A wee spot of bother: The importance of pelvic floor health for mums

Pelvic floor muscles are not the most talked about region of the body, but they are one of the most important. With World Continence Week celebrated on 23 – 29 June, now is the time to focus on our pelvic floors. This year's theme is “Pelvic Floor Exercise in Pregnancy, Childbirth and Beyond..."

A strong, responsive and coordinated pelvic floor provides effective support to the bladder, uterus and bowel.  However, if pelvic floor muscles become weak, problems such as incontinence (loss of bladder and bowel control), prolapse and loss of sexual feeling can occur.  Alarmingly, one in three women suffer from incontinence, an estimated 1.1 million (25%) of people in New Zealand aged 15 years or over.

With these high figures, you would be right in thinking that pelvic floor health should be a priority.  However, many people, particularly women, are not addressing these issues, instead thinking that nothing can be done. The New Zealand Continence Association is working to change this attitude, reminding us that just because problems are common, it doesn’t mean they are normal. On a practical level, the organisation is providing women with information and solutions to continence problems.

Incontinence is not a disease but a symptom of an underlying problem. Over recent years, further research has been done in this area and a wider range of treatment therapies are now available, either through the public system or privately run clinics.

The most common type of incontinence is called stress incontinence, and is often experienced by women during pregnancy and following childbirth. Pregnancy and childbirth place increased strain on the pelvic floor, causing the muscles to become stretched and weakened.  This can result in small amounts of urine leakage, usually associated with physical exercise, laughing, coughing, or sneezing. If these muscles aren’t correctly strengthened following pregnancy, problems are likely to persist. With a trend for shortened lengths of stay in hospital and a current lack of hospital based post-natal classes, it is often mothers who are suffering.

Currently, information on incontinence and pelvic floor health is not as readily available as one would expect, especially considering how many people are affected. Tauranga mother Anna Leeson found this frustrating, following the birth of her son. “After giving birth I saw various medical professionals and attended antenatal classes, and was never told about incontinence or pelvic floor heath,” she says.

“It wasn’t until I started having problems with incontinence that I was even aware of these issues. After that, I did so many Google searches, but I didn’t really know what I was looking for. It’s just not made obvious to new mothers.” Anna’s lack of awareness is not unusual; previous studies on incontinence have shown that 40% of New Zealanders are not even aware of where their pelvic floor is.

Physiotherapist, Lisa Yates agrees. “I repeatedly see women with pelvic floor issues, most reporting that they were never made aware of how pregnancy and birth places them at risk.”
The New Zealand Continence Association has recognised a link between incontinence and exercise; a common cause being strenuous exercise following childbirth. Many women, wanting to regain their figure, return to exercise with a vengeance, unaware of the damage that can be caused to their already weakened pelvic floor. During exercise, pressure is created in the abdominal cavity. If this is too great, the pelvic floor can be forced downwards causing it to further stretch and weaken. Incontinence and prolapses can occur if women return to exercise too soon or choose exercises that are not pelvic floor-safe.

“Everyone wants to get back into shape,” says Anna. “I began walking about four weeks after giving birth, on the advice of my GP, and I attended weekly postnatal fitness classes. My pelvic floor wasn’t mentioned once.” About four months after the birth of her son, Anna began more intense exercise, including squats, which contributed to me developing a prolapse. 

“It felt like my organs had all shifted out of place,” she says. “It wasn’t painful, but it was worrying. I didn’t even know what prolapse was.” Anna was referred to a gynecologist and physiotherapist and has since been able to correct problems with incontinence through pelvic floor exercises, but will ultimately require surgery to reduce the effects of the prolapse. “I was really upset,” she says. “It’s difficult enough with a new baby, not being able to do all the things you want to exercise-wise. Now I’m told that I’ll never be able to do certain things again. If I’d known the risks I would have taken care to protect my pelvic floor.”

A better way to be (or pee)

As said earlier, while having problems with incontinence is common among women, this is not an issue that should be regarded as normal. Many think that “a pad will solve this”, yet incontinence is not something that women should simply “put up with”, as a consequence of childbirth or ageing.
Even more alarming is the recent surge in popularity of crossfit classes (high-energy and often high-impact exercise programmes). During workouts, many women push themselves to the point that they urinate involuntarily (stress incontinence). While some may view this as a sign of how hard someone is working, it is unhealthy to perpetuate the view that this is a normal response to exercise. You wouldn’t keep exercising with a sprained ankle, you would stop and seek treatment – it shouldn’t be any different with pelvic floor issues.
In fact, incontinence and pelvic floor dysfunction are often preventable and can be treated through exercises that strengthen the pelvic floor. Women’s health physiotherapist and mother of three, Lisa Yates, says pelvic floor exercises are the single most important thing women can do to prevent and treat incontinence.
Lisa has been successfully treating pelvic floor problems for over ten years and now works from her own practice, Bond & Yates Continence and Women’s Health Physiotherapy. She became interested in pelvic floor health during tertiary study, and finds it rewarding helping women learn more about their bodies and safely get back into shape after giving birth. “Many women only become aware of their pelvic floor when they become pregnant,” she says. “Ideally, I’d like to see younger women learning about and practicing these exercises, as it is such an important part of the female body. Increasing awareness amongst younger women might help to improve our alarming incontinence statistics.”
Sometimes referred to as “kegels”, pelvic floor exercises can be done any time and are easy once you have learnt the correct technique. Ensure you are in a comfortable position (starting seated or lying down is easiest) with relaxed leg, back and bottom muscles. Tighten and lift your pelvic floor as if you are trying to stop a wee. Research has shown that many people do pelvic floor exercises incorrectly – it can be a difficult thing to learn from a brochure. If you are unsure or feel you have symptoms such as leaking or a heaviness in the pelvic region then you should seek professional advice. A pelvic floor physiotherapist or continence nurse can assess your symptoms, teach you how to do the exercises correctly and help you to effectively strengthen this region.
Previously considered a somewhat taboo subject, incontinence and pelvic floor function is slowly being brought into the public eye. The New Zealand Continence Association can provide more information, advice and a list of trained continence professionals in your area. Call the helpline on 0800 650 659 or Visit their website: continence.org.nz
* Additional information from physiotherapy.org.nz