Well Mama Weblog

Your Pelvic Floor Matters

by Viviane Höger

Scientific evidence paints a bleak picture of the physical health of our pelvic floor – most of us begin and end our lives in diapers. YIKES!

The pelvic floor is intimately involved in all forms of movement and exercise. Yet, while we often exercise many parts of our body to stay fit, few of us ever think about exercising the pelvic floor.

Pelvic floor disorders can have a huge negative impact on us not just physically, but also psychologically and socially. And while prevalent and extremely debilitating, talking about pelvic floor problems such as incontinence, constipation and organ prolapse, still causes embarrassment for most people.   

Although the academic literature on the topic and statistics vary from country to country, evidence suggests that as many as one out of every five of us (women and men of every age) will suffer from some type of pelvic floor dysfunction at some time in our lives. And unlike popular belief, it is not just a "women's" disorder - men and children can suffer with pelvic floor dysfunction too.

Nonetheless, the statistics suggest that women, particularly those who have given birth, present the highest incidence of pelvic floor dysfunction.

Women and pelvic floor issues - the facts:

  • Pregnancy is a major cause of pelvic floor dysfunction in women.
  • Even in nulliparous women (those who have never given birth), the incidence of pelvic floor dysfunction is much higher than in men.
  • With each additional pregnancy that a woman experiences, there is greater risk of pelvic floor dysfunction.
  • Pregnancy places increased stress on the pelvic floor throughout gestation, leaving the muscles fatigued and weak, which can lead to urinary incontinence. Vaginal birth can be traumatic to the pelvic region and cause damage or tearing to the pelvic organs and muscles, such damage is a significant contributor to fecal incontinence and pelvic organ prolapse.

Pelvic floor dysfunction can have an enormous impact on our quality of life. But it is, and I must absolutely stress this, NOT just something we “have to deal with as we age”. In order to do understand why our pelvic floor matters, I have attempted to address the most common questions and misconceptions about the pelvic floor in this blog post.

So what is the pelvic floor exactly?

A network of muscles, ligaments and tissues, the pelvic floor acts as a hammock supporting the organs of the pelvis: the uterus, bladder and rectum. If this integral system becomes weak, is torn, stretched, damaged, or diseased, the pelvic organs, may shift, bulge and push outward or against each other. As a result, problems such as urinary or faecal incontinence, constipation, and organ prolapse, among others, can arise.

The pelvic floor muscles are the foundation of what we acknowledge to be our ‘core’. They help stabilise the pelvis, and support the organs of the lower abdominal cavity, such as the bladder and uterus. The pelvic floor muscles, along with the deep muscles of our back and abdomen, form the group of muscles we work when we focus on developing core strength.

Why is it important to keep the pelvic floor strong?

Pelvic floor muscles need regular exercise (just like other muscles of our body) to retain good muscle tone. If they are not stimulated enough, they may become strained, stretched and weak, and therefore, they can no longer work effectively.

Optimally the pelvic floor muscles will be long and supple with just the right amount of tension to support your pelvic organs and prevent prolapse (a condition that happens when the pelvic organs move out of place).  They equally need to be strong enough to be able to relax and contract the bladder and bowel orifices so they can drain bodily functions with ease.

The pelvic floor plays an important role in maintaining urinary and faecal continence. A weak pelvic floor may not provide sufficient support for this process, resulting in leakage of urine on coughing, sneezing, laughing, straining or playing sport for example. This is known as stress incontinence. In some cases, there could also be leakage of faeces, and/or an inability to control the passing of gas from the rectum.

Urge incontinence is the loss of urine with an urgent need to pass urine and may also be associated with a weak pelvic floor. In addition, if the pelvic floor muscles are weak, and not working in harmony with the muscles of the abdomen and back, structural imbalances can lead to abdominal and back pain, as well as patterns of compensation throughout the body.

Why do the pelvic floor muscles weaken?

A number of things could cause the pelvic floor to weaken:

  • Pregnancy and childbirth
  • Continual straining to open the bowels (constipation)
  • Persistent heavy lifting
  • High impact sporting activities (e.g. road running and weight training)
  • A chronic cough (e.g. asthma, chronic bronchitis or smoker's cough)
  • Obesity
  • Inactivity / lack of general fitness
  • Changes in hormone levels during menopause
  • Pelvic surgery
  • Sports such as bicycling, racing, horseback riding, or water skiing

What happens when the pelvic floor muscles weaken?

