Lets talk more about the pelvic floor!!!!
For so long, women have been left in the dark with matters concerning their own body. It is well recognised that there is a research gap when it comes to many areas of women’s health. Hopefully, the tide is starting to change and in 2021 there was a push to raise awareness around issues that affect women predominantly, such as pelvic floor dysfunction, and new guidance was released. It is estimated that 1 in 3 women suffer with urinary incontinence at some point, however, many still feel embarrassed to discuss their bits down below, especially when things aren’t quite working like they should be. This is a shame because problems with the pelvic floor significantly impact quality of life as well as limit physical activity, which can have a detrimental effect on physical and mental health.
What is our pelvic floor/why do we need it?
The pelvic floor are a group of muscles that are intimately connected to the bony pelvis and provide physical support to the pelvic joints and pelvic organs. They are often described as a hammock at the base of the pelvis, but this does them an injustice, as they are far more reactive and responsive than that image gives credit for. Essentially, they act as a trap door for the 3 holes at the base of the pelvis and therefore affect bladder, bowel and sexual function. They also are part of the core group of muscles so also have an important role to play in core strength. You can therefore see how important the are in so many aspects of our daily lives. When they don’t function well it can lead to urinary incontinence (leaking urine), bowel and bladder urges, vaginal pain and heaviness, lower back and/or pelvis pain, pelvic organ prolapse, flatulence, and bowel incontinence.
How does it impact us across different life stages (18 – 24, 25 – 35, 35 – 50, 50+)
Teens to young adults: Although it is rare to experience unwanted symptoms at this stage of life, the habits and knowledge we instil when we are younger will impact our experience in future years. Education is key and raising awareness can contribute to preventing problems in the future.
Pregnancy: Pregnancy and assisted vaginal birth are both risk factors for pelvic floor dysfunction. Pelvic floor education and advise should be a included in all maternity care. Although symptoms of incontinence are extremely common post-nataly, they should not just be accepted and if women experience leaking and vaginal heaviness/pain they should seek the support of a women’s health physiotherapist. It is also advised to follow physical activity guidance for pregnancy as regular exercise can help maintain core strength as well as general strength which can reduce risk of complications in this area. (maybe link to CMO exercise in pregnancy guidelines)
Menopause: As oestrogen levels drop during perimenopause and menopause this can cause an onset or worsening of any pelvic floor problems. However, it is never too late to make improvements to pelvic health and regular strengthening exercises should be included into the daily routine. If symptoms persist, seek support from a women’s health physio.
Any advice you can provide for strengthening
The most important thing you can do to improve the function of your pelvic floor is by learning to strengthen them and relax them (they need to be flexible as well as strong – like the rest of the body), by performing daily pelvic floor exercises.
How to perform a pelvic floor exercise: Squeeze the muscles of the back passage as if you are stopping wind from escaping and then squeeze the front passage as if you are stopping the flow of urine and then fully relax the muscles between squeezes. Avoid holding your breath and tensing other muscles such as the buttocks at the same time. You should do a combination of long squeezes and short squeezes – ideally 10 repetitions of 10 second holds with a rest in between each and then 10 quick squeezes each with a slow release in between. Do these once every day but if you have symptoms try and increase the frequency to 2-3 times per day. Start with doing the exercises in a seated position and then ideally progress to doing them in standing as this is more functional and we need our PF to work well in standing. Ideally, breathe into your ribcage to relax the muscles and breath out to squeeze. When doing the longer squeezes keep breathing throughout the hold.
Other important areas for maintaining/improving pelvic floor function
Maintain a healthy weight – unfortunately, being overweight or obese does increase the risk of pelvic floor dysfunction.
Don’t strain on the loo – Constipation is a significant risks factor for putting excessive load on the pelvic floor muscles when straining on the toilet. Therefore, ensuring the diet is healthy and contains fibre from a wide range of fruits and vegetables and staying well hydrated can help. It is also a good idea to change your pooing posture to help make emptying your bowels easier. Follow these 4 points 1. Keep your knees higher than your hips (a small footstool can help with this), 2. Lean forward and put your elbows on your knees, 3. Bulge out your abdomen, 4. Straighten your spine.
Exercise to maintain good posture and general strength – Sitting in poor posture can cause the muscles in the pelvic floor to become more dysfunctional. Also, if you are not strong enough to carry out every day tasks this can lead to increased strain on the pelvic floor. This is were resistance training, Pilates and Yoga can all be beneficial.
Quit smoking – Studies have shown that smoking increases the risk of urinary incontinence. This is thought to be due to the persistent cough that many smokers develop as well as chemicals in cigarettes causing irritation to the bladder.
Follow a healthy diet – following a healthy balanced diet not only helps with weight management and bowel health, it also can help reduce the amount of bladder irritants in your diet that can be in some processed foods. In particular try to avoid consuming too much caffeine, fizzy drinks and alcohol if you do have bladder symptoms.
Pelvic floor dysfunction: prevention and non-surgical management. NICE guideline [NG210]Published: 09 December 2021 Recommendations | Pelvic floor dysfunction: prevention and non-surgical management | Guidance | NICE