“Peeing when you laugh is a normal part of aging.” “I just have a tiny bladder.” “Leaking when I sneeze is normal … I’ve had kids.”
You may have heard many of these statements declared by friends or family—you may have even said them yourself—and accepted it as a reality that we all, particularly women, need to live with. But, while they may be common, these symptoms of pelvic floor dysfunction are <not> normal.
The good news is that with better awareness around pelvic health, as well as how pelvic physiotherapy can help, we can be empowered to take charge of our pelvic function—at all stages of life.
Jenna Wilkes, MScPT, a pelvic health physiotherapist, explains that, while pelvic floor dysfunction can affect both women and men, hormonal changes throughout their lives and the functions that the uterus and vagina fulfill mean pelvic dysfunction is more common among women.
“Women are the childbearers and go through menopause—causing significant changes in hormones and muscle tone,” says Wilkes. Unfortunately, many women have been conditioned to accept the negative impacts that these life events may have on their pelvic floor function, but Wilkes wants people to know that there are solutions.
What is the pelvic floor?
Comprising several layers of muscles and connective tissue attached to the front, back, and sides of the pelvic bone, the pelvic floor supports the bladder, bowel, and reproductive organs. These muscles work alongside core muscles to absorb pressure created during lifting, coughing, and sneezing to protect your organs and spine.
“A strong pelvic floor is a functional pelvic floor,” says Wilkes, noting that, when working properly, these important muscles should allow control over urine flow from the urethra and gas and fecal matter from the rectum, as well as relaxation to allow for penetration during intercourse.
Causes and impacts of dysfunction
Pelvic floor dysfunction arises when the muscles become overly relaxed or weakened, though too much tightness in these muscles can cause dysfunction as well. Such dysfunction is commonly linked to injury or trauma—including childbirth and surgery, stress during pregnancy, overuse (as from repeated heavy lifting, chronic coughing, or constipation), hormonal changes, and aging.
Pelvic floor dysfunction can lead to
- bladder or bowel leakage
- difficulty emptying the bowels or bladder
- pelvic organ prolapse
- pain during intercourse
- overactive bladder
- pain during pregnancy
- pain in the pelvis, back, tailbone, hips, and legs
Physiotherapy for the pelvic floor
Known as pelvic physiotherapy or pelvic floor physio, this specialized branch of physiotherapy uses internal and external assessment to establish appropriate treatment for an individual’s pelvic floor muscles, as well as their core stability, to help resolve and prevent common pelvic dysfunctions.
The pelvic floor through a woman’s life
“Bladder leakage is common because [many of us] aren’t taught early enough about our bodies and how they function,” says Wilkes. “… we should not be expected to go through major physical changes (puberty, pregnancy, childbirth, postpartum, menopause) and just <hope> we come out not needing to be that friend that needs a diaper.”
A little potty talk can be helpful! Teaching children how to properly use the toilet can set them up for strong and balanced pelvic floors for the rest of their lives, explains Wilkes, advising the following lessons for all youngsters:
- Inhale into the belly to relax the pelvic floor when urinating or defecating, rather than pushing.
- Avoid hovering over the toilet seat: sit, relax, breathe, and let the flow, flow (hovering can prevent muscles from fully relaxing, leading to incomplete emptying and increasing the risk of bladder infections).
- Use a footstool to elevate the feet and place knees higher than hips when on the toilet to have a bowel movement. Aim for <at least> one bowel movement each day.
- Empty the bladder only when the urge requires (doing so before feeling the need can train the bladder to be overactive).
As girls grow into adulthood, their knowledge of their pelvic floor should grow as well.
- Avoid constipation.
- Drink plenty of water.
- Exercise the pelvic floor (consider consulting a pelvic health physio to ensure proper technique).
- Sidestep irritants to the urinary, digestive, and reproductive tracts:
- Avoid high concentrations of foods and beverages (such as alcohol, coffee, and dairy foods) that might irritate the bladder.
- Wear breathable, natural fiber (such as cotton) underwear.
- Always urinate after intercourse to prevent urinary tract infections.
After childbirth, an estimated one‐third of women will be left with urinary incontinence and about one‐tenth will experience fecal incontinence. To help prevent this, Wilkes suggests the following:
- If you’re thinking about conceiving, consider seeing a pelvic physiotherapist to understand the role of your pelvic floor during pregnancy.
- Once pregnant, book a pelvic physio appointment—recommended at about the 16th week of pregnancy.
- In the weeks before the expected delivery date, consult a pelvic physiotherapist to advise on exercises or products to aid in recovery.
- After delivery, book a pelvic physio follow-up at six weeks postpartum to assess the status of your pelvic floor recovery.
As estrogen levels decline with menopause, the pelvic floor muscles can become thinner and less flexible. Further, as we age, our ability to build muscle mass becomes more difficult. “We need to be aware that these muscles exist and try to incorporate pelvic floor exercises into daily life,” explains Wilkes. “The assessment of the pelvic floor by a physiotherapist can tell you if you have good strength, control, [and] mobility in your pelvic floor.”
To Kegel or not to Kegel?
“That is the question! Kegels are not for everyone and are often not done properly because people lack the awareness of where these muscles are,” warns Jenna Wilkes, MScPT, explaining that Kegels can often be helpful for a weak pelvic floor, but may worsen symptoms associated with an overactive pelvic floor.
A pelvic physiotherapist can help you determine if Kegels are right for you and if you are doing them correctly.
What to expect at your first pelvic physio appointment
During the initial assessment, your pelvic physiotherapist will
- ask you detailed questions about your lifestyle and background, such as bathroom habits and any pain you regularly experience
- conduct an external exam to assess your postural alignment, strength, and how much movement you have in your low back, hips, and pelvis
- analyze your breathing patterns to ensure the diaphragm, core, and pelvic floor are working together
- conduct an internal exam, if needed (and you’re comfortable with it), to determine how the pelvic floor is functioning