Athena Vale
Pelvic floor muscles are essential for supporting the bladder, bowel, and uterus. They also play a role in sexual function. When these muscles weaken, individuals may experience incontinence, pelvic organ prolapse, and sexual difficulties. Various factors can contribute to pelvic muscle weakness, including pregnancy, childbirth, menopause, obesity, constipation, and certain medical procedures. Strengthening the pelvic floor muscles through specific exercises can help prevent and manage these issues. However, it is important to correctly identify and target these muscles for effective results.
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What You'll Learn
Pregnancy and childbirth
Childbirth, particularly vaginal delivery, further stresses the pelvic floor muscles. During childbirth, the pelvic floor stretches up to three times its normal length, and in the final stages of delivery, as the baby's head crowns and exits the birth canal, the pelvic floor muscles reach their peak extension. Vaginal delivery is considered the most significant risk factor for pelvic floor disorders, and the risk increases with operative deliveries using vacuum or forceps. The stretching and straining of the pelvic floor muscles during childbirth can lead to various injuries, including vaginal and perineal tears, which can range from first-degree tears affecting only the outer tissue to fourth-degree tears extending through to the anal muscles.
Additionally, the pudendal nerve, which supplies the pelvic floor muscles, can be compressed or stretched during childbirth, leading to pain, numbness, or reduced control over the pelvic muscles. Pelvic floor disorders after childbirth can include urinary incontinence, overactive bladder, anal incontinence, and pelvic organ prolapse, where pelvic organs move out of place and into the vagina, causing discomfort and pain during sex and everyday activities.
However, it is important to note that pregnancy and childbirth do not inevitably lead to pelvic floor disorders. Prenatal physical therapy and pelvic floor exercises can help prepare the pelvic floor for labor and reduce the risk of injury. Exercises such as Kegels can enhance the endurance and flexibility of the pelvic floor, and breathing and relaxation techniques can help reduce the risk of tearing during childbirth. Postpartum pelvic floor therapy can also aid in a smoother recovery, accelerating the return of pelvic floor muscles to their pre-pregnancy state.
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Surgery and injury
Pelvic floor dysfunction is a common condition that can cause incontinence and constipation. Pelvic floor muscles support the bladder, bowel, and uterus. When these muscles are weakened, they can create problems with bladder and bowel control. Pelvic floor dysfunction can be caused by injury or trauma, including childbirth, surgery, and accidents.
Pelvic floor dysfunction can be caused by prior pelvic surgery, such as a hysterectomy, prostatectomy, or prostate cancer treatment. It can also be caused by traumatic injuries to the pelvic area, such as a car accident or a fall from a high place. In addition, childbirth is considered a traumatic injury that can weaken pelvic floor muscles.
Pelvic floor muscles can also be weakened by heavy lifting, which includes lifting for exercise, at work, or at home. It is important to lift with good posture and engage the pelvic floor first.
Pelvic organ prolapse, a condition where the pelvic organs bulge into the vagina or rectum, may require reconstructive surgery to secure the organs into place. With one type of surgery, called colpocleisis, the vaginal walls are sewn together to prevent organs from extending outside the vagina.
Pelvic floor dysfunction can also be caused by overuse of the pelvic muscles, such as straining to go to the bathroom due to constipation. This can lead to a weakening of the pelvic floor muscles and/or a prolapse of the organs into the vagina or anus.
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Ageing and menopause
Pelvic floor muscles can weaken due to the natural ageing process and hormonal changes during menopause. During menopause, the ovaries stop producing estrogen and progesterone, which leads to the end of menstrual cycles and fertility. This decrease in hormone production can cause a variety of symptoms, including hot flashes, mood changes, and vaginal dryness. Estrogen and progesterone play a crucial role in maintaining the health and function of the pelvic floor muscles. These muscles support the bladder, uterus, and rectum and help control urinary and bowel function.
When estrogen levels decrease during menopause, the pelvic floor muscles can weaken, leading to issues such as urinary incontinence, pelvic organ prolapse, and sexual dysfunction. Urinary incontinence is a common symptom of menopause, and it can range from occasional small leaks to a complete loss of bladder control. Pelvic organ prolapse occurs when one or more pelvic organs, such as the bladder, uterus, or rectum, descend from their normal position and bulge into the vaginal canal. This can be due to weakened pelvic floor muscles and ligaments that can no longer support these organs adequately.
Hormone therapy can help increase estrogen levels and improve muscle and tissue tone in the pelvic floor. Pelvic floor exercises, such as Kegels, squats, and bridges, can also help strengthen the pelvic floor muscles and improve bladder control. Bladder training involves gradually increasing the time between bathroom visits to train the bladder to hold more urine. Making lifestyle changes, such as avoiding bladder irritants like caffeine and alcohol, maintaining a healthy weight, and quitting smoking, can also help manage urinary incontinence during menopause.
In addition to hormone therapy and exercises, pelvic floor physical therapy can be beneficial in managing menopause symptoms. This type of therapy focuses on strengthening the pelvic floor muscles through targeted exercises and techniques. It can help improve bladder control, reduce the risk of pelvic organ prolapse, and enhance sexual function. It can also address other menopause symptoms, such as constipation, bloating, and back pain, leading to improved quality of life.
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Obesity and unhealthy diet
Obesity is a well-documented risk factor for lower urinary tract symptoms (LUTS) and exacerbates stress urinary incontinence (SUI) and overactive bladder (OAB). The Leicestershire MRC Incontinence Study Group found that obesity, smoking, and carbonated drinks increased the risk of an overactive bladder, while consuming vegetables, bread, and chicken reduced the risk. Obesity is also associated with nocturia and urgency cases.
Weight loss is the frontline treatment for preventing and easing POP symptoms. Losing 5% to 10% of body weight can significantly improve urinary incontinence. Pelvic floor exercises are also recommended to strengthen the pelvic floor and prevent the need for corrective surgery.
In addition to obesity, unhealthy dietary habits, such as excessive carbonated drink consumption, can contribute to pelvic muscle weakness and related issues. A healthy diet that includes vegetables, bread, and chicken may help reduce the risk of developing an overactive bladder.
Overall, maintaining a healthy weight and consuming a balanced diet are crucial in preventing pelvic muscle weakness and associated complications, such as POP and urinary incontinence.
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Chronic coughing and constipation
Pelvic floor muscles are important for supporting the bladder, bowel, and uterus. They also play a role in sexual function for both men and women. When the pelvic floor muscles are contracted, they lift the internal organs of the pelvis and tighten the openings of the vagina, anus, and urethra. Relaxing these muscles allows for the passage of urine and faeces.
Chronic coughing is associated with an increased risk of urinary incontinence and prolapse. Coughing causes excessive vesical neck movement, which can lead to stress urinary incontinence. However, studies have shown that voluntary contraction of the pelvic floor muscles before and during coughing can reduce vesical neck displacement and improve resistance to stress.
Constipation is another factor that can weaken pelvic floor muscles. Ongoing or repeated straining during bowel movements can lead to weak pelvic floor muscles and even prolapse of the organs into the vagina or anus. This is a common issue, with estimates suggesting that up to half of people with long-term constipation also experience pelvic floor dysfunction. Pelvic floor dysfunction is characterized by the inability to relax and coordinate the pelvic floor muscles properly during bowel movements, leading to constipation, straining, and stool leakage.
To address these issues, it is important to treat the underlying causes of chronic coughing and constipation. Pelvic floor exercises can also help strengthen the muscles and improve muscle tone. These exercises can be learned through pelvic floor physical therapy or with the guidance of a women's, men's, or pelvic health physiotherapist.
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