Women's Health

24 Jun 2016 4:13 PM - The Pelvic Floor

When we are talking about Women’s Health we are generally talking about urinary, faecal and sexual health in women. And it sounds like a scary, taboo topic, doesn’t it? Well, of course, we are here to tell you that it really isn’t. And thinking about Women’s Health as such may be holding us back from big changes in wellbeing and health in Australia. This piece will be one of several to help debunk some myths around Women’s Health and hopefully educate and empower women facing these issues. And if you are someone who has problems, you are not alone!

Urinary incontinence affects up to 37% of Australian women (Australian Institute of Health and Welfare, 2006), however of those who reported they were suffering, only half reported seeking help from a health professional (Byles & Chiarelli, 2003).

Did you know that your uterus can expand to one thousand times its normal size when pregnant? And a placenta can create up to one thousand times the normal amounts of oestrogen and progesterone than the ovaries usually do when you’re not pregnant? Crazy, right? So why aren’t we taking about the other things that can happen to the female body with such respect?

A fantastic physiotherapist, Taryn Hallam, once described the pelvis to me like a soup can. The filling of all the soup in this analogy is your organs: uterus, bladder, intestine, stomach etc. However this tin of soup has no top and no bottom to the can. So what’s then stopping all the contents just falling out? The pelvic floor muscles and fascia; a genius, yet potentially flawed design of the female human body. In one regard, it’s great- muscles are stretchy and can be strengthened, so a baby can pass through a woman’s pelvis to give birth and recover afterward. But on the other, they can be forgotten about, weakened and altogether misunderstood.

Did you know at the end of pregnancy, the weight of the baby on the pelvic floor has been found to be equivalent to a 100kg man standing on a trampoline?

If that man stood on that trampoline for weeks or months, think about what that trampoline would look like when he got off. Or better yet, someone tried to push him through the fibres of the trampoline!

What really is the pelvic floor then?

The pelvic floor muscles span from your pubic bone to your sacrum, as drawn in in bright pink on this image:

(Adapted from www.fda.gov image, viewed 21/06/2016)

Note that this picture is from the side. Note the positions of the bladder, the uterus and the rectum next to each other. Your pubic bone is the hard bone you can feel at the front of your pelvis, and the sacrum is a continuation of your spine which ends in your coccyx bone.

What does it do?

The pelvic deep pelvic floor muscles sit a bit like a sling. So what do you think would happen when they contract? They get tighter and straighter, making the shortest line between the pubic bone and the sacrum. Whilst there are muscles around the anus and urethra that work by constricting around these exits to stop defecation and urination respectively, these are not your deep pelvic floor muscles. The pelvic floor muscles do not hold your urine and faeces by constricting around your passages. So why do physios go on and on about them?

Well, firstly, when they are weak you can see that they sag down. When the pelvic floor muscles are tight and taut, the weight of your organs is more evenly distributed. When it sags, you have an increase in pressure in the very centre, towards the vagina. Therefore, having weakened pelvic floor muscles puts you more at risk of a prolapse (which is where your bladder, uterus or rectum slips downwards, usually towards your vagina), as you can see below. Prolapses will be more closely discussed in further posts.

Just briefly and very simply, this sagging of the pelvic floor is one of the reasons that women experience loss of urinary and faecal continence as well. Because the organs are not well supported, their function can be altered. This is especially the case with Stress Urinary Incontinence (SUI), which is the loss of urinary continence when there is an increase in pressure (i.e. stress) on the bladder. This increase pressure is most commonly caused by coughing, sneezing, laughing, heavy lifting or jumping/running. We will continue to expand on this in coming posts.

So what can you do?

Well, unfortunately research has found recently that

Up to 50% of women perform a pelvic floor contraction incorrectly if only given verbal cues.

However, an appropriately trained physiotherapist with a special interest and training in Women’s Health can assess and treat pelvic floor weakness and dysfunction. At Prevent, we have private and confidential treatment rooms and specialised equipment to help you.

Want the good news though? According to the Incontinence Foundation of Australia:

80% of sufferers can be improved or cured with conservative treatment

Further, Pelvic Floor Muscle Training (PFMT) for people with SUI has been systemically reviewed to increase quality of life and have very few reported adverse effects (of which, none were serious) (Dumoulin & Hay-Smith, 2010).

So let us help you to improve your confidence, health and wellbeing. If you have any issues that you would like to discuss with our trained Physiotherapists regarding the pelvic floor or anything in this article, do not hesitate to call us on 8361 8182 or email physio@prevent.net.au

By Suzannah Michell

Physiotherapist

Acknowledgements:

Information, analogies and concepts from Taryn Hallam’s Introductory Course of Women’s Health Training Associates (WHTA) are used throughout this article.