Pelvic Floor Health: Why It Matters
Together with the therapists at PelviFit we've put together this guide on the pelvic floor: What it is, why it matters, how to take care of it and when to see a specialist.
If your sneezes or coughs are annoyingly accompanied by a small amount of pee leaking unwillingly, you are not alone. This is one of the most common not-fun-delights we encounter postpartum; simply as we age or for no apparent reason at all.
Pelvic floor problems are extremely common: studies suggest 1 in 4 women experience a symptomatic pelvic floor disorder, while recent research found urinary incontinence symptoms in more than half of women surveyed. Yet most women with incontinence never seek professional help.
The pelvic floor is a group of muscles at the base of your pelvis, supporting your bladder, bowel, and other organs while helping control continence and stability in your lower back. You've probably never given it much thought until now.
This muscle needs your full attention and you might not even know it exists, that's why together with the pelvic physiotherapists from PelviFit in Madrid, we put together this guide to help you.
What is the pelvic floor?
Think of your pelvic floor as a supportive hammock of muscles and connective tissue sitting at the bottom of your pelvis. It stretches from your pubic bone at the front to your tailbone at the back and supports your bladder, bowel and in women the uterus and vagina.
But support is only part of its job. Your pelvic floor also helps you control your bladder and bowel, contributes to sexual function and works together with your diaphragm, abdominal muscles and back muscles to manage pressure and provide stability when you move, lift, cough, sneeze or exercise.
And, like every other muscle group in the body, it needs to be able to do more than simply contract. A healthy pelvic floor should be able to tighten when needed, relax when needed and respond automatically to changes in pressure and movement.
That is why pelvic floor dysfunction is not always about weakness. Muscles can be weak, overactive or tense, poorly coordinated or simply not responding at the right moment. Sometimes several of these things happen at once.
Signs your pelvic floor may need attention
The most familiar sign is leaking, a little pee escaping when you sneeze, laugh, cough, or jump. It's common, especially in perimenopause, but common isn't the same as normal, and it's not something you simply have to live with. You might also notice a sudden, hard-to-ignore urge to go, or that you're visiting the bathroom far more often than you used to.
Other signals are quieter like a feeling of heaviness or pressure low in your pelvis. Pelvic floor dysfunction can sometimes coexist with persistent low back or pelvic pain as well as discomfort or pain during sex, which many women silently endure.
One nuance worth understanding: these symptoms don't always mean your muscles are weak. Sometimes they mean the opposite, muscles that are too tight and can't relax properly. This distinction matters, because the fix for a tight pelvic floor is very different from the fix for a weak one. It's a big reason why “just do more Kegels” is often the wrong advice. It is also why we encourage you to see a pelvic physiotherapist before you take action.
Who can be at risk
Pelvic floor problems can affect women at any age. Sometimes there is one clear reason, but often several factors contribute over time.
Pregnancy, vaginal birth and assisted delivery place significant strain on the pelvic floor.
Changes in estrogen can affect the tissues around the pelvic floor, bladder and vagina.
Repeated straining increases pressure and can contribute to symptoms.
Running, jumping and heavy lifting repeatedly load the pelvic floor. Even fit, strong women can experience leaking or pressure symptoms.
Chronic coughing and carrying extra body weight can add extra load to the pelvic floor.
Pelvic surgery, changes in muscle strength and coordination, and the normal effects of aging can all play a role.
Having one or more of these risk factors does not mean you will develop symptoms, but it can make pelvic floor problems more likely. None are things you should have prevented, they're just the ordinary forces the pelvic floor absorbs over a lifetime. You just need to know where your pelvic floor is, what it is or isn't doing and how to support it.
How to support your pelvic floor
The good news is that pelvic floor function can often be improved. But there is no single exercise programme that is right for everyone.
Start by learning to find it. Imagine gently stopping yourself from passing wind while also closing around the vagina. You should feel a subtle squeeze and lift internally, rather than clenching your buttocks, holding your breath or pulling your stomach in as hard as possible. This is useful as a way to recognise the muscles, not something to practise regularly while actually urinating.
Don’t forget the relaxation. A pelvic floor needs to relax fully between contractions. Constantly holding, gripping your abdomen or doing hundreds of Kegels can be counterproductive, particularly if your muscles are already overactive.
Breathe. Your diaphragm and pelvic floor naturally work together. Try not to hold your breath when lifting, exercising or getting up from the floor. Learning to coordinate breathing with effort can help your pelvic floor manage pressure more effectively.
Look after your bowel habits. Constipation and repeated straining place considerable pressure on the pelvic floor. Fibre, fluids, movement and a good toilet position (feet supported on a small stool and allowing the abdomen to relax) can all help.
Keep moving. Having pelvic floor symptoms does not automatically mean you should stop running, lifting or exercising. Often the goal is to help your pelvic floor cope better with the activities you want to do, rather than avoiding them altogether.
Don’t assume more Kegels are always the answer. If you are experiencing pain, difficulty emptying your bladder or bowel, pain during sex or a constant feeling of tension, strengthening an already tight pelvic floor may make things worse. This is where an individual assessment becomes particularly valuable.
When to see a professional
You do not have to wait until your symptoms are severe. In fact, pelvic floor physiotherapy is often most useful when problems are addressed early.
Consider seeing a pelvic health physiotherapist if you regularly experience leaking when you cough, sneeze, run or exercise; sudden urinary urgency; needing to urinate unusually frequently; difficulty controlling wind or stool; a feeling of heaviness, pressure or bulging in the vagina; pain during sex; pelvic pain; or difficulty emptying your bladder or bowel.
It is also worth asking for an assessment if symptoms are beginning to change your behaviour, perhaps you have stopped jumping with your children, always look for the nearest toilet, avoid running, wear pads “just in case”, or have started avoiding sex because it hurts. Symptoms do not need to be dramatic before they deserve attention.
Pregnancy, the postnatal period and the transition through perimenopause and menopause can also be useful moments to check in, particularly if you notice a change in bladder, bowel, sexual or pelvic symptoms.
A pelvic health physiotherapist can assess much more than simply whether your pelvic floor is “strong”. We look at strength, endurance, relaxation, coordination, breathing, pressure management and how the pelvic floor works together with the rest of your body. Treatment might involve strengthening, relaxation, bladder or bowel retraining, breathing strategies, manual treatment, exercise modification or changes to everyday habits depending on what your pelvic floor actually needs.
Pelvic floor problems are common, but they don't have to become your new normal. Help is available, and the right treatment can make a real difference.
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