Maintaining a healthy pelvic floor can help keep you in control of your plumbing. By Joanna Egan.
More than a quarter of all Australians experience bladder or bowel control issues (incontinence). Women account for eighty per cent of all urinary incontinence sufferers. One in eight women suffers faecal incontinence and one in three who've had a baby experiences some form of urine leakage.
Many of the symptoms of incontinence can be treated, managed and even cured with the right help however research shows more than 60 per cent of Australians with bladder or bowel weakness suffer in silence.
"It's a very personal issue for many women, so to go and speak to someone about the fact that you're leaking urine, you're having gas control issues or you're soiling is very difficult," says Brisbane-based continence physiotherapist and author Sue Croft.
Incontinence often occurs when a person's pelvic floor muscles do not function as effectively as they should, and it can impact upon every aspect of their life. "Our confidence, our self-esteem, our dignity, can all be shattered if there is an upset to something as basic as our continence control," Sue says.
Adopting and maintaining simple preventative measures can help women avoid many types of pelvic floor dysfunction, including incontinence, pelvic pain and pelvic organ prolapse (the displacement of the bladder, bowel or uterus).
Strengthening a weak pelvic floor can help women overcome existing problems. "These conditions can be very anxiety producing, but they are treatable," says Sue. "Making changes can definitely make a difference."
Getting to know your pelvic floor
Your pelvic floor is a thick layer of muscles that stretches like a hammock from your coccyx (tailbone) to your pubic bone, supporting your pelvic organs. It has muscular bands (sphincters) that wrap firmly around the urethra and anus to allow you to control the release of urine, faeces and flatus (wind).
The pelvic floor muscles work with the deep abdominal (stomach) and back muscles to stabilise your spine, to support your baby during pregnancy and to assist with the birthing process. They are also important for sexual function and in women, contracting (squeezing) the pelvic floor muscles can contribute to sexual arousal.
Common pelvic floor problems
If your pelvic floor muscles become stretched or weakened, your pelvic organs may no longer be fully supported and you may lose control of your bladder or bowel movements. For some women, the pelvic floor muscles can also become too tight. This condition is less common, but it can lead to pelvic pain and make it difficult for you to empty your bladder or bowel completely.
Symptoms of pelvic floor dysfunction include:
- Accidentally leaking small amounts of urine when you cough, sneeze, bend, lift, laugh, exercise or play sport. This is known as stress incontinence.
- Losing urine for no apparent reason, feeling a sudden and urgent need to urinate or needing to urinate more frequently than you should (under normal circumstances, women who drink 2L of fluid a day should urinate between 5 and 7 times). These symptoms can indicate that you have an overactive bladder or a condition called urge incontinence. This occurs when the bladder holds less urine than it should (the normal capacity of an adult woman's bladder is 350–500ml).
- Feeling an urgent need to defecate, leaking faeces, soiling yourself before you reach a toilet or accidentally passing wind. These symptoms describe a condition known as faecal incontinence.
- Finding it difficult to empty your bladder or bowel, or experiencing pain during sexual intercourse. These symptoms can occur when your pelvic floor muscles are too tight.
- Feeling a bulge or ache in your vagina, finding it difficult to keep a tampon in place, or sensing heaviness, discomfort, pulling, dragging or dropping in your pelvic region. These symptoms can indicate pelvic organ prolapse. This occurs when one or more of your pelvic organs (your bladder, bowel or uterus) become displaced and sag down into your vagina. It is very common in Australia and occurs in about one in ten women. Symptoms tend to become exacerbated towards the end of each day and if left untreated, they will generally worsen over time. For more information about prolapse, read our Genital Prolapse fact sheet .
How healthy is your pelvic floor?
Many people wrongly assume pelvic floor problems only affect women who have experienced pregnancy, childbirth or menopause. However, women also have an increased risk if they have experienced one or more of the following risk factors:
- frequent heavy lifting
- regularly undertaking high-impact exercise
- gynaecological surgery
- chronic back pain
- trauma to the pelvic region
- frequent straining caused by chronic coughing, sneezing or constipation.
"Pelvic floor problems can affect women at any age," says Sue. "If you start having episodes of giggling incontinence as a teenager, or you lose urine while you're playing sport, or even if your mother trained you to empty your bladder frequently because she herself had bladder issues, then you can start sneaking off to the loo without realising it's an issue," says Sue. This could lead to frequency and urgency issues, and even urge incontinence later in life.
