A lot of information produced on a person’s pelvic floor health largely talks about pelvic floor exercises and maintenance during the pregnancy and postpartum stages in women. So many people are often surprised when they learn about the crucial importance of the pelvic floor for both women and men, given they form part of the deep core muscles and impact everything from our urinary and faecal incontinence to our sexual function and pelvic pain[1], regardless of gender. Here’s a closer look into why it’s important to look after your pelvic floor throughout your lifetime (not just in pregnancy for women), the relationship between the pelvic floor and the common problem of incontinence, and how our pelvic health physiotherapists work with both men and women to help.
What Is The Pelvic Floor?
To use an analogy, think of the pelvic floor like a supportive trampoline or hammock for your pelvic organs - a sheet of muscle and connective tissue that extends from your pubic bone at the front of the pelvis to the tailbone at the back, with the muscles extending outward on both sitting bones (ischial tuberosity) on the right and left sides of your pelvis. The pelvic floor also wraps around sphincters (valves) at the base of the bladder and at the anus, playing an important role in helping them stay closed and preventing leakage. In women, the pelvic floor helps to:
- Control the passing of urine and faeces by being able to both tighten the openings of the anus and urethra to delay emptying, as well as relax to let them pass freely
- Stabilise the pelvis and lower back (including the lumbopelvic complex and the hip joint), given that the pelvic floor is one of four muscles making up our inner ‘core’
- Prevent pelvic organ prolapse
- Reduce pain from intercourse and heighten sexual sensations[2]
- Keep the uterus supported both throughout daily life, and during pregnancy
- Pump blood back towards the heart and support the lymphatic system
In men, the pelvic floor plays very similar roles (excluding uterine support), also being partially responsible for erectile function and ejaculation.
What Causes Pelvic Floor Dysfunction?
Pelvic floor muscle dysfunction can have a wide range of causes in both men and women, from things as simple as constipation or excessive coughing to regular heavy lifting or high-impact activities, being overweight, age-related changes, having surgery for bladder or bowel problems, and neurological conditions that may affect pelvic floor muscles like diabetes[3]. Of course, in women, pregnancy-related changes are another common cause.
Signs that your pelvic floor muscles are not working effectively include:
- Leaking urine or faeces during activities such as running, jumping, sneezing, coughing or sexual activity
- A sudden and urgent need to pass urine, frequent urination, or starting and stopping when passing urine
- Passing wind when bending over or lifting
- A heaviness or dragging feeling in the pelvis or back
Men may also have symptoms of erectile dysfunction, and women may experience pain with intercourse, reduced sensation or heaviness in the vagina, and recurrent urinary tract infections.
Incontinence
Problems with the pelvic floor are one of the most common reasons for incontinence, where there is involuntary leaking from either the bladder or the bowel, often when sneezing, coughing, exercising or laughing. Incontinence is currently estimated to affect one in five women in Hong Kong[4], though the actual prevalence is potentially higher due to those that remain undiagnosed.[5] With urinary incontinence, over-contraction, under-contraction or altered activation patterns of the pelvic floor muscles can all contribute to problems. Having a pelvic floor that is over-contracted can decrease the effectiveness of the muscles when contracted, so it is tight but weak, as well as putting some pressure on the bladder. This can then lead to ‘urge’ incontinence (an overactive bladder) where you feel a sudden urge to urinate, followed by involuntary emptying the bladder or some leaking. Under-contracted, weak or altered patterns of muscle activation can cause ‘stress’ incontinence, which is the leakage that uncontrollably occurs after a sneeze, cough, laugh, heavy lifting, or extraneous exercise.
Physiotherapy For Incontinence And Other Pelvic Floor Problems
Physiotherapy offers excellent outcomes for incontinence (as well as pelvic floor problems), having been shown to successfully treat incontinence in 80% of cases.[6] Your physiotherapist will start with a detailed history, understanding the severity of the problem and how it’s impacting your day-to-day life, and then complete an internal exam (only if consented). An internal exam is the best way to feel the tone, quality and strength of the contraction and the relaxation of the pelvic floor muscles. Your physio will discuss the results of your assessment with you and discuss the treatment options available to help you get the best results. Treatment will be uniquely tailored to your assessment findings and designed to meet your needs. Ensuring you have a good understanding of your results and your options for treatment will be a key part of your physiotherapy session. Treatment options may also include specific exercises targeting the pelvic floor muscles or other associated muscles such as your glutes and abdominals. Your physio will track your progress over time, and make adjustments to your treatment plan as you progress and see results.
Pelvic Floor Exercises At Home
If you’re experiencing pelvic floor-related symptoms and are wanting to start working on your pelvic floor while you wait for your appointment, start by identifying your pelvic floor muscles. There are several ways to do this:- When going to the toilet, gently try to stop or slow the flow of urine midway through emptying your bladder. If you can do this you are squeezing the correct muscles. But please avoid doing pelvic floor muscles while using the toilet.
- Sit or lie down with the muscles of your thighs, stomach and buttocks relaxed. Gently squeeze the ring of muscle around the anus as if you are trying to stop the passing of wind. Squeeze and let go a couple of times to ensure you have found the right muscles. Try to avoid squeezing the buttocks muscles themselves.
Next, try to gently squeeze and lift. Squeeze and draw in your pelvic floor muscles (think about lifting them up inside). Try to hold them while counting to ten, then relax. If you can’t hold for eight counts, just hold for as long as you can. While doing pelvic floor muscle training remember to keep breathing, avoid tightening your buttocks, and keep your thighs relaxed. Also, avoid gripping the superficial upper abdominal region (your external obliques)