A Sporting Woman's quick guide to the Pelvic Floor
If you've been to an antenatal class, a pilates class or had a baby, chances are the phrase 'pelvic floor' has been mentioned. But what does it actually refer to? And why does it matter?
The pelvic floor is the 'foundation' which supports your pelvic organs (specifically the bladder, uterus (womb) and bowel). It refers to the muscles and ligaments which act like a sling to provide this support, and the openings of the pelvic organs pass through the pelvic floor too. The pelvic floor muscles attach to the pubic bone at the front and tail bone at the back, crossing the base of the pelvis like a hammock, and act in coordination with other deep postural muscles, in particular the diaphragm and deep transverse abdominals.
So all is well when the hammock's strong, but when the hammock sags with age and loss of elasticity during and after menopause, or is damaged, for example, through having to push out a 3kg baby after months of the baby's weight pressing down on it....it can be a different story. Heavy lifting, excessive coughing and carrying extra weight can also put pressure on the pelvic floor. Leakage at both ends, especially when running or venturing on a trampoline, altered sensation and painful sex are all warning signs of a problem. childbirth – particularly following delivery of a large baby or prolonged pushing during delivery
Prolapse - from the Latin 'prolabi'- literally means 'to fall out of place.' This occurs when one or more of the pelvic organs moves down from their normal position and bulge into or even out of the vagina). It is rather extreme, but does happen to some women, and seeing a medical and/or specialist physio is essential. Doesn't sound great does it?
What goes wrong?
The pelvic floor may be weakened due to damage, such as trauma during childbirth, age related changes, or other factors. In these cases, strengthening can help. Conversely, you can also get problems where the pelvic floor is actually "over active." Like all other muscles, pelvic floor muscles need to contract and relax effectively. If they stay tense, this too can cause pain and leakage.
Why does it matter?
1) Convenience and comfort
Leaking and/or pelvic pain isn't fun. It's time to dispel the myth that this is just something that women should just put up with. If the thought of jumping on the trampoline or running down a hill make you feel a nervy about leakage, it's a sign to take notice of your pelvic floor control. Diagnosing the cause of the problem, with the help of a specialist Women's Health Physio, is key.
2) Weakness, pain and injury
A high proportion of pelvic floor muscle dysfunction is present among women with low back and 'saddle' area pain, which in turn has been shown to limit activities they can do, such as high impact exercise (1). Working on your 'core' but back and pelvic pain are still there? The pelvic floor could be the missing link.
3) Athletic Performance
High impact physical activities involve abrupt, repeated increases in abdominal pressure and impact loading on the pelvic floor. You rely on involuntary muscle activation to give you support in the pelvis. This needs to be trained, so if struggling, do lower impact work or run on the flat alongside pelvic floor exercises before venturing to do high impact work. (2)
Perimenopause and the pelvic floor
With hormonal change, the bladder and urinary tract linings can become thinner and the the pelvic floor can lose it's tensile strength.
Common symptoms at this time include:
Leaking when you cough, sneeze, or do high impact exercise
Feeling the need to go to the toilet as soon as you get home
Heaviness down below - as though there's something dropping (could be prolapse - get it checked!)
Pain during sex or urinary tract infections
If this is you, try the exercises below and talk to your doctor and/or a pelvic health Physio, as accurate diagnosis and individualised treatment is essential to solve the problems.
How do you strengthen it?
If weakness is the problem, strengthening will help. To do this, you need to do both the specific exercises, as seen in these videos and on the Squeezy app below, as well as more loaded and general exercises like lunges and bridges, which work the pelvic area as a whole.
For an excellent video on how to do pelvic floor strengthening exercises, see here
The Squeezy App
Another useful tool is the aptly named NHS 'Squeezy' app. It's simple, easy to use and will get you started on how to strengthen your pelvic floor.
There are Physios who specialise in this area alone, so if you have ongoing problems, book to see them. They deal with all of the tricky and embarrassing issues in a professional, knowledgeable way. See https://thepogp.co.uk/professionals/physiotherapists/ for a register of these specialist physios in your area.
Weakness isn't always the problem
Some women also struggle to relax the pelvic floor, which in turn presents problems. Learning to relax your deep core muscles and coordinate their action is just as important as learning to engage them. If you grip your abdominals or hold their pelvic-floor muscles tight during running or other exercise, this limits your ability to coordinate these and other muscles (3).
References
1) Dufour, S. et al. Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskeletal Science and Practice; Volume 34, April 2018: 47-53 https://doi.org/10.1016/j.msksp.2017.12.001
2) Luginbuehl, H. et al. Pelvic floor muscle activity during different running speeds—an exploratory and reliability study. Physiotherapy. 2015: 101 E910-911. https://doi.org/10.1016/j.physio.2015.03.1750
3) Faubion, S., Shuster, L,m Bharuchac, A. Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction. 2012 Feb; 87(2): 187–193. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498251/