A woman's risk of developing pelvic floor problems increases with each pregnancy and delivery. "You can experience stress incontinence during pregnancy or you can have frequency issues because of the weight of the uterus, the fact that your baby is dancing around on top of your bladder, and because of the hormonal changes that take place in your body," Sue says.
Pelvic nerves and muscles can also be damaged during birth, increasing your risk of prolapse and associated incontinence.
By practising pelvic floor muscle exercises and making simple life changes, between 60 and 80 per cent of women can significantly improve, or even cure, their symptoms of stress incontinence.
"There is a common perception that once you've had a vaginal delivery it's 'normal' to have continence issues but it absolutely is not," says Sue. "There are definitely things that can be done, and the earlier you start doing them, the better."
What can you do to protect your pelvic floor?
Practice pelvic floor muscle exercises
Like other muscles in your body, your pelvic floor can be strengthened with regular exercise. Building pelvic floor strength enables the muscles to better support your pelvic organs, improves your bladder and bowel control and can stop accidental urine, faeces or wind leakage.
It can also reduce your risk of prolapse, improve your recovery from childbirth and gynaecological surgery, and increase your sexual sensation. A continence physiotherapist can help you learn how to exercise your pelvic floor.
Brace before risky activities
Counteract the downward force from activities such as coughing, sneezing, blowing your nose, lifting, pushing and pulling by engaging your pelvic floor muscles before you do them. To do this, gently pull in your lower abdominal muscles and tighten your vagina and anus.
It's important to note that women can over-brace and over-tighten their pelvic floor muscles so if you experience any pain while bracing, seek help from a health professional.
Eat a balanced diet
Being overweight or chronically constipated places extra stress on the bladder and bowel. Maintaining a healthy weight and improving constipation by drinking 2L of fluid a day and adding more fruits, vegetables and fibre to your diet can help you avoid pelvic-floor dysfunction.
Staying away from caffeine, alcohol and artificial sugars can also help. These substances irritate the bladder, causing it to store less urine than it should and increasing how often and how urgently you need to urinate.
Learn good toilet habits
Many women go to the toilet "just in case". Doing this often can train your bladder to hold less urine than it should. Instead, you should only go to the toilet when you need to and you should empty your bladder or bowel completely, and without straining.
The easiest way to do this is to sit on the toilet with your feet flat on the ground or elevated on a small footstool or some toilet rolls, so your knees are slightly higher than your hips. Keep the natural curvature of your back but lean slightly forward at the hips and place your hands on your knees. Relax your abdominal muscles and bulge your abdomen out. This opens and relaxes your anal sphincter. When you are finished, contract your pelvic floor muscles before you stand up.
Avoid risky fitness regimes
Some exercises can be damaging to your pelvic floor. If you experience, or are at risk of developing, pelvic floor problems, avoid high-intensity, high-impact exercises such as running, jumping and boxing. Sit-ups, curl-ups, crunches, full planks, double-leg lifts and heavy weights also place downward pressure on your pelvic floor.
To make your fitness program pelvic-floor-safe, switch to exercises such as swimming, walking and seated cycling. Use lighter hand-held weights and support your pelvic floor by sitting on a Swiss ball while you do your repetitions. Remember to maintain good posture during exercise, exhale with every effort and brace your pelvic floor muscles while doing exercises that put pressure on them.
Where to go for help
A GP, physiotherapist or continence nurse can discuss the best treatment and management options for you.
To speak confidentially with a continence professional, you can call the National Continence Helpline on 1800 33 00 66 (8am–8pm Monday to Friday). They can help you locate your nearest continence physiotherapist or nurse. Alternatively, you can visit www.physiotherapy.asn.anu.
For information about pelvic floor health, continence, and bladder and bowel conditions, visit www.bladderbowel.gov.au; www.continence.org.au; or www.pelvicfloorfirst.org.au, or pick up a copy of Sue's books, available at www.suecroftphysiotherapist.com.au.
Last updated: December 2012
© Women’s Health Queensland Wide Inc. This article was written by Joanna Egan and reviewed by the Women’s Health Queensland Wide editorial committee. It was published in Health Journey Issue 4 2012.