Is the pelvic floor just responsible for controlling the bladder?
“As the name suggests, the pelvic floor is the muscular floor of your pelvis. It’s often described as a wide hammock or shallow cereal bowl in shape, which attaches to the bony points of your pelvis (pubic bone, tailbone and sitting bones). As well as keeping your urethra, vagina and anus closed or open depending on what you are doing – i.e., to facilitate the emptying of the bladder and bowels or penetration – it also prevents prolapse and aids joint stability within the pelvis. It also plays a key role in providing sexual function – that is, the ability to have comfortable, pleasurable and enjoyable sex and the ability to orgasm.” – Helen Keeble, clinical specialist physiotherapist in pelvic health and co-founder of Umi Health
Aside from a weak bladder, what are the signs your pelvic floor has weakened?
“The common dialogue when it comes to the pelvic floor is that things have become weaker over time, but it’s also important to understand the pelvic floor can also become tight and/or overactive. The signs of pelvic floor dysfunction include accidentally leaking urine when coughing, sneezing, laughing or exercising; failing to reach the loo in time and constantly needing to go to the loo; finding it tricky to empty your bladder or bowels; wind leaking out from either the anus or vagina when bending over or lifting; a distinct bulge at the vaginal opening, or a sensation of heaviness, discomfort, pulling, dragging or dropping; pain in your pelvic area; and painful sex.” – Caoimhe McNamara, specialist women’s health physio at Six Physio
What puts pressure on the pelvic floor – is there more to it than childbirth?
“While the effects of pregnancy and childbirth are most commonly associated with pelvic floor pressure, it can also be affected by chronic constipation; high impact exercise; persistent heavy lifting; being overweight; injuries to the lower back, hips and groin; a lack of exercise; and previous gynae or abdominal surgery.” – Caoimhe
“Holding your tummy in all the time (whether during exercise or just day to day) and holding your breath when lifting weights can also take its toll on the pelvic floor. Also be wary of focusing too much on working out the tummy muscles without also considering the pelvic floor.” – Helen
How much of an impact does the menopause have on the pelvic floor?
“Possibly more than you think. A decline in oestrogen circulating around the body, and the ageing process, can lead to pelvic floor dysfunction which can include incontinence, prolapse and sexual dysfunction. Just like the rest of the muscles in your body, your pelvic floor muscles weaken. Women are also at risk of weight gain at this time which in turn can impact on your pelvic floor strength. The depletion of oestrogen results in a thinner, less elastic, drier vaginal tissue and loss of fatty tissue. As a result, women can experience vaginal dryness, pain during sex, itching and soreness of the vulva and urinary infections.” – Mary Harman, specialist physiotherapist in pelvic health and certificated Pilates instructor
“It’s different for every woman – some women may have no symptoms at all, and others may have one or multiple symptoms to deal with. Common changes within and near to the pelvic floor seen around the post-menopause stage also include a reduction of the vaginal and vulval tissues and increased sensitivity; an increase in urinary tract infections due to changes in the vagina’s pH; bladder irritability; and pelvic organ prolapse. Some of these changes are due to a decline in hormones such as oestrogen, which is why topical oestrogen (available from your GP) can be so beneficial in the post-menopausal stages. Other changes, however, are due to a reduction in size and volume of the pelvic floor muscle itself.” – Helen
If you are suffering from urge urinary incontinence or urinary urgency, is there anything you can do?
“If you are unable to make it to the loo in time or experience urgent desires to go to the loo immediately, it’s firstly important to be aware of what you are drinking and how much. Aim to drink around 1.2-2 litres or three pints of fluid daily. Don’t restrict the amount you drink – drinking too little makes your urine strong, which may irritate your bladder and make it want to empty more often. It can also cause dehydration, constipation and make you more prone to bladder infections. Drinks containing caffeine can make you pass urine more often and more urgently, including during the night. Try replacing caffeinated drinks (tea, coffee, hot chocolate, cola and energy drinks) with caffeine-free or decaffeinated drinks (fruit or herbal tea, milk, squash and water). Fresh fruit juice, alcohol and carbonated (fizzy) drinks can all irritate the bladder so avoid these. Also try to avoid constipation – having a full bowel can put pressure on your bladder, which can make it difficult to empty and make you feel you need to pass urine more frequently. Losing a few pounds can also help if you are overweight. Being overweight puts extra pressure on your pelvic floor and losing even as little as half a stone can reduce leakage.” – Mary
Is it too late to start doing pelvic floor exercises once you’re in your fifties and sixties?
