correct position
- protecting us from infections
- maintaining good posture
Incontinence
When the pelvic floor muscles lose their strength you may experience incontinence. Incontinence is any form of urine leakage and/or the inability to adequately hold gas/stool. Don’t think that incontinence only affects you and maybe some “golden girls”. Poor bladder or bowel control is one of the biggest health issues in the Australian community. It affects around two million Australians, but this could even be underreported. Almost 50% of all women aged 26 to 39 experience some form of incontinence during this age period. Incontinence is the third prime reason why elderly people move into nursing homes (statistics according to the Continence Foundation of Australia).
Mostly the weakness of the pelvic floor first shows up in the form of urine leakage. This could vary, however, depending on individual stress factors that impact on the area. For example, women who dealt with stool elimination problems in childhood may experience muscle weakening in the form of faecal/gas incontinence. In this instance, one of the first symptoms may be the appearance of haemorrhoids.
It is considered loss of continence even if you occasionally leak only a few drops of urine when your bladder is full and you sneeze, for example. This is called stress incontinence (urine leakage due to coughing, laughing, jumping etc).
Unfortunately, not only will minor, annoying incontinence issues not improve by themselves, but they will worsen over time. Eventually your bladder may not need to be full to leak and perhaps increase to more than a few drops. It may even start to happen in more unexpected situations for less provocation. Stress incontinence frequently occurs during pregnancy due to increased internal weight (the weight of the baby) and hormonal changes (the pelvic floor is softer).
There are other types of incontinences. For example, many women face urgency problems. This is when the desire to pee hits you suddenly in a powerful way – yet there is not a lot of urine output. If the pelvic floor muscles are weakened there is a chance that urine loss occurs before the toilet is reached. This is why this condition is called urge incontinence. Women who deal with this problem often know the toilet map of the town by heart and they may even plan their trips around it. Many don’t like to leave their homes altogether.
Unfortunately, as a result, many women start to go to the bathroom “just in case” before leaving their home. So the bladder is encouraged to spring into action more frequently. This is how the urgent need to pee can become a regular event. Bladder training coupled with pelvic floor strengthening is an effective way to deal with these disorders.
You don’t have to be one of the above statistics! You have a choice and the power not to accept incontinence that is caused by weak pelvic floor muscles. Pelvic floor weakness is not normal at any age. These muscles can be strengthened and symptoms reversed with effective training and protective lifestyle measures. Taking care of the pelvic floor will result in wonderful, lifelong rewards.
Pelvic Organ Prolapse
Pelvic organ prolapse is a remarkably common health disorder amongst women. Though it is not a life threatening condition, it can seriously affect one’s quality of life. Pelvic organ prolapse can even effect women in their twenties who have never given birth. Unfortunately, there is little awareness of pelvic organ prolapse. It doesn’t make an easy conversation over a cuppa nor do you find it in popular women’s magazines. In fact most of us have never even heard of this health disorder.
Our pelvic organs are being kept in perfect position by a network of elements within our pelvis. One of these elements is the pelvic floor muscle group. If the support system within the pelvis becomes compromised, one or more pelvic organs can push into the vagina and descend. The descent can continue until the organ creates a protruding bulge outside the vagina. This can happen slowly and progressively, or suddenly due to extreme physical stress. The pelvic organ that receives the most stress will most likely start to prolapse. The pelvic organs are closely linked, so once one organ descends, others often follow.
Early detection of pelvic organ prolapse is critical. At this time the condition can be reversed by lifestyle changes and pelvic floor exercises. Unfortunately, once the descending organ is protruding, exercise can not restore the correct positioning of the organs. However, lifestyle changes – especially changes in postural alignment - can stabilise pelvic organ prolapse.
Early detection of pelvic organ prolapse is difficult as it may be completely symptom-free. Still, symptoms may include: any form of urine leakage (even the smallest amount), frequent need to use the bathroom, dull, persistent lower backache, urinary/bowel difficulties, pain during intercourse, pelvic pain or pressure that is aggravated by standing and relieved by lying down, the feeling that something is falling out, regular urinary infections, presence of a bulge in the vagina. Learning to self-exam can enable women to detect problems early and report their findings to a doctor. Gynaecological examinations can determine exactly what is prolapsing and where.
The following is from a presentation of the Australian Physiotherapy Association (January 2005) to The National Health and Medical Research Council: “There is a substantial body of evidence on urinary incontinence including relevance, cost, and intervention. However there is a dearth of published information on pelvic organ prolapse (POP) despite the fact that it is a condition affecting as many as 50 per cent of parous women and a high proportion of older women. A recent Cochrane Review found no published randomised controlled trials on non-surgical management of POP even though surgery fails in 53 per cent of cases. The APA is not aware of any literature on conservative POP prevention.”
