Continence and Pelvic Floor Physiotherapist Annabelle Citroen tells us who is at risk, what could go wrong and what you can do about it.
Celebrities, comedians, sports women and mum bloggers alike can be thanked for launching the traditionally not so sexy pelvic floor region into the public spotlight. In doing so they have stimulated much needed attention to previously stigmatized issues of incontinence, prolapse and painful sex.
The world of social media too, has played a part in this exposure - full of countless memes and #hashtags combining humour with what is often seen as an embarrassing topic. These public advertisements are resulting in the breaking of historical health taboos, giving permission to talk about poor pelvic health symptoms in a more lighthearted manner.
Where is your pelvic floor?
The pelvic floor collectively refers to the pelvic floor muscles and the surrounding connective tissues that sit at the base of our bony pelvis. Together they support our bladder, bowel and uterus in addition to wrapping around the openings to each of these organs; the urethra, anus and vagina. The pelvic floor serves to keep these organs in place, control our wee, poo and wind and play a vital role in sexual function.
With such important roles it should come of no surprise that when this pelvic floor region is not functioning optimally, undesirable symptoms result. Whilst many are common, the below symptoms are not normal and can (and often do) have a significant impact on quality of life.
Signs of poor pelvic floor health may include:
- Leakage of urine with coughing, sneezing, laughing or high impact exercise.
- More frequent and/or urgent need to wee, possibly accompanied by leakage on the way to the toilet.
- Increased night toilet visits.
- Difficult, prolonged and/or incomplete emptying of the bladder.
- Recurrent urinary tract infections.
- Constipation and/or straining to poo, which may be accompanied by painful haemorrhoids or fissures.
- Bowel urgency and/or loss of bowel control.
- Painful sex.
- Pain in the pelvic region.
- A sensation of heaviness or dragging, or awareness of a lump or bulge in the vaginal region.
Who is at risk?
The truth is, no one is exempt from potential poor pelvic floor health at some point across the lifespan. If not personally, you’re a good chance to at least know someone who will – around 5 million Australians have some form of bladder or bowel incontinence, or both. 80% of those affected are women, with more than half aged 50 and under…… this is clearly not just a problem experienced by the elderly.
Have you had a baby? Surgery within the pelvic region? A history of frequent straining to poo? Chronic cough? Are you overweight? Participate in regular heavy lifting? These are amongst known risk factors linked to poor pelvic health.
The good news about incontinence
Believe it or not, there is some good news to follow this depressing broadcast ... the large majority of these pelvic health conditions could be prevented, cured, or at the very least better managed.
Simple lifestyle changes can make a significant difference in many cases - adequate fluid intake, a healthy diet, managing any constipation and getting active are a good start. Anything that places additional stress on the pelvic floor should be addressed where possible, including modification of heavy lifting and good medical management of respiratory conditions and hay fever.
More specifically, strong pelvic floor muscles are vital in both preventing and managing pelvic health conditions. A pelvic floor physiotherapist can assess, teach and tailor an individualized exercise program targeting these muscles.
As a guide, you can attempt to squeeze your pelvic floor muscles by imagining ‘stopping the flow’ of urine, or trying to stop wind passing from the back passage. With each squeeze you should also aim to lift up inside the vagina. The length of each squeeze will depend on your individual strength – aim for three seconds as start. Following each squeeze, you should feel a complete relaxation or ‘letting go’ of the muscles. Throughout each contraction, ensure you are not holding your breath or squeezing your butt or inner thigh muscles – the idea is that from the outside, no one should know what you are up to down there. Aim to repeat as many times as you can, up to a maximum of 12 squeezes. Ideally these exercises form part of daily and lifelong routine, much the same as brushing your teeth.
World Continence Week (18-24 June)
Public awareness campaigns such as Laugh Without Leaking and World Continence Week remind us that there is no better time than now to put your pelvic health first.
Start the conversation, (if you haven’t already!) – with your mothers, daughters and grandmothers or chat to your trusted health care provider. The Continence Foundation of Australia has the wonderful National Continence Helpline on 1800 33 00 66 for professional guidance and details of local continence service providers.