I had another article lined up for today, but then I wet my pants just a little on the weekend and decided that this was a more pressing topic.
Now, to reduce my embarrassment somewhat, I want to be very clear that wetting my pants is a very rare occurrence. On this particular occasion, I was cooling down after an 11km trail run, went to take a sip of water, choked on it, coughed unexpectedly, and all that pressure was just too much for my pelvic floor muscles. The result was stress incontinence, or the involuntary release of a small amount of urine.
Running and coughing, along with laughing, sneezing, and heavy lifting, are all activities that increase abdominal pressure, pushing down on the bladder. For more than one in three Australian women, these activities can result in stress incontinence. Essentially, the pelvic floor muscles are weakened, so when a stress occurs, (like the repeated jolting of a run, or the sudden pressure of a sneeze) they can’t sufficiently support the urethra (also known as the bladder’s little hose), and a bit of wee comes out.
Unfortunately for many women, stress incontinence isn’t the only outcome of weakened pelvic floor muscles. About 63% of women with stress incontinence also experience pelvic organ prolapse. Pelvic floor muscles don’t just support the urethra, they also hold the bladder, vagina, uterus, and bowel in place. Consequently, a weakened pelvic floor can result in these organs sagging to the point where they may bulge into the vagina.
Many women may be experiencing prolapse without even realizing it. For example, one study looking at pelvic floor dysfunction in women over 55 found that while 98.7% of participants scored positively on the Australian Pelvic Floor Questionnaire, indicating some level of bladder, bowel, sexual, and/or pelvic organ dysfunction, only 67% reported themselves as experiencing pelvic floor dysfunction. Mild symptoms can easily be brushed off, especially given how unacquainted many women are with their pelvic floor, the relative absence of pelvic floor muscle education, and the reluctance and shame many women experience when talking about prolapse.
According to The Royal Women’s Hospital, here are some signs and symptoms of pelvic organ prolapse:
- A feeling of heaviness in your vagina
- A bulge within or extending out of your vagina
- Achiness in your pelvic region
- Difficulty with bowel or bladder control
- Recurring urinary tract infections
- Discomfort or pain during sex
Now, why on a Substack about parenting am I talking about prolapse and urinary incontinence?
Because the BIGGEST cause of pelvic floor dysfunction is pregnancy and childbirth. On average, one in two women who have been pregnant will have some level of prolapse. That means that close to 50% of people who are reading this article are experiencing prolapse right now, have experienced prolapse, or will experience it in the future.[1] Pregnancy weakens the pelvic floor due to the extra weight the pelvic floor muscles are expected to support, and through the hormonal changes that occur during pregnancy. Childbirth then further weakens the pelvic floor muscles, particularly if you had to push for a long time, you had an instrumental delivery, or if the baby was big (in Victorian public hospitals, for example, you automatically qualify for a pelvic floor physiotherapist if your baby is bigger than 4 kilograms at birth). Additionally, it’s much easier to be a good parent when you can run after your kids, pick them up and throw them around, and laugh along at their goofiness without worrying about wetting your pants or your vagina falling out.
Anything that increases abdominal pressure can be a risk factor for prolapse. This includes being overweight, frequent coughing (due to asthma for example), constipation, and regularly lifting heavy things. Additionally, the chances of developing prolapse increase with age due to the lowering levels of the hormone oestrogen following menopause. All of these risk factors combine to make prolapse and stress incontinence incredibly common among women, and particularly among mothers.
However, while pelvic floor dysfunction is COMMON, it is not NORMAL. In fact, believing that it is normal is the biggest barrier that prevents women seeking help. Other barriers include self-managing symptoms (such as by not drinking enough water), believing that it is not a serious condition, and feeling embarrassed. However, if you are experiencing any of the symptoms described above, it’s a big sign that your pelvic floor needs some strengthening.
In general, the first place to turn for help should be your GP. They should be able to assess the severity of your pelvic floor dysfunction and provide a referral to a women’s health or pelvic floor physio.
However, I say ‘should’ for a reason. From my own experience and those of other women that I know, there are far too many GPs who dismiss or diminish complaints regarding a woman’s pelvic floor. If that is your experience too, or you’re not quite ready to seek professional help, here’s a few things you can get started on to improve your pelvic health.
1. Learn how to train your pelvic floor.
The Continence Foundation of Australia has a video teaching you how to strengthen your pelvic floor muscles. Essentially, you will be working on squeezing and lifting up your pelvic floor. If you’re not sure what that should feel like, it’s time to get intimate with yourself. A great tip from my own pelvic floor physiotherapist was to take some time in the shower to insert a finger into your vagina while doing the exercises – if you’re doing them correctly you should feel a gentle squeeze on your finger.
2. Build a habit of pelvic floor training.
Just like with strengthening any muscle, the key is consistency. Personally, I like to do my pelvic floor exercises while I’m waiting at red lights. I also like to do them while I’m writing articles about pelvic floor dysfunction, but I have a feeling that for most people, that isn’t often enough.
3. Invest in biofeedback devices.
Biofeedback devices such as Elvie and Perifit are pelvic floor exercise trainers that give you feedback in real time as they take you through guided pelvic floor workouts. While there are many other pelvic floor trainers on the market, these are the only two that I know of that can detect faulty contractions (bearing down instead of lifting up). They also gamify the experience, making pelvic floor workouts much more fun.
4. Seek out a women’s health or pelvic floor physiotherapist.
If you’re in Australia, you can filter physiotherapists by special interest area here.
Typically, I believe that things that happen in and around our private parts should be kept private. However, I make a big exception when it comes to talking about pelvic floor health. Too many women are embarrassed or ashamed of what happens down there when they laugh, run, or sneeze, and sadly, too many also believe that it’s just a normal thing that they have to live with.
So please, if something doesn’t feel right, do something about it!
[1] It should also be noted that men can also experience prolapse and stress incontinence, and men should also feel supported to seek help if things aren’t feeling right down there. However, pelvic floor dysfunction in men is not the focus of this article because 1. It’s just not as common in men as it is for women, 2. Becoming a parent doesn’t increase a man’s risk of developing pelvic floor dysfunction, and 3. I don’t have any lived experience as a man with pelvic floor dysfunction.
I'd love to hear your thoughts! How do you strengthen your pelvic floor? Any recommendations for pelvic floor trainers or women’s health physios would be greatly appreciated too.
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