New mums and old ladies. What links the two? Incontinence, or to give it its full name, Urinary Stress Incontinence. We know that these are times in a woman’s life when they are more like to be affected by this problem – after giving birth, or during and after the menopause.
We make jokes about it, we laugh at characters on the TV affected by it: it’s become so normalised that it’s completely accepted, we almost expect it. Some in the medical profession still tell women that it’s normal and nothing to worry about. But Pelvic Floor Dysfunction (PFD) isn’t normal, and we should all be concerned about it.
But what exactly are we talking about here? Leaking urine when you laugh, cough or sneeze is a well-known experience to many, but what else? And how does it happen?
Defining the problem
Incontinence can be urinary or faecal and is defined as the involuntary loss of urine or faeces. When the pelvic floor and pelvic organs are unable to withstand any form of pressure, control over the bladder and bowel can be lost. Some women experience this problem only when they exercise or are ill and cough continually, for example. But for others, walking, turning over in bed, or simply getting up to stand can cause an involuntary loss of fluid or solids.
Pelvic organ prolapse comes about when a pelvic organ, such as your bladder, uterus or bowel, drops (prolapses) from its normal place in your lower abdomen and pushes against the walls of your vagina or other organ.
But here’s the thing, men can suffer with incontinence and pelvic organ prolapse too. And children. And women who haven’t given birth vaginally, or at all. Whilst women are still the biggest group affected, anyone can experience PFD.
What causes PFD?
PFD is caused by a weakness in the pelvic floor muscles. Not surprisingly, pregnancy is one of the main contributors to the weakening of pelvic muscles. Carrying a growing foetus for nine months puts considerable strain on abdominal and pelvic muscles, as does giving birth. A vaginal delivery can stretch and weaken muscles; nerve damage can also occur, also resulting in muscle weakness. A long labour, a large baby and the use of forceps and other devices can raise the risk of damage too.
Menopause, during which the elasticity and strength of our connective tissues declines and we experience hormonal imbalance, is another major player.
It’s a common misconception though that only menopausal women and women who have had a vaginal delivery will be affected. Simply carrying a baby for months can result in PFD. Women who have had a C section can still be affected. As can men and children; two groups that don’t usually give birth. So what are the other causes of PFD?
- Obesity & overweight
- Pelvic tumours/fibroids
- Chronic coughing from asthma, lung disease or smoking
- Constipation & poor bowel habits
- Heavy lifting
- Impact exercise
In other words, anything that causes an increase in pressure in the pelvic area that can’t be sustained by our pelvic organs and muscles. That big guy down the gym lifting huge weights? He could be suffering. The little girl with asthma and hay-fever? Her too… As a society, we would be better off if we removed the ridiculous stereotypes around PFD and included all categories at risk, so we could help everyone who is suffering.
What can you do?
If we are all potentially at risk of developing PFD, what can we do to help prevent it? There are three key areas we could all improve: 
- Posture: simply by correcting our posture so our ribs sit directly over our pelvis can make a big difference. Many people have rounded upper backs, arched lower backs or necks that are almost horizontal. Your pelvic floor can’t function optimally unless you are in your own neutral alignment.
- Breathing: stand in front of a mirror, take a deep breath in through your nose and watch. Do your shoulders rise or your ribs expand? Does your belly balloon? Breathing is crucial to pelvic health as our diaphragm and pelvic floor are meant to work in unison. If you breathe into your chest only (and see your shoulders move up and down as you inhale and exhale) your diaphragm won’t move through its full range, and neither will your pelvic floor. This leads to disconnect and dysfunction.
- Nutrition: a healthy and optimally functioning body needs a wide range of nutrients from good quality clean protein to phytonutrients and enzymes. It also needs to be as free from chemicals, toxins and anti-nutrients as possible. If your diet doesn’t supply this, the building blocks of your body begin to break down and weaken. In addition, some food and drink, including alcohol, coffee and sugar are known bladder irritants and can result in poor urinary habits, exacerbating an existing pelvic floor problem.
In short, exercise for the pelvic floor is important, but getting the basics right – how you breathe, move and eat – can go a long way to reducing your risk of dysfunction.
