Pelvic Floor Dysfunction
The pelvic floor consists of muscles, ligaments, nerves, blood vessels, tendons and connective tissues that are interwoven within the pelvis, stretching from the pubic bone to the base of the spine.The Pelvic Floor:
- Provides support and stability to the spine and pelvis
- Helps keep the pelvic organs in place
- Plays a key role in sexual health
- Helps maintain continence
Occasionally the pelvic floor can be compared to a trampoline, because of the ability for it to respond to weight and bounce back. However, if it bears weight for a long period of time, such as during pregnancy or is stressed due to a vaginal birth, the muscles or tissues can become overstretched and weak if not maintained with targeted exercise.
- Heavy lifting
- Changing hormone levels (menopause)
- Being overweight
- Persistent coughing or sneezing
- Straining to go to the toilet – constipation
- Age (gravity)
- Over or underuse of certain muscles
- Pregnancy and Delivery
- The weight of your baby pushes against your pelvic floor.
- The hormonal changes (such as relaxin) that occur in your body during pregnancy causing the muscles and ligaments in your pelvic floor to stretch and weaken.
- The strain of labour and delivery.
- Postural changes in pregnancy.
- Developing new strategies for breathing.
- Stretching of connective tissue.
- Birth and a return to activity too soon postpartum.
Women who are at greater risk of developing pelvic floor dysfunction during pregnancy and childbirth include women who have had:
- Multiple births
- Large babies (over 8 lbs.)
- Severe perineal tearing
- Instrumental births (using forceps or ventouse)
- Long second stage of labour (over 1 hour)
- Physical strain while pregnant
Common types of Pelvic floor dysfunction include:
Being unable to squeeze the muscles at the bottom of your bladder in order to prevent leakage is a sign of incontinence. The most common types of urinary incontinence after birth include:
- Stress incontinence: The loss of urine when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy is called stress incontinence. This occurs when the sphincter muscle of the bladder is weakened
- Urge incontinence: An intense, sudden urge to urinate followed by an involuntary loss of urine is called Urge incontinence. Urge incontinence causes you to urinate frequently including throughout the night with your bladder muscles contracting to give you a brief warning to find a toilet.
If you have a pelvic floor weakened due to pregnancy and birth, it is likely that your uterus, bowel or bladder could sag down and push against the wall of your vagina. This is known as pelvic organ prolapse. There are 5 types of pelvic organ prolapse:
- Cystocele (bladder),
- Rectocele (large bowel),
- Enterocyte (intestines),
- Vaginal vault (vagina caves in on itself after uterus is removed-hysterectomy)
- Uterine (uterus).
Among these types of prolapse there are 4 stages.
Women with a stage 1 or 2 prolapse can often be asymptomatic. This can lead to discovering the problem in a later stage with early detection treatment can usually reverse the issue. Stage 3 prolapse is when an organ is at the vaginal opening or bulging out while a stage 4 prolapse would require immediate surgery to put an organ that has completely fallen out of the vaginal opening back in its place within your pelvic floor.
- Diastasis recti
Diastasis recti is a condition where the right and left sides of the rectus abdominus (the six pack muscles) separate at the linea alba (the connective tissue between the rectus abdominis). Diastasis affects approximately 80-85% of first pregnancies and can negatively impact the strength of the abdominal wall, which can aggravate lower back pain as well as influence other health issues related to the pelvic floor. Click the link to find out more on Diastasis Recti.
Doing pelvic floor exercise on a daily basis will help to treat and prevent weakness and dysfunction. Lifestyle changes such as posture, maintaining healthy weight and consuming a high fiber diet can assist with pelvic floor. You can also protect your pelvic floor by drinking liquids and eating foods that promote bowel movement and keep you regular.
Avoid the Following:
- high impact workouts
- heavy lifting
With the right knowledge and preparation, much of this type of dysfunction can be avoided or minimized.If you suspect that you are suffering from a pelvic floor or pelvis issue, contact a pelvic floor specialist or your doctor to learn more about your treatment options. Women need to know that at 6 weeks postpartum, even if they get a green light from their doctor or midwife, an appointment with a pelvic floor physiotherapist is highly recommended to get a thorough assessment of the pelvic floor so they can prevent the development of postpartum incontinence and pelvic organ prolapse.
When restoring your pelvic floor it can take anywhere from 3-5 months before you notice an improvement depending on the degree of dysfunction. Restoring your pelvic floor is an ongoing process that requires committing these exercises into your lifestyle.