If you've heard the term 'pelvic floor' bandied about with more regularity than 'deliver Brexit,' but aren't so much the wiser as to what yours actually is – and why it matters – then this is for you.
From why getting the deets on this group of muscles matters, to how to make yours extra strong, here's what you need to know.
So, what is your pelvic floor?
Your pelvic floor is a hammock-shaped complex of muscles, a bit like a trampoline, that can change shape depending on how much pressure is on it.
‘It spans from the coccyx at the base of the spine to the pubic bone at the front, filling the bottom of the pelvis,’ says pelvic floor physiotherapist Katie Mann.
These muscles have three important functions. ‘The first is for support,’says Mann. ‘It has to hold up the pelvic organs – such as the uterus, bladder and bowel – as you walk around. The second is a sphincter effect, helping to keep the bladder and bowel closed until you choose to go to the loo.
The third is for sex – if it’s too weak, that can lead to loss of sensation and poor orgasmic response.’
Why don't we hear more about it?
A study from the Medical University of Vienna found that there is significantly more shame and embarrassment around pelvic floor issues, such as incontinence, than there is around other difficult-to-talk-about conditions, such as depression and cancer.
In fact, research has found that as many as 30%of women with incontinence will also be depressed, with the condition doubling the risk of postnatal depression.
Campaigns such as #pelvicroar and World Continence Week are attempting to break the silence and share advice.
Meanwhile, many of you are taking matters into your own hands. ‘Social media has been a powerful tool in breaking down the taboos surrounding pelvic floor issues,’ explains pelvic physiotherapy specialist Elaine Miller.
Case in point: midwife and Instagram influencer Clemmie Hooper (@mother_of_daughters) recently asked her 611k followers how their pelvic floors were, admitting that hers was ‘pretty crap’ and that she was using a pelvic floor trainer gadget in an effort to
do some ‘fanny admin’.
The post received more than 1,000comments, many from other women sharing their own tales of troublesome pelvic floors.
What can weaken your pelvic floor?
High-impact exercise presents particular risks. A 2016 US study found high rates of stress incontinence among female triathletes, with 37.4% of those surveyed affected, while female runners were similarly afflicted.
The sheer impact of pounding the pavement can slacken the pelvic floor muscles over time, while the motion also raises intra-abdominal pressure – the pressure inside your torso – which weighs down on your pelvic floor.
Those lifting sessions aren’t helping, either. ‘Weightlifting can be a challenge for the pelvic floor,’ explains Dr Robinson.
‘Lifting anything greater than 5kg has an effect.’ Right. This isn’t to say that you need to swerve strength training – just be mindful of your pelvic floor by focusing on form.
In fact, while studies have shown that most exercise raises intra-abdominal pressure, the level of this increase can vary between individuals, suggesting that how you lift can make a big difference.
A basic rule: don’t hold your breath, as this adds pressure, but activate and hold your pelvic floor while doing the move.
Being an unhealthy weight
Carrying excess pounds can increase the internal pressure on your pelvic floor, causing the muscles, and your bladder, to weaken over time – making leaks more likely.
‘Achieving a healthy weight is crucial as, not only can this reduce your risk of developing incontinence in the first place, there’s good evidence that doing so can improve existing weakness by lightening the load on the pelvic floor,’ explains Dr Robinson.
So, it’s not that slimming down will gift you a watertight pelvic floor – more that you’re giving your muscles less work to do.
Equally, carrying too little body fat can pose issues, too. ‘Low body fat causes your oestrogen levels to drop and become hypo-oestrogenised, where your periods stop,’ says Dr Robinson.
‘This is crucial because there are oestrogen receptors throughout the pelvic floor, and if you’re not stimulating those receptors with your own oestrogen, the muscles will weaken.’
Being blocked up is a risk factor for a weakened pelvic floor, as straining to ‘go’ also puts a lot of pressure on these muscles, explains Mann.
Accordingly, piles could suggest you need to show your pelvic floor some love, as they can be a result of constipation. As for clearing that blockage, drinking more water and eating more fibre-rich fruit and veg should do the trick.
Like any other muscle, the pelvic floor weakens as you get older, thanks to depleted collagen levels. The drop in oestrogen during perimenopause and after the menopause means that incontinence becomes more common then, too.
The good news is that you can ease some symptoms of the menopause by, you guessed it, eating healthily and exercising often.
How to sort your pelvic floor out
DIY exercises and electronic gadgets are great, sure, but getting strong after birthing a child isn’t all on you.
In January 2019, the government announced a new long-term strategy aimed at tackling incontinence.
The substance? A commitment to enabling women to access post-natal physiotherapy after birth via new multidisciplinary pelvic health clinics and treatment pathways (across England only).
Specialists at these clinics will also help educate GPs, who are often women’s first port of call when tackling the issue.
‘Incontinence has never been a public health priority, so this is a very welcome plan,’ explains Miller.
‘France has long provided physiotherapy for women as standard and it’s exciting to see the UK step up.’
Expect a manual internal examination to assess the strength of your muscles, followed by a rehab programme tailored to you.
What if that doesn't work?
Your doctor may prescribe duloxetine, a drug that works by stimulating nerves around the urethra, boosting the sphincter effect of the muscles (not recommended during pregnancy).
The surgery option involves an operation to lift the bladder neck and stitch it in place, ora sling can be made to support it, using your own tissue. Mesh implants were previously used in this procedure, but after serious safety concerns, NICE relegated them to a last resort.
6 step guide to pelvic floor exercises
Do your Kegels right with pelvic floor physiotherapist Katie Mann’s six-step guide.
1/ Contract the back passage as if stopping wind, while at the same time squeezing at the front as if trying to stop the flow of urine.
2/ Make sure your buttocks aren’t contracting – an easy mistake. It’s not the bottom you sit on that you’re trying to contract, it’s the area around your anus and vagina.
3/ Try to breathe normally and don’t let your thighs squeeze together. Your legs should be relaxed and any movement should be an internal one.
4/ The action should feel like a lifting sensation between your belly and groin. Don’t worry if your lower stomach contracts– that supports the action of the pelvic floor.
5/ Ideally, do your exercises three times a day. Try 10 long squeezes, holding for 10 seconds, followed by 10 quick squeezes. Let the muscles relax after each contraction.
6/ Find a way to fit it into your routine – regular repetition reaps benefits. Try when you’re on the bus or at your desk. An alarm to remind you to do them can help.
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