By LISA GIMENEZ-CODD
Mum, Female Wellness and Exercise Coach, Creator of OptiMum Health – supporting females to appreciate themselves, make the most of now whilst increasing strength, health and confidence.
I’ve been interested in the pelvic floor for some time now but, even I, was astounded by the extent of its involvement in our everyday lives when I first had mine tested.
Yep, you read that right.
I had my pelvic floor tested. And I will continue to do so regularly!
I suggest you do too.
In this article, I take the mystery, fear, and shame away from this process and show you that getting your pelvic floor health assessed can not only be incredibly beneficial to your overall health, it can also be a liberating and confidence-boosting experience.
Whether you’ve had a vaginal delivery of a C-section recently, whether you’ve had a baby years before or whether you’ve never had one, whether you’re entering menopause, undertake a lot of high-intensity exercise, or spend much of your day sat at a desk, please read on. Because all these things impact your pelvic floor! And pelvic floor health is something that all women should be familiar with.
Allow me to begin by recapping what the pelvic floor actually is:
What is the Pelvic Floor?
Your pelvic floor is the intricate webbing closing the gap through the bottom of your pelvis. It forms a network of muscles, ligaments, nerves and blood vessels joining your bum bones (ischial tuberosities) with your tail bone (coccyx) and front of your pelvis (pubis).
Without it, quite simply, your bottom would fall out!
Though men and women have a pelvic floor, it’s mainly with respect to women that we hear the pelvic floor mentioned. That’s mostly because of the downward pressure it experiences during pregnancy and childbirth (when the pelvic floor has to support additional weight of baby, uterus, placenta, and amniotic fluid) and the fact that, unlike the male pelvic floor, the female pelvic floor is penetrated by not only the urethra and anus but also by the vagina and this makes it more susceptible to damage.
This amazing system of muscles is so co-ordinated that it can allow parts of its structure to relax whilst other areas contract. It’s a bit like the complex interaction of muscles in your face allowing you to blink independently of mouth movements.
This “aerial view” of a pelvic floor shows how complex this group of muscles is – it’s not one single muscle and it weaves and interlaces itself around vital exit points from our body.
The Pelvic Floor in Childbirth
During a vaginal birth, the baby exits, head first (hopefully!) through the pelvic floor muscles, and out through the vagina. If you undergo any tears or cuts as a result, this can affect how this sensitive area feels afterwards.
If you’re sat there thinking you’re OK because you had a Caesarean, think again. A number of studies have shown that women having Caesarean sections were just as likely to have symptoms of incontinence, in the long term, as those having a vaginal delivery!
Changes that happen during pregnancy, combined with other factors such as your age, estrogen levels, genetics, and weight, all impact on your probability of pelvic floor dysfunction.
Childbirth often leads to “core stability” issues, a weakened pelvic floor, and a certain degree of pelvic organ prolapse. It can be scary. Childbirth can also leave you wondering whether everything “down there” has gone back as it should.
These are times when it is easy for women to turn tortoise – to pull their heads back into their shells and just hope everything will be alright. They feel vulnerable at this time too and and the idea of opening up to someone to ask for help or a check of their private parts is, understandably, the last thing they may want to do.
What if you’ve never had a baby – is maintaining pelvic floor strength and function still relevant to you?
Our bodies change as we age. Genetic factors can also affect the structure, strength, and stability of your pelvic floor. Your posture and daily life activities also have a huge impact on how this vital collection of tissues functions.
For women, further hormonal changes occur in the peri-menopause and menopause itself, which can affect our bladder and the ligaments supporting organs in the pelvis. Having strong, responsive pelvic floor muscles then becomes even more important.
Your pelvic floor responds to movement of your whole body. It plays, for example, a key role in supporting us internally when we cough or sneeze.
The pelvic floor tires under continued stress and demand, often in ways that we don’t imagine it would, and it’s important for us to relax those muscles. It’s as important as us being able to contract them!
The Glass of Water
Imagine if I gave you a glass of water to hold and asked you to hold it straight out in front of you – no big deal, you’d think…right?
The longer you hold that glass of water our front, the heavier and heavier it will start to feel.
If I were to come back half an hour later, you’d be wilting – just under the weight of a glass of water. Even when I took the glass away from you, your arm would undoubtedly ache.
This is the same for your pelvic floor: it tires under pressure. That’s why you must actively work to strengthen it and focus on improving its day to day function.
Do Away With Excuses & Seek Advice
Typically speaking, women are great at sorting out everyone else’s health but often neglect their own….especially when it’s anything related to “down there”.
“I’ll sort it next week”
“I’m sure it’ll sort itself out”
“It’ll get better with time”
…all excuses to avoid bearing your intimate parts to a medical professional!
If your ‘symptoms’ have arisen since childbirth, you may also assume they are ‘normal’.
However, if you have
- Any feeling of heaviness through the vagina and/or anus,
- Pain in this region,
- Frequent trips to the loo and maybe even leakage of urine (however slight)
- Bleeding different from your regular menstruation and/or after sex
- Anything that feels unusual for you
After having a baby, you will have a 6 week post-natal check. You can specify, when making your appointment, that you would like to see a female doctor. Be aware though, that doctors do not always perform a physical examination these days. Regardless of this though, you should also ask for one if there is anything you are unsure of.
Whether your appointment is following childbirth or any other time, write a list of your concerns and questions before you go and take it with you.
Know that feeling embarrassed is completely normal! But these professionals view your vagina no differently to treating your right shoulder.
If you visit a women’s health physio post-partum – as a result of stress incontinence, or because of suspected or actual pelvic organ prolapse – what can you expect?
For me, things felt ‘different’ after a particularly busy summer, moving house, and then an active holiday where I did some very steep hill sprints. My pelvic floor protested somewhat so, on my return, I I sought out the services of a female health physiotherapist.
