Your pelvic floor – get the lowdown on the down low!

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Until we’ve fallen pregnant and had a baby, 99 per cent of us won’t have given our pelvic floor a second thought. But, boy, don’t we know about it when it’s not working as it should, especially when we exercise?! Physiotherapist and fellow NSM Victoria Watson has these helpful tips.

“I hardly ever jump on the trampoline with the kids. ‘I’m afraid I’ll wet my pants if I do.”

“We were out at lunch on Sunday, and when I finally got up to go to the loo, the queue was so long, I wet myself a bit while I was waiting! Mortified!”

“You know that saying – I laughed so hard I wet myself? Well it actually happened to me!”

These comments, and hundreds more like them, are just snippets of conversations that girlfriends have all over the world. We generally all have a good laugh, sympathise and sometimes share a similar story in return.

The thing is, pelvic floor disorders are so very common. But they don’t have to be. First, the facts.

  • According to a 2006 report by the Australian Institute of Health and Welfare, up to 37 per cent of Australian women are affected by some level of incontinence – that’s more than one in three!
  • A survey reported in the Australian and New Zealand Continence Journal in 2003 found that about 65 per cent of women sitting in a GP waiting room have some type of urinary incontinence, yet only one third say they have sought help from a health professional.
  • It’s understood that about 75 per cent of women will develop some degree of pelvic organ prolapse, or descent of their pelvic organs, during their lifetime.

What exactly is meant by pelvic floor disorders?

There are three main categories of pelvic floor disorders. Firstly, let’s explore urinary incontinence. There are many types of urinary incontinence, but the most common are stress urinary incontinence and overactive bladder (or urge) incontinence.

Stress urinary incontinence is defined as the involuntary leakage of urine during increased abdominal pressure. Common causes include pelvic floor weakness or connective tissue factors, but there are many other contributing factors.

Overactive bladder incontinence is commonly known as urge incontinence. It is characterised by a sudden, compelling desire to pass urine, which cannot be deferred. This is a complex disorder that can be caused by many factors such as bladder muscle sensitivity, bladder filling capacity and external stimulants including caffeine and artificial sweeteners.

Secondly, there is Pelvic Organ Prolapse or the slipping down of the pelvic organs, such as bladder, uterus or bowel, into the vagina. The pelvic organs are lifted by internal ligaments and supported from below by a strong pelvic floor. When there is damage to either of these supporting structures, prolapse can occur.

Finally, there is defecation disorders such as chronic constipation or fecal incontinence. There are many causes of constipation including dietary influence, muscular and neurological control. Strain involved in constipation causes a significant increase in load on the pelvic floor and can significantly affect continence.

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Who is at risk?

Any woman who has:

  • given birth
  • a history of chronic respiratory conditions
  • a history of regular heavy lifting
  • been an elite/high-level athlete

As a women’s health physiotherapist, I sometimes see women in the early stages of incontinence where urinary dysfunctions, such as stress incontinence or an overactive bladder, are merely an annoying part of their life. At this stage appropriate assessment and education can enable them to regain control and prevent the problem from developing into something more severe.

However, sadly, I also see women who have had their quality of life severely compromised by pelvic floor disorders – women who feel that the pelvic organ prolapse, incontinence or defecation disorders from which they are suffering affect every decision they make. They constantly wonder: ‘When is it ok for me to go out?’ ‘How many pads will I have to take?’ ‘Will there be toilets?’ ‘Is there likely to be a queue for the bathroom?’ ‘Will anything there be likely to make me sneeze?’ ‘Will there be lifting/stairs/running involved?’

Did you know that a survey by America’s National Association for Continence found that women will, on average, wait 6.5 years after beginning to experience bladder control problems before seeing a healthcare professional?

What can be done?

There are four key ways you could go about this…

1. Prevention

One of the most common causes of pelvic organ prolapse is the return to high-impact exercise with poor pelvic floor strength.

Scenario 1: new mum, still breastfeeding, keen to start getting fit again. In reality, the pelvic floor muscles are weak or traumatised post birth, and the ligaments that support the pelvic organs are still soft. High impact or exercises that increase our intra-abdominal pressure forces the organs down, and this is how prolapse can occur.

Scenario 2: 50-year-old mum with some more time on her hands now the kids are older decides to start getting fit. She has never had urinary problems, so has never really done any pelvic floor exercises. She is menopausal and her pelvic ligaments are relatively inelastic. She begins to train with an outdoor boot camp group, but while lifting a kettle bell, she feels something pull in her abdomen. It was painless, but now she can feel a bulge or fullness in her vagina. Pelvic organ prolapse has occurred.

If both these women knew the risks, they would probably have sought advice. Not all women are at risk, but the statistics indicate plenty of us are. Getting good advice from someone who can calculate your risk factors and give you safe options is easy. Coping with a pelvic organ prolapse is not.

2. Assessment

There are many management strategies for pelvic floor disorders. Accurate assessment and diagnosis is the first step. A women’s health physiotherapist will take a very detailed history and conduct a thorough examination, which usually involves an internal vaginal examination. During this time she will assess the position of your pelvic organs and the strength of the pelvic floor musculature.

3. Education

In your first session with a women’s health physiotherapist, you will probably find out more than you ever wanted to know about your pelvic organs and pelvic floor muscles! You could be taught strategies, positioning, training regimens for the pelvic floor muscles – dependent on the outcome of the assessment.

4. Other intervention

Sometimes your physiotherapist might recommend vaginal support devices, such as pessaries, or a referral to a gynaecologist if surgery is indicated.

We are lucky in Australia, particularly in Sydney, to have access to excellent resources and women’s health practitioners. We shouldn’t ignore pelvic floor problems – they are not insurmountable and, in most cases, can be remedied. We shouldn’t be afraid of talking about these issues with our GPs or physiotherapists. If they can’t help you, they will be able to advise you on who next to see. There are so many options, the least of which is suffering in silence.

Just because something is common, it doesn’t mean that it should just be accepted.

For more information on the pelvic floor, or to book a consultation, please contact Victoria Watson at Mosman Physiotherapy on (02) 9968 2666. Also visit www.mosmanphysio.com.au

Other excellent online resources include: Pelvic Floor First, Women’s Health Training Associates Physiotherapist Directory, Continence Foundation of Australia

Are you one of the many who have suffered pelvic floor problems? And, if so, how long did you leave it till you sought treatment? Let us know your stories in the comments section below.

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