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Looking after your pelvic floor is about more than incontinence

Woman in grey underwear standing in front of yellow background for story on understanding the pelvic floor
It's hard to motivate women to work on their pelvic floor until they have an issue, but preventative health is always best.()

If I had a Facebook status for my relationship with my pelvic floor, I'd choose "It's complicated".

I know it's an important relationship that I need to nurture, but we never see each other and don't have a strong bond.

"It's a crazy muscle, you can't see it, so it can be hard to connect with it," explains Shan Morrison, a specialist pelvic health physiotherapist with the Continence Foundation of Australia.

She says that makes it hard to motivate women to work on their pelvic floor until they have an issue.

But preventative health is always best.

"The key times are pregnancy when women become aware of the pelvic floor, and the evidence shows doing exercises can prevent incontinence and prolapse."

While some women will manage to get away without problems until they hit menopause, Ms Morrison is seeing more young women who need help.

"Even young girls and women — it's an important muscle in their body.

"It has a sexual function as well. And this is where I'm seeing younger women with pain who can't use tampons or have pap smears, and for them it's not about strengthening pelvic floor but being aware of it and being able to contract and relax it."

She says all women should be able to take their time going to the toilet, never leak, never strain with their bowels, or experience painful sex or periods.

Pelvic floor disorders in women

The pelvic floor muscles span the bottom of the pelvis and support the bladder, bowel and uterus.

Women often put up with pelvic floor disorders for years before seeking help due to feelings of embarrassment and shame, explains Ms Morrison.

"It really impacts their quality of life. It stops people exercising — and that's the worst impact it can have.

"They also may not want to socialise or be intimate."

Associate professor Anna Rosamilia is a urogynecologist and says the biggest risk factors are pregnancy and childbirth, but there are also people who have never had children who are at risk.

They may have a chronic cough, constipation or obesity, for example.

"There are some women who probably inherit the tendency as well," Dr Rosamilia says.

Diagram of the female pelvic floor for a story on kegel exercises
A diagram of the female pelvic floor.()

There are four main categories of pelvic floor disorders in women:

Bladder

The most common is bladder problems. One in three women experience urinary incontinence and half of those are aged under 50.

This can include stress incontinence where someone will leak with things like coughing or exercising, says Ms Morrison.

There is also bladder urgency, when you need to rush to the toilet quickly.

Finally there is voiding dysfunction.

"They don't empty their bladder effectively, they might dribble afterwards or have a second go at it," Ms Morrison says.

Bowel

Bowel problems may include not being able to control wind, losing control and having an accident, or not being able to empty effectively.

Prolapse

Pelvic organ prolapse can impact about one in two women who have a baby, explains Ms Morrison.

It's where one of the pelvic organs like the bladder or uterus moves out of place, and they feel a dragging or heavy sensation.

Pelvic pain

Pelvic and sexual pain can often be related to pelvic floor dysfunction, says Ms Morrison.

"Whereas most of what we've mentioned already relates to it being weaker, this is when the muscles are held too tight."

Women can often have a combination of the above issues.

Connecting with and taking care your pelvic floor

Whether you are looking at preventative treatment or resolving an issue with your pelvic floor, consulting with your GP is your first stop.

If there is a disorder you need to treat, they will refer to you a pelvic health physiotherapist or urogynecologist.

Pelvic floor muscle training is something all women should be doing, says Dr Rosamilia.

This can be done with or without the assistance of a pelvic floor exercise device.

For example, for women who struggle to connect with their pelvic floor, devices like electrical stimulators can be helpful.

Ms Morrison says a specifically designed pelvic floor training program will help reach your maximum potential.

"It's not just about doing the exercise, it's about then improving the muscle strength and co-ordination and endurance.

"And get women to do [what they've learnt] in functional situations, like when she's coughing.

"We do a lot of functional training; it's not just about sitting there squeezing and relaxing."

Women who can't resolve their issues with physio treatment can explore surgical options.

This is general information only. For detailed personal advice, you should see a qualified medical practitioner who knows your medical history.

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