ESSENTIALS 7: PELVIC HEALTH
#7.1 All about the pelvic floor
The Pelvic Floor, hidden away as it is, can easily forgotten about and ignored. However, the function of these very important muscles need our attention and need to be looked after. The different stages of a woman’s life can challenge, it and we need to be prepared!Podcast Episode available
I am going to introduce you to this set of very important muscles and explain why, as women, we need to consider taking care of them!
We will look at the anatomy and function of these muscles; what can go wrong with them and what issues may occur as a result.Women will go through the different stages of their life and will notice that the function of the pelvic floor muscles may not be as good as they should be. Pregnancy, the subsequent Postnatal period along with the Menopause are often responsible for giving us a few challenges in this area. Sadly, we are lead to believe by companies wishing to sell their wares that having a few continence issues is normal! – but it is not normal to regularly leak! You will see adverts with young and older women claiming that it’s ok because they have a ‘magic weapon’ in their pants.
If you have leakage issues they need addressing, not catching with a pad or special pretty pants!
Just to note, some continence issues can be unavoidable due to illness or medical conditions and in these cases protection may be required. But it is possible to improve their function if the issue is a question of retraining weakened muscle.
Many women have not been taught the importance of keeping their pelvic floor muscles in good shape, so if this is all new to you, you won’t be alone.
ANATOMY OF THE PELVIC FLOOR
The pelvic floor is made up of pairs of multi-directional muscles in layers that have their own individual functions, including controlling continence. The muscles make a bowl shape at the bottom of our pelvis. We need ALL these muscles to be strong enough in order that our pelvic floor can function properly and is able to support the weight of the organs and contents of our pelvis. We also need the muscles to be able to release well, just like all the other muscles in our body. Without this the muscles can become overtight leading to some of the same issues we see if the muscles are not strong enough.
EXERCISING THE PELVIC FLOOR MUSCLES
Understanding, and ongoing practice, of how to make the muscles work will help to improve and maintain a healthy pelvic floor. We are going to cover this in full in this program.
Improving function is not achieved through exercise alone. We have other factors to consider such as correct breathing, good posture and lifestyle other factors.
In this program I am going to bring you specific exercises to help you have a well-functioning pelvic floor. However, you may have certain considerations to take into account before practicing the exercises so please take the time to complete the checklist before starting them. If you have any concerns regarding the suitability of the pelvic floor exercises or of any of the other exercise sessions in the program please contact me to discuss.
WHAT ARE THE FUNCTIONS OF THE PELVIC FLOOR?
• Provides support / a floor for the contents of our abdomen – and the weight of a growing baby in pregnancy.
• Opens and closes our pelvic outlets / controls continence / gives tone to the female mid passage.
• Resist the increases in intra-pelvic/abdominal pressure during activities such as coughing or lifting heavy objects.
• Plays a part in sexual function and health and also influences sexual pleasure.
• Has an active role within childbirth to birth baby.
• Helps to stabilise our pelvis because it is part of the deep hip muscle structure.
CAUSES OF PELVIC FLOOR DYSFUNTION
- Age
- Pregnancy & childbirth – particularly if you have had an assisted vaginal delivery, episiotomy, significant tear or very large baby. It is so important to strengthen the pelvic floor during pregnancy!
- Chronic constipation & conditions such as IBS
- Heavy or repeated lifting – as we lift there is an increase in intra-abdominal pressure which puts strain on the pelvic floor
- High impact exercise / trampolining / heavy weights – heavy weights based and very vigorous gym activities with jumping can put the pelvic floor under a lot of strain
- Being very overweight adds extra stress for the pelvic floor
- Excessive coughing
- Menopause – changes to soft tissue
- Certain neurological conditions
- Some medication
- Surgery (hip, hysterectomy, prostate)
- Postural imbalances & poor posture – seated occupation, weak gluts / poor alignment & breathing patterns
- Back issues / poor core connection & pelvic stability
- Inactivity – this can be addressed!
- Illness e.g. neurological illness
- Prolapse (bladder or bowel)
- Infection – Urinary Tract Infection / cystisis
- Piriformis syndrome
- Damaged coccyx
- Hypermobility
- 57% of women with stress incontinence have a diastasis (separation of the abdominals)
WHAT CAN HAPPEN IF OUR PELVIC FLOOR ISN’T FUNCTIONING WELL?
