Take control of your pelvic floor muscles for life, writes Dr Binal Dave
The occurrence of pelvic floor dysfunction may increase steadily during the ageing process in women and men. Pelvic floor dysfunction may be associated with dysfunctions of micturition, defecation, prolapse and sex. The natural history and mechanism of pelvic floor dysfunction in the aged are not understood well or explored. Let’s review the effect of age on the prevalence of pelvic floor dysfunction and on the structural and functional changes of the lower urinary tract, anorectum and pelvic floor. Altogether, the ageing process has a negative impact on either the function or structure of the lower urinary tract, anorectum and pelvic.
The pelvic floor
The pelvic floor is the base of the group of muscles referred to as your ‘core’. The pelvic floor muscles work with your deep abdominal (tummy) and deep back muscles and diaphragm to stabilise and support your spine. They also help control the pressure inside your abdomen to deal with the pushing down force when you lift or strain – such as while exercising. Pelvic floor muscles support the bladder and bowel in men, and the bladder, bowel and uterus in women. They also help maintain bladder, bowel control and play an important role in sexual sensation and function.
Who’s at risk?
Some people are more at risk of developing pelvic floor problems than others. These include:
- women who are pregnant or have recently had a baby
- women who have ever had a baby
- women who are going through, or have been through, menopause
- women who have had gynaecological surgery (e.g. hysterectomy)
- men who have had prostate surgery
- elite athletes such as gymnasts, runners or trampolinists
Additional factors that can increase a person’s risk of developing pelvic floor problems include:
- a history of back pain
- previous trauma to the pelvic region such as a fall or pelvic radiotherapy
- ongoing constipation (i.e. regularly straining to empty your bowels)
- a chronic cough or sneeze (e.g. due to asthma, smoking or hay fever)
- being overweight or obese
- heavy lifting on a regular basis – either at work or at the gym
If you experience pelvic floor (or bladder or bowel control) problems it is advisable to see a pelvic floor rehabilitation specialist to determine the cause of your symptoms and discuss the best treatment and management options to suit your needs.
Tests to Determine Causes/Severity
A physiotherapy pelvic floor evaluation consists of a thorough history and physical examination. The purpose of the history is to understand the nature and background of the specific complaint as well as contributing factors that may pertain to treatment of the condition. The physical examination consists of a visual inspection of the pelvic region with a visual observation of the person’s ability to contract the muscles of the pelvic floor followed by external and internal palpation of the muscles of the pelvic floor.
The purpose of the physical examination is to obtain objective information on the strength and control of the muscles of the pelvic floor as well as to observe for any pelvic organ prolapse.
Treatment for Pelvic Floor Conditions
Pelvic floor physical therapy treatments are typically one hour in length and start at once a week or once every two weeks. As a person’s condition improves, the frequency of physical therapy visits is decreased. Patients are seen for six visits on average but this may increase or decrease depending on the specific needs of the patient.
Once symptoms have resolved patients typically follow up in person or by phone in one month and are discharged from physical therapy if they are doing well. The exercises that are given for home are usually recommended to be continued for life to help maintain the gains made in therapy and prevent a future recurrence of the condition.
When to seek professional help
Seek professional help when you have bladder or bowel control problems with symptoms such as:
- needing to urgently or frequently go to the toilet to pass urine or bowel motions
- accidental leakage of urine, bowel motions or wind
- difficulty emptying your bladder or bowel
- vaginal heaviness or a bulge
- pain in the bladder, bowel or in your back near the pelvic floor area when exercising the pelvic floor or during intercourse
These problems may not necessarily be linked to weak pelvic floor muscles and should be properly assessed.
Important information for men who have undergone prostate surgery
Performing pelvic floor muscle exercises before and after prostate surgery is vital to your recovery as it is these muscles that help you control your bladder.
Doing pelvic floor muscle exercises after surgery (whilst a urinary catheter is in place) can irritate the bladder and cause discomfort. It is therefore recommended that you do not do any exercises during this time. However, once the catheter is removed you may start the pelvic floor exercises straight away.
Like all exercises, pelvic floor exercises are most effective when individually tailored and monitored.