Childbirth and the pelvic floor
How the pelvic floor muscles are prepared for childbirth and how they are cared for during pre and postnatal times will determine long-term pelvic floor health. As you will see, idyllically pelvic floor training should be a part of pregnancy preparations. However, learning how to effectively train and protect the pelvic floor can be beneficial any time.
Prenatal
Many women experience pelvic floor weakness during pregnancy. It can be in the
form of stress incontinence, urge incontinence, or most often a mix of the two.
All causative factors for this are not fully understood, however, hormones are most likely to take some blame. During pregnancy, a woman's body secretes a hormone called relaxin, which causes ligaments to loosen, allowing the baby to pass through the birth canal. Relaxin also increases the elasticity and relaxation of muscles, including the pelvic floor muscles. This means that the pelvic floor muscles can not perform their functions to their fullest potential, which would explain the occurrence of stress incontinence. In their compromised state, the pelvic floor muscles are further stressed with the increasing weight of the baby. Consequently, during this time the area should be especially protected from harmful lifestyle factors and supported with exercise.
In addition, the foetus can compress the bladder, sending a false “I’m full” signal to the brain. This would cause frequent visits to the bathroom despite little urine output.
Childbirth
Most women extensively prepare for the arrival of a new baby. Still, the actual area where birth takes place is often not included. This is because it is not in our culture to prepare the birth canal – the pelvic floor muscles group - for childbirth. These muscles seal the base of our pelvis. So, to allow the baby to pass through this bony passage they need to stretch open. To do this the pelvic floor muscles must expand like no other muscles in our body. This is why delivery is the number one challenge for these muscles. Just like performing the splits for your hamstrings; can you imagine doing the splits without preparing first? Just think what would happen to your muscles. Similarly, the pelvic floor muscles are much more prone to injury if they are not prepared for the biggest task they will ever face. The untrained, rigid musculature opens up slowly and is prone to tearing. Birthing injuries to the pelvic floor muscles can be reduced by effective training as part of birth preparations. Prepared muscles can stretch and relax more effectively. This also makes the baby’s job easier when passing through the birth canal.
During Discreetly Fit’s pelvic floor training we learn to fully relax the pelvic floor muscles. This skill can be very useful when applied during the pushing phase of labour. It can aid the muscles to fully expand and allow the baby to pass through the birth canal without injuries to the mother. Risk of long term pelvic floor injury is higher if the baby is over 4 kg, if the delivery is assisted with vacuum or forceps, if the pushing phase of the labour is too short, or too long (over 1 hour), in the case of twins, if an episiotomy is performed, or if there was deep tearing. In these cases it is especially important to rehabilitate the pelvic floor muscles with exercise.
There is high risk of pelvic floor injury from vaginal birth if the baby is over 4 kg, if the delivery is assisted with vacuum or forceps, if the pushing phase of the labor is too short, or too long (over 2 hours), in case of twins, epidural, poor birthing position of the mother (lying on the back), excessive pushing, if an episiotomy is performed, or if there was 3rd or 4th degree tearing. In these cases it is especially important to support the pelvic floor muscles with exercise and avoid pelvic floor aggravating lifestyle factors.
It might be logical to conclude that having an elective c-section will help to avoid pelvic floor injuries associated with vaginal delivery. However, the risks, complications, slower recovery time, and loss of experience of natural childbirth associated with c-sections outweigh the benefits of avoiding the pelvic floor dysfunction that may be experienced immediately after vaginal delivery. Research shows that long term there is no significant difference in occurrences of incontinence and pelvic organ prolapse between women delivering vaginally and those who had a c-section. Please note that research does not differentiate between interventional vaginal birth and natural vaginal birth.
Postnatal
Of course we all want the pelvic floor muscles to return to their original shape after delivery. But it is not possible without specific training. Additionally, each pregnancy/delivery will further injure the pelvic floor. For best results, the rehabilitation of these muscles should begin within 24 hours after childbirth. This is why it is worthwhile to learn the exercises before delivery. Pelvic floor training can also help to heal episiotomy scars or tearing.
Furthermore, the pelvic floor continues to be softer, due to the hormone relaxin, for months after delivery. Breastfeeding mothers will continue to have a compromised pelvic floor until their period returns. This is due to low oestrogen levels. Oestrogen is known to improve nerve function, promote blood flow, and correct tissue deterioration in the urethra, anal passage and vaginal areas. This means that at times when oestrogen levels drop below normal pelvic floor function is compromised. For the above reasons, it is also especially important that the pelvic floor is cared for with exercise and it is not stressed with damaging lifestyle factors during the post natal period.