The Pelvic Floor muscles may not function well because they have weakened but also because they may be over tight (hypertonic). Both these scenarios can lead to similar symptoms, so it is important to know where you are in terms of what is happening with the muscles. Always consult your health practitioner or see a pelvic health specialist if you feel things are not functioning as they should.
Note: WE MUSTN’T ASSUME THE MUSCLES NEED TO BE STRENGTHENED AS THIS IS NOT ALWAYS THE CASE
IF THE PELVIC FLOOR HAS WEAKENED
- The pelvic floor cannot do its job of supporting the bladder, uterus and bowel well enough. This results in prolapse and possible bladder or bowel continence issues. Woman are more vulnerable than men.
- Pelvic floor dysfunction can lead to issues with letting us evacuate from the bladder or bowel
- It can interfere with sexual function and enjoyment
HIGH TONE /HYPERTONIC PELVIC FLOOR
The pelvic floor can become overactive. If we don’t learn to relax it, it can lead to the muscles being too tight. This will therefore lead to the muscles being weak and will create issues with continence, sexual discomfort and pelvic pain.
Working ANY muscles a lot – and not relaxing them – IS NOT GOOD!
SYMPTOMS OF HYPERTONIC PELVIC FLOOR MUSCLES
- urinary frequency, urgency, hesitancy, stopping & starting of flow, painful urination
- constipation, straining, pain during or after bowel movements
- interstitial cystitis : painful bladder syndrome
- unexplained pain in lower back, pelvic region, hips, genital area or rectum
- pain during or after intercourse, orgasm or sexual stimulation
- uncoordinated muscle contractions causing the pelvic floor muscles to spasm
THE IMPACT OF URINARY INCONTINENCE / STATISTICS
- It is estimated to affect up to 5 million people in the UK – though as it is much under reported and this figure could be much higher. It allegedly affects 1 in 3 women
- This costs to NHS £117 million per year
- It is the 2nd largest reason for admitting the elderly into residential care (1st is dementia related)
- It can lead to being unsure about going out if unsure of toilet facilities
- It can lead to dressing differently because of the problem
- It can affect our sex life – up to 50% avoid sexual activity
- Reports state that 1 in 3 women aged 45 – 75 avoid physical activity. The lack of activity increases the risk of obesity, diabetes, coronary heart disease, falls, osteoporosis and loss of mobility. This is yet another unnecessary strain on our NHS. Failure to address issues postnatally can lead to women avoiding exercise.
This will shape the quality of their life in old age - It can lead to social isolation
- Evidence suggests that urinary incontinence has a profound effect on quality of life – and something can be done to help with the issues people have – due to the ‘normalisation’ of incontinence by the media, family and friends, sufferers often see their symptoms as inevitable if they have had children or are getting older. fewer than 1 in 10 people who have these issues talk to a health professional either through embarrassment or because they don’t think there is an answer to the problem. it may take someone who has issues up to 10 years to seek help.
- Evidence suggests that urinary incontinence has a profound effect on quality of life. Due to the ‘normalisation’ of incontinence by the media and family and friends; sufferers often see their symptoms as inevitable if they have had children or are getting older. Fewer than 1 in 10 people who have these issues talk to a health professional either through embarrassment or because they don’t think there is an answer to the problem. It may take someone with these issues up to 10 years to seek help.
TYPES OF URINARY INCONTINENCE
- stress incontinence – involuntary loss of urine on effort, exertion, when coughing or sneezing
- urge incontinence – ‘key in the door’ – sudden desire to pass urine which is difficult to ignore
- mixed incontinence – both of the above
- overflow incontinence – involuntary loss of urine associated with over distension of the bladder (inability to urinate even with urge) (prostate issues, other medical issues etc)
THERE ARE SO MANY WAYS TO DEAL WITH PELVIC FLOOR MUSCLE ISSUES
Seeking medical assessment and helpAppropriate exercise
Improving nutritional status including choice of drinks
Addressing daily toilet habits
Certain gadgets can help improve function
PLEASE SEEK HELP FROM A MEDICAL PROFESSIONAL IF YOU ARE AWARE OF ANY OF THE FOLLOWING
Continence issues that can’t be resolved with other measures or if they are really affecting your daily lifePelvic pain or painful sex
Heaviness or bulging feeling in your mid or back passage
Continuous urinary infections (Cystitis)