Up to a third of all women experience a problem with their pelvic floor muscles
at some time during their life. The most common problems are leaking with
activity, sneezing or coughing (stress urinary incontinence) and pelvic organ
prolapse (a feeling of something coming down in the vagina).
What is the Pelvic Floor?
The diagram below shows the normal anatomy of the pelvis, including the pelvic floor muscles.
The pelvic floor or pelvic diaphragm is composed of muscle fibres and connective tissue which span the area underneath the pelvis. It is important in providing support for pelvic organs (e.g. the bladder, intestines, uterus) and in maintenance of continence as part of the urinary and anal sphincters.
It facilitates birth by resisting the descent of the foetus, causing it to rotate forwards to pass through the pelvic girdle.
The pelvic floor also helps maintain optimal intra-abdominal pressure.
Why do problems occur with the pelvic floor muscles?
The pelvic floor muscles can be weak, overstretched, slow to work, too tight or torn just like the other muscles of your body.
Pregnancy and childbirth can cause problems for the pelvic floor muscles especially if you have had an assisted vaginal birth, an episiotomy or significant tear or a very large baby. It is important to do your pelvic floor exercises regularly during pregnancy.
Chronic Constipation – having to strain to empty your bowels on a regular basis can cause overstretching and weakness. Difficulties with emptying may be due to poor relaxation of the pelvic floor muscles.
Heavy or repeated lifting – causes increases in abdominal pressure which may put your pelvic floor muscles under strain.
High impact exercise – heavy weights-based and very vigorous gym activities with jumping can overload your pelvic floor muscles.
Being very overweight – may increase the pressure on the pelvic floor muscles.
Smoking – might cause a regular cough which may put pressure on the pelvic floor muscles.
Menopause – vaginal changes after the menopause may make your pelvic floor problems worse.
Chronic cough from conditions such as COPD, Bronchiectasis.
Other conditions which affect the muscles may have an effect on the pelvic floor muscles e.g. neurological conditions and diabetes.
Symptoms
You may have more than one of the following symptoms:
Bladder:
• leakage with coughing, sneezing and activity which may include sexual
intercourse (stress urinary incontinence)
• urgency – a sudden need to go to the toilet that may include leakage (urge
urinary incontinence)
• going to the toilet too often (frequency)
• getting up at night to go to the toilet (nocturia)
Bowel:
• leakage with activity or urge (anal incontinence)
• difficulty getting clean after bowel movements
• leakage of wind
Vaginal:
• a feeling of something coming down, or heaviness (pelvic organ prolapse)
• pain which can be vaginal or sometimes abdominal
• lack of sensation during sex
Physiotherapy can help with these problems.