I was recently asked if I could cover the topic of pelvic floor health; I am always delighted to have suggestions come my way for articles and though this one is relevant for both men and women, it is particularly pertinent for women.
The pelvic floor consists of a group of muscles that act rather like a trampoline floor holding up our internal organs. This group of muscles attaches to the inner bowl of the pelvis, attaching to, and connecting, the hips, the pubic bone and the sacrum. It mainly supports the organs that sit on top of it, such as the bladder, the uterus and the rectum in women and the bladder, the prostate and the rectum in men.
It is imperative to have good pelvic floor health, as it is responsible for many important functions. It controls our sphincters, which regulate the elimination of our urine and stool. It acts as a hammock for our organs and it provides stability to our pelvis as we move. Our pelvic floor also impacts our sexual health and function. Plus, it plays an important role in pumping our lymphatic fluids back up the body for return to the heart and this is important for our immune system, as remember, the lymphatic system is responsible for transporting waste in the body and protecting against unwanted bacteria, viruses, parasites and fungi that may cause disease or ill-health.
Pelvic floor issues most commonly and obviously show up as issues with leaking, and this week I’ll be dealing with this topic, though there are many other areas to be explored.
Here are some of the signs you might be dealing with regarding pelvic floor issues:
• Urinary urgency: when you really need to go and feel an urgency; it’s not a calm relaxed affair.
• Urinary frequency: going more than eight times a day (unless you drink gallons of water). This also relates to waking up at night to pee. There is a general rule that before the age of 55 we should not wake up at all at night to urinate, that changes once you are between the ages of 55-65 and older as, from this age on, your body starts producing a third of its urine at night.
• Stress incontinence: this is when you may leak urine upon lifting heavy objects, coughing or sneezing. Often chronic cough can lead to leaking urine as the pelvic floor has weakened from the exertion.
• Urge incontinence: this is a step up from number one where the urge is so great you cannot hold the sphincter closed and leakage occurs.
• Difficulty emptying the bladder: so that feeling of still having more urine to release; or pain on urinating. Pain on urinating is commonly a sign of a urinary tract infection (UTI) however so your first port of call should be to see your doctor and run tests to check for such. While we often assume our issues are down to a weak pelvic floor, an overly tense pelvic floor can lead to recurrent UTIs amongst other conditions. One thing to note here is that men rarely if ever get UTIs, as their ureter is longer, therefore it is advisable to seek medical attention quickly if experiencing pain on urination.
• Pelvic floor pain, this is mainly experienced in the hips and back. You might need to explore whether it is arising from spinal nerve damage or impingement or whether it is due to your pelvic floor muscles.
vii) Constipation, if the pelvic floor is too tight and can’t relax you will have difficulty emptying your bowel. This can lead to higher risk of UTIs, as well as causing abdominal pain and discomfort. Conversely, if the pelvic floor is weakened, fecal incontinence can arise whereby we experience all of the above forms of incontinence but with our stool rather than urine.
So how can you tell if your pelvic floor issues are as a result of weakness or tightness? To accurately determine such it would be wise to attend a good pelvic health therapist but you can do a quick DIY check at home for weak pelvic floor muscles. This involves inserting a finger into the vagina and squeezing, it should not be lax or loose and you should be able to discern the contraction. Men can check by inserting a finger into the rectum with the same principles applying. If there is any doubt as to whether your pelvic floor is too weak or too tight you need to get it checked as doing pelvic floor strengthening can be detrimental if your pelvic floor is tight or if you have a prolapse.
If you are a woman who has ever had a traumatic delivery, or have carried large babies through pregnancy or had pubic symphysis dysfunction, it is also advisable to attend a pelvic health therapist. Statistics from the US indicate that up to 40 per cent of women have some prolapse (where the pelvic floor or one of the organs supported by the pelvic floor sinks and bulges into the vagina). It is quite a shocking statistic. This high figure is largely due to issues that arise in the child-bearing years for those of us who have borne children but thanks to the menopause all women will face declining oestrogen levels from our mid-forties on, which according to statistics, leads to both stress incontinence and urge incontinence in about 50 per cent of women. What is most shocking however is the way in which it can be ignored or neglected.
This is largely because it is mainly women who are most often in the role of care-giver, whether looking after children, or parents, or both, and it is women who tend to be employed more in care-giver roles. Combine that with the hectic pace of life these days and we can find ourselves putting our needs to the bottom of the list. And because pelvic floor issues are rarely life-threatening, we are inclined to just get on with it and ignore them. But if you are dealing with any of the above issues, they deserve to be addressed because quality of life really matters. Life is too short to be putting up with a problem that can and should be fixed, especially if it is causing you to withdraw from activities you used to enjoy because it is impacting your confidence .
How to strengthen your pelvic floor at home. DIY exercises
The pelvic floor is part of your core, so a well-trained Pilates teacher will be able to work with you to help you find and sense the correct muscles to engage. Pilates and Yoga are both excellent to help strengthen the pelvic floor, but I must stress here that it is essential the pelvic floor is brought through its full range of motion in tandem with good breathing practice and body awareness. Pelvic floor exercises should never be about squeezing and clenching, this can cause greater problems than it will ever solve. For this reason, it is worthwhile attending a specific pelvic floor health class or booking an individual session with a teacher to get effective guidance. This works well for the general population who might need strengthening of lax muscles, they can be trained same as your core, but if your situation is more complex or serious or if you have a prolapse for instance, you are best to book in with a pelvic floor therapist who can advise you as to whether necessary medical intervention might be required.
Gentle kegels
This exercise should never cause pain or irritation
Learn how to do this exercise lying down and, as the sensations become more distinct, you can progress to sitting and standing positions. Above all ensure you are relaxed as you practice.
Exhaling, start to draw your pelvic floor in and up (this naturally happens as we exhale, we are just deepening the experience of it here), gently squeezing and holding for a count of five.
Inhaling, begin relaxing your pelvic floor muscles down for a count of five. The pelvic floor muscles must be able to relax as well as contract. Be careful here that you don’t bear down or push down on these muscles, it should a gentle relaxation and not effortful, so ensure your breath has the same quality of ease. Being too forceful can cause irritation to the ureter. On a side note here, make sure when you urinate that you never force urine flow, as this can further weaken the pelvic floor.
Repeat this three times and maybe start with once a day progressing to a few times daily. Once you become familiar with the technique you can practise it sitting and standing.
