Beyond Kegels and cranberry juice: Understanding the pelvic floor

  • Women who have children and try to return to their active lifestyles, including high energy, intensity exercise including running and CrossFit, are often surprised when they experience a form of urinary incontinence, called stress incontinence. Getty Images/iStockphoto

  • TuckerKueny, MD Llewellyn Simons

  • CarolynBentley, PT Ben Barnhart

  • Maureen Etchells, PT   Ben Barnhart

Published: 7/8/2019 2:05:10 PM

Nearly 90 people attended our recent women’s health talk, Beyond Cranberry Juice and Kegels: What You Should Know About Pelvic Floor Health.

As clinicians who treat pelvic floor issues in women of all ages — problems ranging from urinary incontinence to pelvic organ prolapse — we were not surprised at the interest in this little-discussed topic.

Talking openly about a condition that can be saddled with shame, stigma and embarrassment reminded us of the importance of public dialogue. If you are suffering from pelvic floor condition — no matter where you are in your lifespan as a woman — we have an important message: pelvic floor problems are not a normal part of aging; help is available.

Defining the pelvic floorregion

Many of us are familiar with our “core,” the midsection of our bodies. But where is the pelvic floor? While both genders have a pelvic floor, the pelvic floor in women is the set of muscles, ligaments, and connective tissue in the lowest part of the pelvis that supports the bladder, uterus, rectum and vagina.

Pelvic muscles or connective tissue in this area can become weakened over time due to childbirth, pregnancy, obesity or chronic constipation. This weakening can lead to the leakage of urine or stool and other problems.

One or more symptoms of a weakened pelvic floor area could include feeling pelvic pressure or a bulge in the vagina; leaking urine when laughing, sneezing, jumping or performing other activities; having an overactive bladder or experiencing a “gotta go” feeling; difficulty emptying the bladder; problems having a bowel movement.

Pelvic floor disorders impact 1 in 3 women

About 1 in 3 women will experience some type of pelvic floor disorder in her lifetime. Of the three most common types are bladder control problems, which impact 16 percent of women. Pelvic organ prolapse (POP) is less common, about 3 to 6 percent of women, but up to 50 percent of women show signs of prolapse upon examination. Bowel control problems/accidental bowel leakage occurs in 9 percent of women. If you have concerns about weakness, speak with your women’s health provider or ask your insurance company about a referral for pelvic floor physical therapy.

What you can control

When it comes to keeping the pelvic floor healthy, you have control over your lifestyle: don’t smoke; maintain a normal weight; eat a balanced diet; get regular exercise; limit caffeine and excess fluids; avoid constipation; control your blood sugar. What’s not in your control, unfortunately, is your life stage. Pregnancy and childbirth are risk factors and age is a risk factor, regardless of whether you have been pregnant.

Myth: Bladder control problems only occur after menopause

Women who have children and try to return to their active lifestyles, including high energy, intensity exercise including running and CrossFit, are often surprised when they experience a form of urinary incontinence, called stress incontinence. A weakened bladder is likely the cause.

Myth: Living with a pelvic floor disorder is a normal part of aging, especially in older women

Urinary incontinence (UI) is more common in older women. Up to 38 percent of women aged 80 and over experience UI, yet 1 in 4 women ages 20-39 years old have UI. The cause is less about age and more about weight, from either childbearing or being overweight. Extra weight puts pressure on the bladder and stresses the pelvic floor connective tissue and muscles. Bodybuilding and intense weight training are also a risk for both urinary and bowel incontinence.

Myth: The only successful treatment is surgery

The anatomy of each woman is unique and there is no single operation for every person. Surgery for Pelvic Organ Prolapse depends on your individual anatomy; your overall health and other health problems; prior surgeries and desire to retain sexual function.

Don’t wait to talk to your medical provider

More than 25 percent of women wait over 5 years to seek help from their doctor while 33 percent broach the topic with their provider within 1 and 5 years.

Important take-aways

We tell our patients all the time that urinary incontinence may be common, but it is not normal. The same is true for other pelvic floor-related conditions. You don’t have to “just live with” the problem. Do not let embarrassment prevent you from speaking with your medical provider about this condition. If your provider doesn’t think to ask you, initiate the conversation.

Tucker Kueny, MD, is an Obstetrician Gynecologist with Cooley Dickinson Medical Group Women’s Health. Physical Therapists Carolyn Bentley and Maureen Etchells offer pelvic floor rehabilitation services through Cooley Dickinson Rehabilitation Services at 8 Atwood Drive, Northampton.

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