Understanding your pelvic floor

The secrets to improving pelvic floor function – ladies only

The vagina is both for fun and function. Childbirth (whether vaginal or caesarean) is an incredible achievement, but due to human babies having relatively oversized heads and the female pelvis being relatively narrow to allow us to walk upright, many women experience trauma to the pelvic floor. In addition the hormones of pregnancy and menopause can also increase the stress on the pelvic floor muscles and contribute to pelvic floor dysfunction, which can result in incontinence, constipation and even back pain.

Some women, particularly those who have experienced vaginal birth, may have a vaginal prolapse. This occurs when the tissues of the vagina become weakened and some of the surrounding structures bulge into the vagina. This is extremely common, affecting up to forty per cent of all women who have had a vaginal birth. When I was a medical student, we were taught that after menopause, prolapse would invariably get worse, but now we know that with the right strategies, a prolapse may even improve. These are some simple lifestyle steps that can have a big impact on pelvic floor function:

1. Learn to do your pelvic floor exercises PROPERLYThe pelvic floor is a string of muscles that goes from your tailbone to your pubic bone, and so doing pelvic floor exercises involves drawing up the muscles around the rectum, vagina and urethra. The next step is to activate the deep core muscles in the abdomen. Over time, you can then build up to co-ordinating all muscles at the same time.

2. Once you’re doing your exercises properly, get upright – many women do their pelvic floor exercises while they are sitting. This is a good way to start practicing, but the pelvic floor also needs to be active when you are upright doing day-to-day activities. This involves progressing to getting upright, and even to making sure your pelvic floor is engaged when you exercise. A good rule is that if you can’t engage your pelvic floor while doing an exercise, you need to take a break. An exercise physiologist or women’s health physiotherapist can be a great help in this stage.

3. Avoid constipation – Constipation is passing infrequent or difficult to pass stools. This can lead to straining on the toilet, which can actually worsen a prolapse. A diet high in fibre is key to improving constipation because it makes the faeces bulkier and softer, so easier to pass. Fibre is the indigestible part of plant-based foods, like fruit, vegetables and wholegrains. Not only is this good for protecting your pelvic floor, but diets high in fibre are actually linked to better overall health and a more diverse gut microbiome.

4. Use the correct POOsition – The optimal position for defecation is actually crouching, not sitting. When we sit upright, a loop of muscle naturally kinks our rectum, meaning that we have to strain more to poo. By placing a stool under your feet and leaning forward, you can get the optimal angle and avoid straining and the pressure on your pelvic floor.

5. Get professional help – It is worth seeking out a physiotherapist or exercise physiologist with a specialisation in women’s health.  It can feel embarrassing to discuss such personal issues with someone, but women who enter this profession are experts at their job and making their clients feel at ease. They can help you develop a personalised management plan to focus on your specific needs.

Even with the right lifestyle measures, some women may still require surgery for a symptomatic prolapse or incontinence, but these lifestyle measures are still important to optimise outcomes. One of the most important lessons to come from the vaginal mesh scandal is to highlight how important it is to talk about these common and treatable conditions.  Speaking about this with other women, many will have shared the experience of pelvic floor dysfunction. Poor pelvic floor function is not inevitable with age. Even decades post-partum, with the right exercises and lifestyle measures, continence and sexual function can improve significantly. Whether your goal is avoiding prolapse surgery or running with the grandchildren, taking these steps to optimise pelvic floor function can make a huge contribution to living your best life.

First published on Over 60