These are some of the symptoms associated with pelvic floor weakness:

  • Stress incontinence – leaking urine when laughing or sneezing or jumping
  • Increased urinary frequency i.e. going to the toilet every 30 minutes
  • Incomplete emptying
  • Constipation, straining, pain during or after bowel movements
  • Uncoordinated muscle contractions causing the pelvic floor to spasm
  • Pain on intercourse
  • Feeling of heaviness or pressure in pelvic area
  • Lower back pain
  • Sacroiliac pain
  • Hip pain
  • Coccyx (tail-bone) pain

Do pelvic muscle exercises really work?

Research shows that pelvic floor muscle exercises are effective for some types of incontinence such as stress incontinence and/or an overactive bladder causing urge incontinence. They can also help faecal incontinence when the cause of the problem is a weak pelvic floor. However, they will not work if there are other causes of urine or bowel motion leakage (for example, infection, inflammation or underlying bowel disease).

There is ample evidence to show that pelvic floor muscle exercises are effective when the exercises are done correctly and when taught and supervised by a professional with pelvic floor specific training. If your 'do-it-yourself' pelvic floor muscle exercise programme did not work, then chances are they were not done correctly. A trained therapist will be able to provide you with an individualised training programme specifically developed for your problem and the condition of your pelvic floor muscles.

I’ve delivered my baby via C-section, so I don’t have to worry so much about my pelvic floor muscles, right?

Pregnancy itself increases the risk of pelvic floor dysfunction by causing the muscles and ligaments in and around the pelvic floor to lengthen. Women who have had C-sections are just as likely to have pelvic floor dysfunction as women who have had uncomplicated vaginal deliveries. It’s important to be mindful of your pelvic floor after a C-section too.

Can the pelvic floor muscles ever regain their strength once you’ve had a baby?

Yes! Postnatal pelvic floor muscle exercises have been shown to greatly assist in the recovery of pelvic floor muscle function, and to reduce the likelihood of urinary incontinence that is common among postnatal women. 

Is it normal to pee a little if I’m lifting something heavy, jogging or jumping?

No, it’s not normal. Sure it is very common, particularly in the postnatal period, but it is never normal to pee when you don’t intend to. If you do, it means your pelvic floor muscles have weakened. It is always advisable to look for a pelvic floor specialist, who if not able to help you through tailored therapy, will refer you back to your doctor for further examination and diagnosis. 

If I have been diagnosed with prolapse/diastasis/incontinence, will I ever be able to lift/run/jump again?

While it isn’t a good idea to push through and ignore pelvic floor issues, it’s not always necessary to completely give up an activity that you love either. A lot of advice around pelvic floor dysfunction focuses on what not to do, but there’s nearly always a way to make gradual progress towards returning to things like running and weight lifting without further compromising your pelvic floor health.

Is it possible that with time some pelvic floor issues will simply go away on their own?

Unlikely. Issues like incontinence and prolapse often worsen with time, especially around menopause. Hormonal changes, particularly dropping estrogen levels, affect connective tissue and make it less elastic. It is common for women to have minor pelvic floor problems that become significantly worse as menopause approaches. Dealing with it sooner rather than later is always a good idea.

I’ve had this problem for so long, is there a point in addressing it now?

It is never too late to work on strength and coordination of any muscle group - the pelvic floor is no exception!

Would you like to find out more about what you can do to maintain your pelvic floor fit and strong?

I am extremely excited and proud to be leading a ‘pelvic floor fitness’ workshop/class at the BE Festival 2017. It will consist of an open and honest discussion on the importance of pelvic floor health, and also a fun and dynamic fitness class incorporating Pilates and strength training exercises.    

Together we will:

  • Learn to identify the pelvic floor muscles through sensory awareness
  • Learn exercises to increase sensory awareness of the pelvic floor
  • Learn the correct the breathing technique for optimal pelvic floor engagement
  • Learn how to protect and strengthen your pelvic floor through everyday activities
  • Learn to incorporate the correct pelvic floor engagement technique while undertaking fitness activities

For more details about the festival, and to sign-up for Well Mama’s class and many other awesome workshops, classes and complimentary treatments see links below: 

When: Sunday, 3rd September 2017

Where: Oertig Nurseries, Altwiesenstrasse 29, 8602 Wangen ZH
Take tram or train to Dietlikon and walk 15 Minutes.
By car, key in Förliwiesenstrasse 4, 8602 Wangen b. Dübendorf/ZH and take a left over the bridge into Altwiesenstrasse. There is lots of parking.

Please register your interest to join a session with gill@macandbroek.com or kitchenfury.org@gmail.com

Webpage: https://macbroek.squarespace.com/be-festival-2017

FB: https://www.facebook.com/beday2017/

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