The Truth About the Pelvic Floor

The pelvic floor muscles are tightly slung between the tailbone (coccyx) and the pubic bone, and support the bowel, bladder, uterus and vagina. Muscular bands (sphincters) encircle the urethra, vagina and anus as they pass through the pelvic floor. When the pelvic floor muscles are contracted, the internal organs are lifted and the sphincters tighten the openings of the vagina, anus and urethra. Relaxing the pelvic floor allows passage of urine and faeces.

If the muscles are weakened, the internal organs are no longer fully supported and you may not be able to control your urine. Common causes of a weakened pelvic floor include childbirth, obesity and the associated straining of chronic constipation. Pelvic floor exercises are designed to improve muscle tone and prevent the need for corrective surgery.

Symptoms

The symptoms of a weakened pelvic floor include:

  • Leaking small amounts of urine when coughing, sneezing, laughing or running
  • Failing to reach the toilet in time
  • Uncontrollably breaking wind from either the anus or vagina when bending over or lifting
  • Reduced sensation in the vagina
  • Backache
  • Tampons that dislodge or fall out
  • A distinct swelling at the vaginal opening
  • A sensation of heaviness in the vagina.

Common causes

The pelvic floor can be weakened in many ways, including:

  • The weight of the uterus during pregnancy
  • Vaginal childbirth, which overstretches the muscles
  • The pressure of obesity
  • Chronic constipation and associated straining to pass motions
  • Constant coughing
  • Some forms of surgery that require cutting the muscles
  • Lower levels of oestrogen after menopause.

Complications of a weakened pelvic floor

Loss of bladder control is a common symptom of a weakened pelvic floor. Some people experience bowel incontinence, which means they can’t always control the passage of wind or faeces. Weak pelvic floor muscles can also cause sexual difficulties such as reduced vaginal sensation. In severe cases, the internal organs supported by the pelvic floor, including the bladder and uterus, can slide down into the vagina. This is called a prolapse. A distinct bulge in the vagina and deep, persistent vaginal aching are common symptoms.

Familiarising yourself with the pelvic floor

Pelvic floor exercises are designed to strengthen the muscles. Each sphincter (vaginal, urethral, anal) should be exercised, so you need to familiarise yourself with these muscles in order to contract them at will. If the pelvic floor is especially weak, it may be difficult to detect any muscular contractions at first.

Suggestions on identifying your sphincters include:

  • Vaginal – insert one or two fingers into your vagina and try to squeeze them.
  • Urethral – when you are urinating, try stopping the flow in midstream. This should only be done to identify the sphincters. Do not do it on a regular basis.
  • Anal – pretend you are trying to stop yourself from breaking wind and squeeze tightly.

The exercises

You can perform these exercises lying down, sitting or standing. Ideally, aim for five or six sessions every day while you are learning the exercises. After you have a good understanding of how to do the exercises, three sessions each day is enough.

Before you start, direct your attention to your pelvic floor muscles. Try to relax your abdominal muscles. Don’t bear down or hold your breath. Gradually squeeze all three sphincters and increase the tension until you have contracted the muscles as hard as you can. Release gently and slowly. Then perform the exercises, which include:

  • Squeeze slowly and hold as strongly as you can for 5 to 10 seconds while breathing normally. Release slowly. Repeat 10 times. Relax for 5 to 10 seconds between each one.
  • Perform quick, short, strong squeezes. Repeat 10 times.
  • Remember to squeeze the muscles whenever you clear your throat or cough.

Professional help

It is important to perform these exercises correctly. You can consult with your doctor, physiotherapist or continence advisor to ensure proper performance. It may take weeks or months before you notice a substantial improvement. In severe cases, pelvic floor exercises aren’t enough to solve the problem and surgery may be needed. Be guided by your health care professional.

Other considerations

You can further improve the strength of your pelvic floor in many ways, including:

  • Lose excess body fat
  • Cure constipation by including more fruit, vegetables, fibre and water in your daily diet
  • Seek medical attention for a chronic cough.

Where to get help

  • Australian Physiotherapy Association Tel. (03) 9092 0888
  • National Continence Helpline Tel. 1800 33 00 66
  • Victorian Continence Resource Centre Tel. (03) 9816 8266
  • Family Planning Victoria Tel. 1800 013 952 or (03) 9257 0100 http://www.fpv.org.au
  • Family planning clinic
  • Your doctor or other health care professional

Things to remember

  • The pelvic floor muscles support the bladder, uterus and bowel.
  • The pelvic floor can be weakened by pregnancy, childbirth, obesity and the straining of chronic constipation.
  • Pelvic floor exercises are designed to improve muscle strength.

Summary

The pelvic floor muscles support the bladder, uterus and bowel. Pregnancy, childbirth, obesity and the straining of chronic constipation can weaken the pelvic floor and cause urinary incontinence. Pelvic floor exercises can help.

The Pelvic Floor & the Core

The pelvic floor muscles work as part of the ‘core’ to regulate the internal pressure in the abdominal cylinder along with the abdominal, back and breathing muscles.

During exercise the internal pressures in the abdomen are constantly changing. For example, as you lift a weight the internal pressure increases, and as you put a weight down the pressure normalises.

In most people this pressure regulation happens automatically, however if any of the muscles in the core, including the pelvic floor, are weakened or damaged, then this automatic action may be altered.

In the ideal situation the muscles of the core work together in a co-ordinated way: as load is placed on the spine, the pelvic floor muscles lift, the abdominal and back muscles draw in to support the spine and it is easy to breathe (diagram 1). Alternatively, if when a client lifts a weight they hold their breath or draw the abdomen in without engaging the pelvic floor muscles, they may place excessive pressure down on the pelvic floor (diagram 2). If repeated stress or strain is placed on the bladder and bowel (and uterus in women) this may result in a weakening of the ligaments and leakage or pelvic organ prolapse may occur.

Correct and incorrect pelvic floor muscle action
 Diagram 1. Correct action                    Diagram 2. Incorrect action

Stabilising the core

The act of drawing the belly button to backbone has been advocated to turn on the core and stabilise the spine. New research is showing however, that some people tighten their back muscles, draw in the abdomen, hold their breath and place pressure down on the pelvic floor in an attempt to stabilise the spine. It has become more common for clients to try and brace their core muscles constantly during a whole exercise session in the belief they are toning the abdomen and supporting the spine.

To work well, the core muscles need to be flexible and contract and relax. Constant bracing can lead to stiffness. Leakage may occur because the pelvic floor muscles are weak, but can also occur because people have been bracing the core too much and have made the muscles stiff.

Information sourced from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pelvic_floor, http://www.pelvicfloorfirst.org.au/pages/the-pelvic-floor-and-the-core.html

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