“It’s never too late to start, and pelvic floor exercises have been shown to be beneficial at any age, especially if you are experiencing symptoms such as leaking and prolapse. The aim is to do ten short squeezes and ten long squeezes (up to ten seconds) two to three times per day. Start by doing these lying down if you’ve never done Kegels before, and then eventually do them standing. Ensure you take a full breath in and out between every short and long squeeze to ensure you are fully letting go before starting the next one. You should notice a difference within six to eight weeks, but it can take on average four to six months to have a significant improvement, so don’t give up.” – Helen
What should you do if you struggle with these exercises?
“To do a basic contraction, try to imagine you have wind, but you want to try and hold it in. You then draw the muscle forwards as if you were desperate to pass urine but trying to hold it in. If you find it hard to start with the muscle at the back and draw it forwards, there is no harm in squeezing at the front and back at the same time. NICE guidelines recommend you do these exercises three times a day, but if this is difficult to achieve, doing them once a day will still help. What’s important is that you concentrate during these exercises to ensure you are working the muscles as well as you can. Try to avoid tightening your buttock muscles, holding your breath or gripping your abdominals.” – Mary
What about urge incontinence specifically – are there any exercises that can help?
“Consider a bladder retraining programme. This is a therapy that enables you to suppress and ignore the urge to pass urine, so you’ll ultimately need fewer trips to the loo. It will encourage the bladder to stretch and hold urine more comfortably. However, this takes time and only you can make it work – you will have good and bad days to start but don’t give up – the process can take weeks or even months. Firstly, stop going to the loo to pass urine ‘just in case’. When you get the urge to pass urine, try and hold on. Initially just for a minute or two, then gradually build up the time between emptying your bladder. You can also try standing still or sitting on a hard seat, squeezing your pelvic floor muscles for five to ten seconds, four to five times. This can help relax the bladder.” – Marsha Evans, specialist woman’s health physio at Six Physio
Can a pelvic floor trainer help?
“Pelvic floor muscle trainers can be helpful but they’re not essential. If you are somebody who finds it easier to do your pelvic floor exercises with some visual or tactile feedback, then a pelvic floor trainer could be a useful tool for your rehab. If your pelvic floor muscles are very weak, often a pelvic floor trainer can help with muscle activation. There are many different types of PFM trainers on the market and identifying exactly what you want to get out of the trainer is important before purchasing one. A women’s health physio can help and can also make sure your trainer is set to the correct setting. The NHS Squeezy app is also a fantastic resource – both for setting up a pelvic floor exercise routine you can follow, and to enable you to search for a women’s health physio local to you.” – Marsha
If you are considering surgery, what are your options?
“NICE guidelines state that surgery should be the last resort. However, a colposuspension is one surgical solution for incontinence. It involves making a cut in the abdomen and lifting the neck of the bladder and stitching it there. It can help to prevent leaks. Sling surgery is another option – this involves an incision in the abdomen and vagina so that a sling can be placed around the neck of the bladder to support it and prevent leaking. Botox can also be injected into the sides of the bladder to help relieve urge incontinence and an overactive bladder. However, this is only a temporary solution as Botox wears off after a few months.” – Dr Shirin Lakhani, founder of Elite Aesthetics and intimate health specialist
Are there any other treatments worth exploring?
“The Emsella Chair is an increasingly popular treatment, delivering the equivalent of 11,400 Kegel exercises per 30-minute treatment. During the treatment, you sit on the chair fully clothed – the electromagnetic fields stimulate the movement nerves in the pelvic floor, causing the muscles to contract and release hundreds of times per minute. The treatment also targets the entire pelvic floor by bypassing neurones in the brain and so enables the patient to use 100% of the muscle rather than the 40% which can be activated by consciously tensing. It costs £1,500 for a course of six treatments. Ultra Femme 360 is also one of my most popular treatments. A radio frequency device that emits energy, it’s a fast and effective treatment for vaginal laxity, tissue quality and incontinence. By stimulating collagen growth and nerve regeneration it can also effectively treat the symptoms that often cause a low libido. It costs £1,500 for a course of three eight-minute procedures.” – Shirin
For more information visit Helen-Keeble.com and Umi-Health.com, SixPhysio.com, MaryHarman.co.uk and EliteAesthetics.co.uk
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