The pelvic floor, an oft-ignored muscle group that does the humble work of supporting the bladder, bowels, uterus, prostate and other organs in the pelvis, is often a topic of conversation in mom chats and Pilates classes. But anyone can have pelvic floor issues, especially as they age: men, women, people who have given birth and those who haven’t.
“I didn’t have children, so I didn’t even know what the pelvic floor was,” said Tamsen Fadal, 55, author of “How To Menopause.” “But around 49 or 50 years old, I’d be coughing or sneezing, and all of a sudden I was peeing.”
That’s because, like all muscles, your pelvic floor muscles get weaker as you age, which can lead to incontinence, or leaking when you cough, sneeze or exercise, experts said.
“I always say, if you’re feeling weak in your whole body, you’re weak in your pelvic floor, as well,” said Christina Prevett, a pelvic floor and orthopedic physiotherapist and postdoctoral research fellow at the University of Alberta.
In an American Journal of Obstetrics and Gynecology study of over 600,000 women who never gave birth, 32 percent of those between 55 and 64 experienced urinary incontinence, a common symptom of pelvic floor weakness. Other research suggests that 40 percent of women over 70 experience urinary incontinence, and 16 percent of men may have pelvic floor dysfunction, too.
Those who gave birth decades ago also can experience a resurgence of pelvic floor symptoms, said Rufus Cartwright, a consultant urogynecologist at Chelsea and Westminster Hospital in London.
For Dianna Baran, a 57-year-old mom of four, pelvic floor issues started after the birth of her second daughter, and have persisted on and off for 26 years. “I think it’ll be a lifelong issue for me,” she said.
Meanwhile, Daniel Au, an assistant professor of urology at the University of Missouri School of Medicine, said about half of men in their 50s have urinary issues that affect their quality of life, and it goes up each decade.
The main question for men dealing with incontinence: Is leaking a pelvic floor issue, a bladder issue or a prostate issue? Au said it can be a combination of all three, but people often blame the prostate exclusively. “If your prostate medication isn’t making it better, you’re probably barking up the wrong tree,” he said.
Signs your pelvic floor is weak
“The pelvic floor is like a net that holds the pelvic organs up and in,” Au explained. You need tension to hold everything inside, and properly timed relaxation to let urine and poop out. “Too much in one direction or the other leads to issues,” he said.
If the muscles are too tight, you may experience pain in the pelvic area, pain while peeing, pain during sex or constipation. But declining strength is more likely to be the issue as you age.
“In the 65-to-70-plus age group, most of the time it’s a weakness problem,” Prevett said.
Here are some common signs of pelvic floor weakness.
- You’re leaking urine. This is the symptom that makes most people think about their pelvic floor for the first time. Leaking with lifting, jumping and laughing is a sign these muscles are too lax, Au said.
- You can’t stop the flow of urine. One way to test the strength of your pelvic floor muscles is to see if you can stop the flow of urine while on the toilet. (Don’t do this all the time, Prevett said, since the muscles should be relaxed when you’re peeing.) Not being able to do it points to weakness.
- You can’t control your gas. The pelvic floor muscles wrap around the rectum, so loss of bowel control and increased flatulence can also signal pelvic floor weakness. Feeling an urgent need to poop is an early sign of an issue, Cartwright said.
- You feel a bulge. A weak pelvic floor can sometimes lead to pelvic organ prolapse, when an organ such as the bladder drops or sags into the vagina, causing a bulge. It can also feel like pressure in the pelvis, he said.
- Your sex life is suffering. A small prolapse typically isn’t painful during sex, Cartwright said, but when the prolapse is bigger and things feel looser, sex can be uncomfortable. In some cases, the prolapse can physically interfere with penetration.
- You experience pain. There’s a correlation between pelvic floor weakness and pelvic pain. In one study, 66 percent of women with pain in their lower back or pelvic area turned out to have a weak pelvic floor. “When the pelvic floor is unbalanced in either direction, it can put undue strain on other associated muscles, tendons and ligaments,” Au said.
How to strengthen your pelvic floor
Do Kegels
“We have Grade A, Level 1 evidence that pelvic floor strengthening is going to improve pelvic floor dysfunction,” Prevett said. She said she tells her clients to pair Kegel exercises with other activities throughout the day to enforce the habit. For example, do two Kegels when you’re at a traffic light, two when you’re brushing your teeth and two at each meal.
To do a Kegel, contract your muscles as if you were trying to stop the flow of urine, hold for eight seconds, then release. Rest for eight seconds between contractions.
Strength-train
“Core, glutes and hip training will carry over to strengthening the pelvic floor,” Prevett said.
A small study found that women improved pelvic floor muscle strength and reduced leaking after lifting weights twice a week for 12 weeks. The program consisted of squats, deadlifts and modified pull-ups and push-ups. The women were also instructed to activate their pelvic floors while lifting.
Fadal likes to do bridges and squats before her warmup at the gym to make it a habit.
Retrain the reflex
“Our pelvic floor is a reflexive, anticipatory system that we don’t think about unless we have pelvic floor issues,” Prevett said. You sneeze or cough, and ideally the muscles contract, so nothing comes out the other end.
Part of keeping your pelvic floor healthy is retraining this reflex. Exercise helps here because you can practice activating these muscles before doing a movement like a squat or push-up.
Prevett also suggested the “knack maneuver,” a.k.a. “squeeze before you sneeze.” In an International Urogynecology Journal study, women who were instructed to contract the pelvic floor before sneezing, laughing, bending or lifting saw improvements in the frequency and severity of leaking after four weeks of practice.
Avoid pushing
“Sometimes, people purposely dehydrate themselves when they’re leaking, but then they end up constipated, which makes it worse,” Prevett said. Pushing excessively during a bowel movement is really straining on the pelvic floor, she said.
That also means you want to eat enough fiber and avoid “power-peeing,” or pushing pee out forcefully. “Let pee take its course,” Prevett said.
See a specialist
Many of the above symptoms could indicate other issues, so it’s best to see a professional for a diagnosis. A pelvic floor physical therapist will help identify the problem and prescribe targeted exercises that can help.
If you dedicate yourself to pelvic floor training, you can expect to see improvements in four to six weeks, experts said.
That was Baran’s experience. “I really thought I was going to need reconstructive surgery,” she said, “but because of pelvic floor therapy, I didn’t.”
Still, if she stops doing her pelvic floor work — and, let’s say, she has allergies and is coughing a lot — she’ll start leaking again. “I’m like, ‘Crap, I’ve got to do my exercises,” she said. “It’s not just one and done.”
The post 6 signs your pelvic floor is weak — and what to do about it appeared first on Washington Post.
