Pelvic Floor dysfunction – we asked Dr Heather King from IMC and women’s health physiotherapist Kelly McGinnity at UFIT all about the uncomfortable truth about post-partum pelvic floor issues.
What is the ‘pelvic floor’ and why is it important?
Dr Heather:
The pelvic floor includes a group of muscles and ligaments inside your pelvis. They support the pelvic organs, which include the bladder, uterus and bowel. Your pelvic floor is important as it allows you to control the passage of urine, wind and stools. The muscles contract when you cough, sneeze or laugh to prevent leakage of urine. During pregnancy they support the weight of a growing baby and facilitate in the birthing process. The pelvic floor muscles also play a role in sexual function during intercourse.
What are the most common pelvic floor issues you see?
Dr Heather:
The most common pelvic floor issues I see are stress incontinence (leakage of urine when you cough, sneeze, laugh, exercise), pelvic organ prolapse when one or all of the pelvic organs (uterus, bladder or bowel) drops into the vaginal canal and can at times cause an obvious bulge, feeling of a lump within the vagina, sexual discomfort or a dragging feeling down below. Faecal incontinence or a lack of bowel control
What causes these issues?
Dr Heather:
The main reasons for having problems with your pelvic floor are from pregnancy and childbirth. It doesn’t affect everyone but your pelvic floor can be damaged especially if you have had a difficult delivery such as forceps, a prolonged pushing stage in labour, multiple deliveries or you have delivered a large baby. Pelvic floor dysfunction tends to happen more with vaginal deliveries than with caesarean sections but it can affect both. Other factors such as increasing age and the menopause can affect the pelvic floor.
Anything that increases the pressure in your tummy can cause strain on your pelvic floor. Examples include being overweight, constipation, a chronic cough or doing lots of heavy lifting at work. Previous pelvic surgery such as having a hysterectomy can also weaken the structures within your pelvis and cause pelvic floor dysfunction.
How do you test for pelvic floor dysfunction?
Dr Heather:
Pelvic floor issues are often picked up when women attend for their routine cervical smear. Pelvic function is often discussed at this point and a vaginal examination is performed.
When should someone seek help?
Dr Heather:
You should come in for a review if you feel you have any of the issues described below. Pelvic floor dysfunction is much more common than you think and a lot can be done to help.
Urinary:
- Leakage of urine when coughing, sneezing, laughing, exercising.
- The sensation of not fully emptying your bladder.
- Urgency and increased frequency of passing urine. (You need to rush to the toilet to pass urine or the number of times you need to go during the day or night is excessive)
Bowels:
- Constipation or a feeling of not emptying completely.
- Pain or pressure in your rectum.
- Leakage of stool or finding it hard to keep in wind.
Prolapse:
- Feeling of a lump in your vagina
- Dragging feeling, heavy feeling down below.
- Pain/discomfort during intercourse.
- Pain/pressure in your vagina.
Can there be long-term issues if one doesn’t seek help?
Dr Heather:
Pelvic floor issues are very common and if dealt with early can often be managed with physiotherapy alone. Pelvic floor issues often get worse with age so dealing with them early and learning how to manage them can at times prevent surgical management.
If you have an ongoing bladder prolapse then it can cause problems with recurrent urinary tract infections. Ongoing rectal prolapses can cause back pain, constipation and a feeling of not emptying your bowel properly. With a worsening prolapse intercourse can become difficult and at times painful. Sexual pleasure often improves with a strengthened pelvic floor.
What sorts of exercises are needed to strengthen pelvic floor?
Kelly:
Kegels or Pelvic floor muscle contractions are the exercises that are required to strengthen the pelvic floor muscles. They are the same group of muscles that we contract when we are trying to stop ourselves from breaking wind or when we are busting for a wee so that’s what I’ll often ask my patients to think about when they are doing their exercises. When you contract these muscles, you should feel a tightening and lifting occurring from the anus, vagina and urethra. Your upper abdominals and buttocks should remain relaxed and you should not be holding your breath.
If you haven’t used the pelvic floor muscles before, I recommend squeezing these muscles as hard as you can on a breath out. Hold the contraction for a few seconds, then completely relax the muscles. Aim for 10 repetitions in a row. Once this becomes easier, you can increase the amount of time that you hold the contractions for. For best results, you need to do the exercises 3 x per day.
How long does it take to notice a strengthened pelvic floor?
Kelly:
Strength changes can start to occur as early as 6 weeks into pelvic floor muscle training, although we know that for many conditions the best improvements occur with 6 months of exercises.
The good news is that the symptoms of pelvic floor muscle dysfunction can improve at a much faster rate. Women with issues such as incontinence or prolapse can often see an immediate reduction in their symptoms after one session of physiotherapy because of advice that is given regarding how to modify their daily activities and through correction of their Kegel technique.
After natural childbirth can women really regain as much pelvic strength as they had before children?
Kelly:
This depends on several factors that occur in delivery. If forceps are used or a woman is pushing for a long time, there is an increased risk of a levator ani muscle injury. In some cases, the levator ani group, which is part of the pelvic floor muscles, can partially or completely detach from their insertion on the pelvis. This will affect the amount of strength that a woman will gain after delivery, but it doesn’t necessarily mean that she will have issues such as incontinence and prolapse.
If a natural delivery is unassisted, the woman does not push for longer than approximately 60 minutes and she performs regular pelvic floor muscle exercises, then it is likely that she will regain her pre-pregnancy strength.
What is your advise for women suffering from pelvic floor dysfunction?
Kelly:
Pelvic floor dysfunction after childbirth is common but it is NOT normal and it can be fixed, so make an appointment to see your Doctor or a qualified Women’s Health and Continence Physiotherapist! They will be able to identify and address the factors contributing to your problem and start you on your journey to recovery.
Written by:
Dr Heather King, IMC Camden. Call 6733 4440 to make an appointment
Kelly McGinnity, UFIT, www.ufit.com.sg
