How’s your pelvic floor health?

If you’re like many women, that’s not something you really think about until something starts to feel “off” down there. Even then, some women are too embarrassed to talk about uncomfortable issues, like leaking urine while sneezing or feeling discomfort during sex.

But why suffer in silence when there are a variety of treatment options available? Educating yourself about your pelvic floor—and some common issues women face—is important. It could not only help improve your overall health but also your quality of life. 

What weakens your pelvic floor?

Your pelvic floor muscles play an important role in your body’s normal functioning. After all, they keep your pelvic organs—the vagina, uterus, bladder, urethra and rectum—in place. Over time, however, these muscles can weaken, particularly after menopause (the accompanying loss of estrogen can increase your risk).

Being pregnant and delivering a baby vaginally also increase the likelihood that you may develop pelvic floor weakness, particularly if you’ve had large babies or multiple pregnancies.

Other risk factors for pelvic floor issues include:

  • Repeated heavy lifting
  • Chronic coughing or straining from constipation
  • Being overweight or obese
  • Having certain medical conditions that can cause nerve damage, including diabetes or multiple sclerosis (MS)
  • Undergoing certain surgical procedures, such as a hysterectomy

Problems linked to pelvic floor weakness

Weakness of the pelvic floor can lead to a variety of health issues. If the pelvic organs aren’t supported adequately, they can drop down. This can result in urine leakage or problems emptying the bladder completely, trouble having bowel movements or fecal incontinence (more on this later) and lower back or pelvic pain. In some cases, the pelvic organs may protrude from the vagina or anus.

Though women may not often discuss these issues openly, they aren’t rare. In fact, one in five women in the United States experiences a pelvic floor disorder at some point. Here’s what you should know about several common pelvic floor issues.

Pelvic organ prolapse (POP)

This disorder occurs when the pelvic floor muscles weaken and allow one or more of the pelvic organs to descend into the vagina. Women who experience it may develop a range of symptoms, such as:

  • A bulge in the vagina
  • Pelvic pressure or discomfort with sex or physical activity
  • Pelvic pressure that worsens throughout the day, particularly while standing or coughing
  • Leaking urine or having bowel movement problems
  • Difficulty inserting tampons

From there, depending on your individual circumstances, treatment options may include:

  • Using a pessary, or a removable device that can be inserted into the vagina to help support your pelvic organs
  • Pelvic therapy, which includes exercises to help strengthen the pelvic floor muscles
  • Dietary changes, such as eating more high-fiber foods to help make stools softer and more regular
  • Surgery, which can help repair the prolapse and support the pelvic floor

Urinary incontinence

If you find that you’re leaking urine—whether it be a few drops or more significant accidents—it’s known as urinary incontinence.

Depending on the type of urinary incontinence you have, you may also have more urgency or feel the need to urinate more frequently, wake up at night to use the bathroom, have pain while urinating or leak urine while asleep.

Incontinence typically affects twice as many women as men. This is likely due to contributing factors unique to women, such as pregnancy, childbirth and menopause, which can all weaken or damage the pelvic floor.

The good news is that urinary incontinence is not a normal part of aging, and it can be treated. Treatment options will likely start with nonsurgical options, such as lifestyle changes and bladder training. If you’re overweight, losing even a few extra pounds can ease pressure on the pelvic floor and help prevent urine leakage. Avoiding beverages near bedtime, limiting your intake of alcohol and caffeine, performing exercises to strengthen the pelvic floor and trying biofeedback—using sensors to locate the muscles you need to strengthen—can also help. Pessaries, which may come in a variety of shapes and sizes, can also help prevent bladder leaks.

If those treatments aren’t effective, your doctor may recommend medication, electrical nerve stimulation, bulking agents to narrow the bladder opening and prevent leakage or possibly surgery.

Fecal incontinence

This occurs when a bowel movement occurs involuntarily or can’t be prevented despite attempts to stop it. Passive fecal incontinence, on the other hand, is when bowel leakage occurs unknowingly, or without your being aware that it’s happened. 

Fecal incontinence is more common than you may think; it’s estimated to affect as many as 1 in 3 people. Though it can be embarrassing to discuss, it’s important to tell your doctor if you’re experiencing this issue‚ especially if it’s frequent or severe.

Some non-invasive treatments—including dietary adjustments, bowel training, pelvic floor exercises and medication—can be very effective. In fact, they can improve symptoms by about 60% and can even resolve fecal incontinence altogether in as many as 1 in 5 cases. If these options fail, however, your healthcare provider may discuss other therapies such as biofeedback, sacral nerve stimulation, vaginal balloons, non-absorbable bulking agents or surgery.

Talking to your doctor

While some healthcare providers test for pelvic floor strength regularly, many women who are experiencing symptoms related to pelvic floor disorders are too embarrassed to broach the topic. But opening up about what you’re experiencing can help you get the treatment you need and ease your symptoms.

Don’t wait. It’s better to raise the issue sooner rather than later. This way, you can work with your healthcare provider to outline steps to prevent or improve pelvic floor issues.

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