Does it hurt when you have sex or when you orgasm? Do you ever leak after a sneeze or a cough? Or maybe you get up more than once at night to go to the toilet? All these may be signs of a pelvic floor disorder.
The pelvic floor muscles support the pelvic organs and control bladder and bowel functions, explains Professor Linda Cardozo, spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG). They are shaped like a sling that runs from your pubic bone to the base of your spine.
“If you are on the toilet and you try to stop yourself urinating, if you contract your pelvic floor muscles you will stop the flow,” says chartered physiotherapist and pelvic expert Ruth Jones. This should not be done as an exercise, she warns, but it explains how to identify the muscles.
Pregnancy and childbirth, as well as obesity, chronic constipation or any other activity that has a high impact on the pelvic floor muscles can lead to pelvic floor disorders, including urinary or anal incontinence, constipation, abdominal pain, painful sex, and even organ prolapse. Little data is available, but a study from 2003 reported that at least one-third of adult women are affected.
“The pelvic floor muscles can work too hard as well as not work hard enough and be weak,” says physiotherapist Jones. “Part of the problem is understanding if your problems are because you are working those muscles too hard or not working them hard enough.”
If the muscles are too tense, people often experience pain, even during intercourse or while orgasming. “It is really, really important that you relax your pelvic floor muscles as much as you can – if you think that the intercourse is going to hurt, you’re more likely to contract even more,” Jones adds.
Weak pelvic floor muscles, on the other hand, can cause incontinence, reduced sensitivity during sex and pelvic organ prolapse, Professor Cardozo reports. Although Jones points out that it isn’t always a case of lack of strength.
“Let’s say [a woman] went through childbirth and part of the muscles were damaged, it might come off as a problem of attachment. [The muscles] can’t contract, so they can’t support the bladder or urethra,” she says.
Touching some of the most intimate spheres of personal life, pelvic floor disorders affect people’s physical health, social life, relationships, career, domestic routine and daily activities. The ramifications for an individual's mental health can be dramatic.
“Many can become very depressed and anxious. They feel like they're not being able to live a complete life if they are not able to be physically intimate with somebody,” Jones says. She has had clients who would not leave the house because they were too afraid they were going to wet themselves, or who couldn’t sit down or wear jeans, because of the pain.
Elaine Miller is an Edinburgh-based physiotherapist specialising in pelvic health, and has experienced pelvic floor disorder first hand. “After I had children, I was leaking,” she admits. “It certainly affected my mood, because you just don’t feel good about yourself. [Even] from a societal point of view, the people who leak either they are usually very old, very young or very infirm.”
Her pelvic floor issue first started about 12 years ago but, to begin with, she didn’t do anything about it. “I didn’t bother. I think it’s really common that women, they recognise [incontinence] as a problem but don’t make it a priority to fix it,” she says. And research seems to confirm this, with one study showing that it takes, on average, between three and 10 years for women to seek treatment.
Miller agrees that stigma and embarrassment remain major hurdles, as many are reluctant to discuss their symptoms. She also suggests that after childbirth, new mothers may feel like they don’t have the time and energy to focus on personal health issues while taking care of their baby.
But early diagnosis of pelvic floor disorders would result in more efficient treatment and help to keep the muscles healthy. Be it a question of strengthening or relaxing, there are specific exercises designed to restore a normal tone.
“Doing regular pelvic floor exercises can help improve muscle tone, bladder and bowel control and sensitivity during sex,” observes Professor Cardozo. “If women are pregnant, or planning to get pregnant, they should start doing pelvic floor exercises as soon as possible as this will reduce the risk of experiencing incontinence after childbirth.”
Cardozo has one simple tip for women in need of building strength: “The easiest [way to carry out the exercises] is to sit or stand comfortably with knees slightly apart and then draw up the pelvic floor muscles as if trying to avoid passing urine or flatus.”
Do not tighten the stomach, buttock or thigh muscles, she warns. You can do 10 contractions, holding them for about 10 seconds each. Gradually increase the length of time and mix it up with slower and quicker sets, three or four times a day, she says.
Pelvic floor disorders also include issues of urinary frequency, meaning experiencing an urge to go to the toilet more often than would be considered normal. “If you go to the toilet more frequently than every three to four hours, that’s not ‘normal’. Also, if you get up more than once in the night, that’s also suggestive of an overactive bladder,” says Jones.
She offers one do-it-yourself quick fix: “If you stand and go up on your tiptoes, for example, that would help you inhibit the feeling, or actually contract your pelvic floor muscle until the sensation quietens down.”
General awareness of pelvic floor-related issues has grown through the years but further education is needed, both within and outside the scientific community, to encourage more patients to look for treatment. And that includes men, as there is evidence that regular pelvic floor exercises can help with getting or maintaining an erection, as well as with avoiding premature ejaculation.
As Jones points out: “With the typical things like prolapse and incontinence, the GPs are aware and refer to a chartered physiotherapist. But if it is about pain or erectile dysfunction, they might not be as aware of the role the pelvic floor muscles can have.”