Pelvic floor, from little dribbles to the big ‘O’

Saturday, 19th May marked the inaugural Core, Floor and More workshop.  Our aim for the day was to get women talking about their pelvic floor muscles, to raise awareness of issues, exercises and treatment and to share information.

We had nearly thirty women at our first workshop so thank you to those of you who came along to find out all about your lady parts.  We’ve already had requests to host more workshops like it.  In the mean time, here are some key points from the workshop to act as a little reminder.

Facts and Figures

According to a 2000 study published by the British Journal of Obstetrics and Gynaecology, at least one in three women is affected by pelvic floor disorders (PFD), the broad spectrum term for things that go wrong down below like prolapse or incontinence, with potentially many more suffering in silence. The University of Adelaide study found urinary incontinence affects 17% to 45% of adult women, with a much greater percentage suffering in their 80s and 90s and with life expectancy on the up, it’s even more important to stop our lady parts from heading south.

Risk Factors

When it comes to your pelvic floor, the key risk factors for women are pregnancy and child-birth. The type of delivery you have can further increase your risk (forceps deliveries are especially problematic) as can the age at which you deliver your first baby.  Some gynaecologists will say that you are twice as likely to develop a PFD if you deliver your first baby over the age of 40.

The second milestone which increases your risk of a PFD is age.  As we age, the elastic collagen in our muscles decreases, add to that any pre-existing issues from pregnancy and birth and then a sudden loss in oestrogen levels during the menopause and you could be left a little less than functional down below.

Obesity, a chronic cough, constipation and major obstretic surgery such as hysterectomy can all increase your risk further.

Minor Pelvic Floor Disorders

Minor PFDs are common.  A feeling of not being quite right or of leaking or dribbling a little when you sneeze or cough in your post natal years is thought of as quite common place.  But nobody has to put up with it. Perhaps the big issue here is that little PFDs could end up being a bigger issue once the menopause hits.

Barrier to exercise

A weakened pelvic floor can make it difficult to take part in high impact exercise.  Ask any woman who has given birth in the last 12 months to do five jump jacks and check the look on her face!  Running, jumping, skipping, burpees can all send a new mummy scarpering for the nearest loo from whence she may never return.  But what’s vital to remember here is that the right type of exercise is precisely what women need to be doing to get their lady gardens back in shape.  The more inactive a woman is (and this doesn’t refer exclusively to vertical exercise) the more out of shape her bits will most likely be.

Pelvic Floor Exercises

Are you doing them right? Here’s the big issue.  We can’t see them.  It’s virtually impossible to get feedback unless you visit a physiotherapist and they insert some kind of probe into your vagina. Unlike a bicep, which you can admire in the mirrors of your local gym (if this is your thing), pelvic floor muscles aren’t quite so easy to examine at the health club. And, if you do have some kind of PFD, it’s quite likely that you aren’t doing them correctly.  

So how do you get feedback?

The towel test.

Grab a bath towel and roll it up like a sausage.  Straddle a chair and place the towel sausage between your legs, directly underneath your garden of loveliness.

Rock forwards on the towel sausage and you’ll notice your pelvic floor muscles instinctively respond.

Also notice at this point that you get more feedback by sitting directly over the towel rather than when your pelvis is rocked forwards or backwards.  This is because in order to get an effective pelvic floor contraction you want your spine to be in a neutral position.

Exercise classes like Pilates are great because there is a constant focus on the pelvic floor as well as abdominal tone.  A good, functional pelvic floor and great abdominal tone tend to go hand in hand.

Not just for the child-bearing years

We hear lots and lots about these during child-bearing years but then just forget about them. Like any muscle in the body, if you don’t use it, you lose it. We naturally lose muscle mass with age and it applies to all muscles in the body. The good news about your pelvic floor is that it is made up of muscle that you can train, the bad news is that it can get out of shape just like your bottom or your thighs.  Pelvic floor training needs to be a life long hobby, not just for pregnancy.