When the love muscles lose their strength
Many women, predominantly after childbirth, experience lack of sensation during sex and difficulties reaching orgasm. The weakening of the pelvic floor muscles play a major role in these scenarios for more than one reason.
When the pelvic floor muscles are strong, they enjoy abundant blood supply. This ensures that the nerve endings of the vulva are adequately sensitive. This helps us - not only during the arousal phase of sex, but also during intercourse - to receive plenty of good-quality sensation and stimulation. Healthy blood supply also aids the swelling of the clitoris, which further maximises the experience. Unfortunately, when the pelvic floor muscles weaken, the blood supply to these nerve endings also weakens and as a result we feel less.
A muscle loop, formed by the pelvic floor muscles, wraps around the lower one third of the vagina. This area is greatly responsible for the amount and quality of sensation we experience during sexual intercourse. The tighter this ring of muscle is, the better sex feels and the easier it is to reach orgasm. It also assists your partner’s work by grabbing him firmly, to stay in and feel good.
Both parties are affected by the weakening of the female pelvic floor and sometimes as a result relationships suffer, due to sexual unhappiness. Regaining strong pelvic floor muscles can help you when “sex is just not the same as used to be” and restore normal sexual function.
Menopause and the pelvic floor
Many women are not even aware that the muscles of the pelvis exist until menopause. Often these muscles function easily and unnoticed, until menopause brings attention to them – and not for very good reasons. The reasons are often incontinence and prolapse of the pelvic organs. Let’s see why menopause is such a critical time in pelvic floor health.
All skeletal muscles -including the pelvic floor muscles- gradually lose strength as we grow older. This is avoidable, as with regular exercise we can counteract this weakening effect. However, if the pelvic floor was not trained over the years, it may be that by the time menopause arrives the pelvic floor is naturally weakened enough to show problems.
We don’t even realise that unintentionally the pelvic floor gets stressed on a regular basis from everyday lifestyle factors. These accumulate over the years and if they are coupled with injuries from child birth, the result can be serious weakness.
The hormonal changes that heavily affect the pelvic floor during menopause just add insult to injury. The pelvic floor muscles are oestrogen dependant, so some laxity occurs after the withdrawal of oestrogen at the time of the menopause.
Effective pelvic floor training is a great tool to work against the above forces. It can ease the effects of menopause on pelvic support and bladder control. Managing deteriorative lifestyle elements is especially important during menopause and postmenopausal times. At these periods the pelvic floor is in a weakened state so it is vulnerable to injuries.
Consequences of a weakened pelvic floor
Have you considered what it would mean to lose a perfectly functioning pelvic floor?
If you have kids or perhaps you are a working Mum, or career woman, you know that losing your health is a luxury you can't afford. Who will take care of the family? Who will run your household? Who will play with the kids and take them to the play ground? How about the loss of income that may occur? Have you considered the cost of surgery that you may need? We need to protect ourselves from ill health 110%, or we will negatively affect our own lives and the lives of those who are close to us.
We all try to be superwomen and multitask to complete our daily schedule. Under these circumstances it is so easy to put our own welfare behind the needs of those we love or the demands of work. However, this can have serious consequences when it comes to the pelvis. Imagine always having to wear a pad, just to “cure” urine leakage. Imagine the loss of dignity and limited freedom that this would cause. How about not being able to get on with your activities freely, because you are in constant need of finding a loo? How would you feel if your sex life would become an issue, because your vagina is just not what it used to be? Can you imagine the devastation and uncertainty that is associated with pelvic organ prolapse? Think of what it would be like living with a protruding pelvic organ from your vagina all the time…… Are you aware of what is involved with surgery aiming to fix an advanced pelvic floor problem? The cost, the risks and the recovery time?
These are very possible realities if your pelvic floor weakens severely and your pelvic organs are continuously stressed the wrong way.
You may think that at that stage you could fix problems with surgery. There are hundreds of procedures to fix pelvic floor related problems. However, no ideal methods have been found to date. It is extremely challenging for doctors to achieve lasting good results. Often further surgery is required, as when one problem is fixed another one is created. Furthermore, recovery from pelvic surgery is very painful and can take a long time. Many women suffer permanent disability resulting from pelvic surgery. These can include urinary and bowel problems, recurring prolapse, fecal incontinence, compromised sex life, chronic depression, and pelvic discomfort and pain.
It is easy to see that the key is prevention and early reversal of the weakness. There are no magic cures. The only safe answer is to learn how to strengthen and protect the pelvis. By doing so, you will save money and enjoy the freedom and self confidence that a well functioning, healthy pelvis can give you for life. This way you can be proud of being a fully functional woman, even after multiple births.
If you took the Pelvic Floor Health Check on this site and you found that your pelvic floor needs urgent attention, take responsibility for your precious health and act now!
Following are some links I hope you find helpful: