WHAT IS THE PELVIC FLOOR?
The pelvic floor is a group of muscles and ligaments that support the bladder, uterus, and bowel. These muscles are located at the base of the pelvis and connect the pubic bone at the front to the tailbone at the back. The pelvic floor also contains openings for the urethra (bladder), vagina (uterus), and anus (bowel) to pass through.
A strong pelvic floor provides support to the pelvic organs and can prevent issues such as incontinence and prolapse of the bladder, uterus, and bowel. The pelvic floor muscles play a crucial role in controlling bladder and bowel function, enabling you to maintain control until an appropriate time and place to empty them. They also play an important role in sexual function.
WHAT CAN CAUSE PELVIC FLOOR DYSFUNCTION?
Pelvic dysfunction in women is very common. It is estimated that up to 50% of women over the age of 50 experience urinary incontinence, and up to 30% of women experience pelvic organ prolapse. The prevalence of these conditions can be even higher in women who have had a vaginal delivery or who are experiencing menopause.
Pelvic floor dysfunction is a common problem and can have a significant impact on quality of life, and unfortunately many women may not seek treatment due to embarrassment or lack of awareness. The great news is that there is plenty you can do to help yourself.
What are causes of a weak pelvic floor?
- Pregnancy and childbirth: The physical demands of pregnancy and childbirth can weaken the pelvic floor muscles, leading to problems such as urinary incontinence or pelvic organ prolapse.
- Menopause: The hormonal changes associated with menopause can cause a loss of pelvic muscle strength and tone, increasing the risk of pelvic floor problems.
- Aging: As women age, the pelvic floor muscles naturally lose strength and tone, which can lead to problems such as incontinence and pelvic organ prolapse.
- Obesity: Excess weight can put additional strain on the pelvic floor muscles, increasing the risk of pelvic floor dysfunction.
- Hysterectomy: Removal of the uterus can also weaken the pelvic floor muscles, increasing the risk of pelvic floor problems.
- Chronic constipation: Straining to have a bowel movement can put pressure on the pelvic floor muscles, leading to problems such as incontinence or pelvic pain.
- Chronic cough: A persistent cough can also put pressure on the pelvic floor muscles and contribute to pelvic floor dysfunction.\
WHAT ARE THE EFFECTS OF PELVIC FLOOR DYSFUNCTION AND WEAKNESS?
There several effects of a dysfunctional pelvic floor:
- Urinary incontinence: this can be in the way of Stress (involuntary passing of urine often when under strain) or Urge (the feeling of needing to go immediately).
- Fecal incontinence: involuntary loss of faeces.
- Pelvic organ prolapse: This refers to a condition where the pelvic organs, such as the bladder, uterus, or rectum, drop from their normal position and bulge into the vaginal or rectal area.
- Chronic pelvic pain: This can be caused by weak or overactive and tender pelvic floor muscles.
- Sexual dysfunction: A weak pelvic floor can impact sexual function, leading to issues such as reduced sensation or difficulty with sexual intercourse.
- Constipation: Weak pelvic floor muscles can also contribute to constipation and difficulty with bowel movements.
HOW IS PELVIC FLOOR DYSFUNCTION MANAGED?
If you are experiencing pelvic floor issues it is always wise to be evaluated by a Women’s Health physio who is specifically trained to deal with these dysfunctions. Not all pelvic floor problems are due to weakness, rather some may be due to overactivity, the management of which is quite different. So proper evaluation for long standing issues is recommended.
Some common management strategies include:
- Lifestyle changes: Maintaining a healthy weight, avoiding constipation, and avoiding activities that put strain on the pelvic floor muscles (such as heavy lifting) can help to improve pelvic floor function.
- Pelvic floor muscle exercises (Kegels): Strengthening the pelvic floor muscles through regular Kegel exercises can help to improve bladder and bowel control, reduce pelvic pain, and prevent pelvic organ prolapse.
- Physical therapy: A Women’s health physio specializing in pelvic floor rehabilitation can help to assess and treat pelvic floor dysfunction. This may include pelvic floor muscle exercises, manual therapy, and electrical stimulation.
- Medications: Medications such as antimuscarinics, beta-3 agonists, and duloxetine can be prescribed to help improve bladder control in some women.
- Medical procedures: In some cases, surgery may be recommended to treat pelvic floor dysfunction. For example, surgery may be recommended to repair a prolapsed uterus or to tighten the pelvic floor muscles.
HOW DO I STRENGTHEN AND MAINTAIN MY PELVIC FLOOR FUNCTION?
In the absence of dysfunction it is recommended to regularly train the pelvic floor with Kegel exercises.
To perform Kegel exercises:
- Identify your pelvic floor muscles: To identify your pelvic floor muscles, try stopping and starting the flow of urine. The muscles you use to do this are your pelvic floor muscles. It’s important to avoid doing Kegel exercises while urinating, as this can lead to a decreased ability to fully empty your bladder.
- Contract and relax the muscles: Once you have identified your pelvic floor muscles, contract (tighten) the muscles for 5-10 seconds and then relax them for 5-10 seconds. Repeat this contraction and relaxation several times in a row. You should have a feeling of Lifting your pelvic floor, not PUSHING down. Relax your thighs and buttocks.
- Practice long and short, sharp contractions: As part of the routine the pelvic floor should be trained with long holds ie 10-15 second holds while breathing x 10 times. They also need ot be trained to work quickly ie short, sharp contractions x 5-10 reps. Make sure you still perform the contraction correctly.
- Incorporate into your daily routine: Aim to perform Kegel exercises several times a day, gradually increasing the number of repetitions and the duration of each contraction.It’s important to perform Kegel exercises correctly in order to achieve the best results. If you have any concerns about your pelvic floor muscle function, it is recommended to speak with your healthcare provider or a physical therapist who specializes in pelvic floor rehabilitation.
PELVIC FLOOR DEVICES
There are many devices on the market to help with Pelvic Floor dysfunction. Your therapist will help guide you to which one may be useful for your situation. There are devices to assist with
- Pelvic Floor Weakness- EMG, stimulation, biofeedback
- Pelvic Floor Over-activity- EMG, stimulation, biofeedback
- Sexual dysfunction- dilators, biofeedback
- Organ prolapse- assistive devices
The full range of pelvic floor devices and women’s health ranges here can be found on our website here.