Fast and Slow

Pelvic floor muscles are made up of both fast and slow twitch muscle fibres.  Around 70% of your pelvic floor muscles are slow twitch, which play a supportive role, keeping your organs and inside bits in place.  The remaining 30% is fast twitch, this means it’s like a sprinter or jumper’s muscles, they work quickly to stop you peeing when you sneeze, cough or jump.  So you need to train your pelvic floor muscles in both ways.  The slow, controlled squeezes and waves as well as the faster, stronger, quick contractions.

Effects of pregnancy on the pelvic floor

There are three major issues with pregnancy that affect your pelvic floor and also your abdominal strength generally.

Your body is flooded with the hormone relaxin. We need this hormone to help open the pelvis and deliver a baby but it also causes your pelvis to become quite unstable as well as ligaments and muscles.  Just think about it as all going a bit jelly like.

Towards the second half of your pregnancy (earlier for some women or those carrying multiple babies) your back begins to arch more as the weight of your uterus and baby pull forwards.  This tends to pull your pelvis out of it’s neutral position and with the pelvis out of neutral it’s much harder to engage your pelvic floor muscles or core abdominals. This puts a lot of pressure on stretched pelvic floor muscles.

As your baby grows, so does the weight of your uterus, this is constantly bearing down on your pelvic floor muscles which, together with the change in your posture can weaken and stretch your pelvic floor muscles.  This is why some women begin to get some leaking towards the end of their pregnancy.

Effects of birth on the pelvic floor

Think about your pelvic floor muscles just like any other muscle in the body. Designed to stretch, push, pull and stabilise. During child-birth, it stretches.  A lot. But not just on the obvious outside bit where the head (or bottom) pushes through.  Think about the full pushing process, there’s a lot of action that takes place higher up the birth canal and a lot of stretching.  There is damage we may never see or be aware of but it’s all up there.

The easiest way to describe child birth is like a massive muscle strain.  If you badly strained your hamstring you’d be hobbling around for weeks and have to do some exercises to get it back up to full strength.  The same goes for your pelvic floor.

Avoiding tears during labour and birth

Contrary to some old wives tales, there is no such thing as a pelvic floor that’s too tight to get a baby out.  The stronger, or more conditioned your pelvic floor muscles are the  better equipped they’ll be to stretch and recover, not to mention assisting your pushing phase.  

Gentle perineal massage is also advised during your last trimester to encourage your perineum to stretch rather than tear during childbirth.

The position you are in during birth can also make a big difference to your risk of tears.  A crouching position will naturally open your pelvis providing a bigger space for baby’s head to come through.

Symptoms of a Pelvic Organ Prolapse

  • Feeling of dragging or heaviness down below
  • Feeling of bulging or something coming out when straining on the toilet
  • Vaginal flatus (air trapping)
  • Difficulty or pain during intercourse
  • Bath water trapping
  • Difficulty opening bowels

Talk about it

These are quality of life issues we are talking about rather than life or death, so we tend not to bother getting anything done about it.  Add to that the fact that it’s all a bit embarrassing if you wee yourself and it’s a recipe for keeping quiet. But this issue affects a lot of women in many different ways, from little leaks to painful or non-eventful sex and potentially even complete pelvic organ prolapse.  Get help. Talk about it with your GP first and get a referral.

The big ‘O’

The last word has to be all about sex. Your sexual organs are intricately linked to your pelvic floor muscles.  The pudendal nerve (the nerve which ends at your clitoris) runs through your pelvic floor muscles. The initial contraction of your pelvic floor muscles, stimulated by the pudendal nerve, in turn stimulates your orgasm.  Whilst your brain is the most important muscle when it comes to the female orgasm, the pelvic floor muscles have a massive role to play. The stronger they are, the better the initial contractions which in turn stimulates the big ‘O’.  Food for thought?

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