Pelvic floor problems
The pelvic floor is hidden!. However, it’s dysfunction leads to a myriad of problems including urinary and bowel incontinence and prolapse.
Your pelvic floor is one of your biggest assets.
It comprises of a hammock of muscle called the levator ani. It is comprised of 3 groups of muscles all intertwined. There is also the connective tissue which covers the muscle and attaches to the wall of your pelvic bone. IN some part, the connective tissue forms bands of ligaments that act as the anchor holding the rectum, womb and bladder to the pelvic frame. The frame of your pelvic bone is the structure to which this all hangs. The inside organs of your tummy comprising most of your bowel, womb and bladder are then all supported by this hammock.
Over time, this whole hammock can weaken. There are many things that can lead to this including:
- Pregnancy and childbearing.
- Menopause
- Trauma
- Chronic straining conditions
- Neurological disease
- Weight gain
- Genetic factors.
Pregnancy and Childbearing
This is the most potent cause of pelvic floor weakness. It can be due to several things like: - increasing weight of the pregnant womb. This puts pressure on the pelvic floor and stretches the muscle and ligaments - vaginal delivery. As the baby progresses through the vaginal canal it stretches up the muscles and ligaments. The pressure of the process can lead to muscle tearing including disruption of the attachments of the muscle and connective tissue from the pelvic bony frame. Torn muscle can heal but once torn, from the bony frame the muscle will not spontaneously reattach. Healed torn muscle is always weaker than the original intact muscle.
In addition, the stretching of the vaginal canal can also damage the nerves supplying the pelvic floor muscle. When a nerve it damaged, it tries to heal itself. However, this is not always successful. In physiology we know one nerve fibre supplies one muscle fibre. So, if that nerve dies, the muscle fibre also dies with it. Whilst there are obviously a huge amount of nerves supplying the muscle, nonetheless, where there is damage and failure of nerve healing the muscle fibres will die too. Hence this can result in further muscle loss in addition to that from muscle tearing. For many women, a vaginal delivery will necessitate some tearing or the need for a cut, forceps or suction (vacuum) delivery. All this adds to the potential for trauma and weakening of the pelvic floor, Other factors that impact on it will be the duration of labour, difficulty in delivery, speed of delivery, size of baby, position of the head and shoulders at delivery. All these are unknowns and can impact significantly. The major damage occurs with the first 2 vaginal deliveries.
Menopause
Menopause happens when the ovaries stop working. They stop producing hormones and so your periods stop completely. The hormones that is important is estrogen, the female hormone. When the level of estrogen falls, it causes changes in the tone and strength of the muscle. Whilst t s not immediately obvious, over time, this can lead to a weakening in the strength of the muscle. If the muscles are already weakened by previous birthing trauma, then symptoms are more likely to appear at this time.
Trauma
The most obvious trauma is vaginal childbearing. However, trauma also occurs due to other situations. Pelvic trauma from accidents come to mind. These are not common causes though. Chronic straining conditions By this I mean situations which cause repetitive straining. These can include some of the following: - Chronic cough. Several chronic lung conditions like bronchiectasis, asthma, and emphysema spring to mind. Other shorter-term conditions like covid induced coughing, pneumonia etc also can contribute to pelvic floor dysfunction. Smoking is major culprit though with the lower incidence of smoking, this is less of a problem now. - Constipation. A common condition leading to repetitive straining. Chronic constipation and irritable bowel syndrome spring to mind. Good bowel management is important t minimize this effect. - Gardening. Keen gardeners can do a disfavour to their pelvic floor. Avoid carrying the 20 kg potting mix bags!!!
Weight lifting
Trying to become the world heavy weightlifting champion may also affect your pelvic floor! This does not mean you should avoid exercise. Far from it. Best however if you are planning weight training or high impact exercises and you already have a weak pelvic floor, seek the advice of a specialist like a personal trainer for your exercises. They can tailor your exercises to suit you.
Doing the normal shopping and household chores should not affect you….sorry….!
Neurological disease
Damage to the neural nerve supply through degenerative disorders or from pelvic or spinal trauma may lead to pelvic floor dysfunction.
Weight gain
The pressure exerted on the pelvic floor is higher with an increase in your weight. This I particularly so in those whose pelvic floor is already weakened. So, aiming for a weight close to your ideal weight is always helpful.
Genetic
I find that some women have an inherent weak pelvic floor. In many women who are pregnant for the first time, when I examine them, they appear to have a weak and poorly co ordinated pelvic floor muscle tone and performance. The vast majority are symptomless. However, they would benefit from early intervention in pregnancy.
How do you prevent pelvic floor problems?
Essentially there is no way one can prevent problems due to the myriad causes that can lead to it. Even avoiding pregnancy is no guarantee. However, there are ways to minimise them, which I will explore in another article.