Your pelvic floor is that taboo topic that everyone really tries to avoid talking about…at least until you have children.
But what if you were more informed about what the pelvic floor does, how it might affect your wellbeing and what you can do to look after your pelvic floor? Well read on if you want to find out!
Some quick facts:
- Urinary Incontinence affects up to 37% of Australian women and 13% of men
- 65% of women sitting in a GP waiting room report some form of urinary incontinence
- Approximately 50% of women who have had children will have some degree of pelvic organ prolapse
- Even after surgery to mend a prolapse 1 in 3 women will prolapse again
Continence Foundation of Australia (2018). Pelvic Floor and Pelvic Organ Prolapse. www.continence.org.au
What is the pelvic floor?
The pelvic floor are a series of muscles that start at the pubic bone (the bone at the front) and extend to the coccyx (the tailbone). The muscles surround our bladder, anus and vagina and help to control our bladder and bowel (continence), help give us an orgasm during sex and provide upward support to our pelvic and abdominal organs. The pelvic floor forms the base of our core thus having good, strong pelvic floor function is very important.
Why does it become weak?
The pelvic floor, like any muscle can become weak if it is not exercised or is put under too much load, namely intra-abdominal pressure (more on that in a sec) and childbirth. Childbirth is the major culprit for weakening of the pelvic floor as the baby has to be pushed out of these muscles through the vagina. Did you know the muscles of the pelvic floor have to stretch so much during childbirth that any other muscle would rupture if it was put under the same stress! However, women who have not had children may also be at risk. These include women who undertake a lot of heavy lifting either in their job or sport, poor breathing mechanics and straining to pass a bowel motion (constipation). These activities all increase intra-abdominal pressure and forces pressure down on the pelvic floor.
Signs of Pelvic Floor Weakness/Issues:
- Urinary incontinence (leaking small to large amounts of urine when you cough, sneeze, laugh, run etc)
- Faecal Incontinence
- Feeling a bulge in or around the vagina (you may also be able to see a bulge in a mirror if the prolapse is significant)
- Pain with sexual intercourse
- Recurrent urinary tract infections
- Difficulty completely emptying the bowel
- Incomplete bladder emptying or a stream of urine that deviates to one side
How do I exercise my pelvic floor?
NOTE: This advice is very generic advice and these exercises may not be suitable to every person with pelvic floor dysfunction. The efficacy of the exercise relies on correct performance. Performing these exercises incorrectly may worsen your condition. Consult your healthcare provider first if you have any concerns about these exercises and your condition.
To contract your pelvic floor muscles you need to try and think about stopping the flow of urine mid stream. This will result in a lift (contraction of the pelvic floor). You can also see this by placing a mirror between your legs. You should see a lift around the vagina and an in drawing of the perineum.
We have 2 types of pelvic floor contractions – long and short holds
- Long Holds
- Long holds are best used for when lifting an object or performing a pre determined task ie lifting a box
- You should try to squeeze and hold for up to 10 seconds, then relax for 10 seconds. Repeat this sequence 10 times
2. Short Holds
- Short holds or rapid contractions are best for times when we need our pelvic floor to rapidly contract such as coughing, laughing or sneezing
- Aim to perform 2 sets of 15 repetitions
When performing these exercises you don’t want to be gentle. We advise our patients to contract their pelvic floor “like you are sucking up a thick shake”. Like any other muscle of the body you are trying to grow the pelvic floor needs to be challenged with progressive overload to induce change.
When should I see a Physiotherapist?
You should see a physiotherapist EARLY if you notice any of the aforementioned symptoms. The sooner we can identify the issue and provide the right treatment, usually the better the outcome. You should also see a physiotherapist if you are unsure if you are performing the pelvic floor exercises correctly. If you suffer constipation and strain to pass a bowel motion don’t be afraid to tell us! This is really important information to us understanding your condition and what may be causing your symptoms and we can help you. We are as much about prevention as we are treatment.
Ideally conservative management would be the treatment of choice in most conditions as there are high failure rates with surgical intervention especially for pelvic organ prolapses. In some cases surgery becomes necessary however first line of management should be conservative. Beyond exercises for the pelvic floor, physiotherapists have a wealth of knowledge and can be a great resource for advice and education.
What should I expect at my first consultation?
Your physiotherapist will sit down with you and ask a range of questions including what your main symptoms are, when did they start, how are these symptoms impacting your life and what you want to achieve from treatment. They may also ask you questions about your sexual activity, bladder and bowel function and children/childbirth. From this, they may want to perform an internal examination. This is something that will be discussed and you have the opportunity to consent or decline the examination. The internal examination provides us with a lot of detail; we can check the position of the pelvic organs, feel the muscle strength of the pelvic floor, check all the muscles are intact and very specifically determine how long you can hold a contraction for and thus your pelvic floor exercise program.
Your physiotherapist will also address any contributing factors to your issue such as constipation or poor lifting techniques. In some instances they may send you home to complete a diary regarding your bladder and bowel function to further understand your problem. Your first consultation will typically go for approximately 1hour.
Are there any Apps I can get to help me with my exercises?
YES! There is a great pelvic floor exercise app available FREE from the apple store. It is caused KPFE and it’s a pink icon with a big K. Once you download the app you are able to easily setup your own specific program. It also allows you to setup reminders so you never forget to do your exercises.