You can do this like I did – by approaching a private practice – or you can ask your GP for a referral as I mentioned above (the latter is the best way forward if you’ve recently had a baby).
But because I’ve had my babies a few years ago, I decided to go down the private route.
I found my female health physio simply by a Google Search of “female health physio [hometown]”. The name of the lady who’s practice I visited – Ruth – came up first and I then spent some time researching her credentials and seeking reviews. I also looked at the Wellbeing of Women (WoW) website – www.wellbeingofwomen.org.uk for information on a variety of women’s health issues.
How is your Pelvic Function be Assessed?
A pelvic floor examination is nothing like having a cervical smear test done. Typically for those, your GP has a very short time window so you enter the room are asked to disrobe and hop on the bench, knees up, cold speculum inserted, close your eyes and think of England, trying not to hold your breath and it’s done. Phew! You are generally in and out of the room in 10 minutes, if that.
My appointments with Ruth have all been much more personal, relaxed and I feel much more at ease. Time is taken to ensure you know what is involved, to understand that you can back out at any stage and take your time – there is no rush.
All female health physiotherapists will initially check you with their fingers. Yes, it’s intrusive. No, it’s not painful.
Why do they do this?
They need to get a view of the vaginal walls and internal structure to see if it is where it should be. Unfortunately though, due to the internal structure of the area, “seeing” is difficult, so touch is the next best thing.
Touch also allows them to judge tension, or lack of it, in those structures.
It takes a few minutes only.
They may also use ultrasound to view your pelvic floor function.
The method used by my women’s health physiotherapist, Ruth, uses a probe, which is inserted into the vagina. This then sends signals back to a machine.
It uses EMG (electromyography) to sense electric impulses within muscles – in this case my pelvic floor.
When the measurements are displayed visually on a screen and/or audibly (by way of bleeping noises) it’s possible for the therapist to measure the muscle activity.
You, as a patient, also get to see and/or hear what’s happening, giving you appropriate “biofeedback”.
Ruth’s machine gave both visual and audio biofeedback which I found really helpful – it distracted me away from the intimacy of the situation and, if I’m honest, brought out my competitive nature…..
I started laying semi-reclined on the bench. Ruth kindly inserted the probe for me (there is always the option to do this yourself if you prefer) and I turned to look at the screen.
Once my fascination had subsided a bit, Ruth was able to begin the session. She talked me through what was happening and why, throughout the whole examination. This put me at my ease and ensured I understand what my body was doing and how I could support it.
First off, we were looking at the “fast twitch fibres” within the pelvic floor – these do what it says on the tin: they twitch…fast!
We need these parts of the pelvic floor structure particularly when we cough or sneeze or impose any other sudden, sharp movement through our body.
Appropriately I felt, the screen showed a little person with a barbell. If I could squeeze my pelvic floor sufficiently quickly to raise the line above a threshold (set by Ruth), the little person would lift the barbell – challenge set!
The key point to note here is that the therapist sets the threshold so she can determine an appropriate “challenge” for you and then also measure your improvements against that benchmark in future visits.
Being slightly competitive (!) in nature, I actually enjoyed making that bar shoot up to the limit. The pictures below on the left and in the middle show this screen before the contraction of muscles and just after I start to contract.
The screen on the right then shows the trace of all of the fast contractions I did – watching the man lift the barbell was far more interesting and helped me concentrate on what I had to do – the visual biofeedback (seeing what was happening on the screen) worked really well for me.
So my fast twitch fibres were working well.
The story does not end there though.
We also have more endurance-based fibres within the pelvic floor musculature. These are the slow-twitch fibres and they support us through all of our activities.
Here, the ‘challenge’ was slightly different: contract the pelvic floor and sustain that hold. The pictures below show that my slow twitch fibres are a little more erratic.
Here, my pelvic floor showed evidence of being hypertonic (contracting too much) and fatigued.
Ruth worked out a suitable level for me to exercise (yes, it is exercise!) in terms of both effort and time of hold and we used this to agree my homework!
I knew how vital the pelvic floor’s function was but it wasn’t until I saw it on a screen that its important really hit home.
The beginning of this trace photo shows just how easy it is to ‘hang onto’ these muscles. Notice, for instance, that my “resting” position actually has my pelvic floor muscles tensing: they’re working harder than they need to be!
Feeling inquisitive, I lifted my head off the bench to get a better view. As soon as I did this, the trace line shot up!
Wow, so just lifting my head off the bench caused my pelvic floor to contract!
I laid my head down and again, a spike appears in the line that’s tracking across the screen.
Just moving my head up and down from the bed caused my pelvic floor muscles to activate!
Intrigued, I coughed (knowing that your fast twitch muscles activate in the pelvic floor on this cue) and, sure enough. a bigger peak appeared on the visual graph, accompanied by a faster ticking sound from the speaker.
This made me laugh. Guess what that caused? An even bigger jump in activity flew onto the screen.
It was some minutes before my physio could begin her intended routine as I tried moving in different ways to see the effect on my pelvic floor – sitting up, laying back down, lifting a leg….amazing!
Seeing it all on screen made it so clear that one’s pelvic floor needs to move whenever one moves.
It also clearly demonstrated what happens internally when one fails to engage these muscles effectively in everyday movements as the bladder, and other organs, can be pushed down into the pelvic canal.
Simple, everyday actions like standing up and sitting down require your pelvic floor to do its thing!
I spend a lot of my working day teaching people to activate and release their floors, relative to movements they are doing. I’m invariably supporting them and so my floor is working too… perhaps a little too much – I now understand that I am prone to ‘hanging on to’ – or ‘over-tensing’ – these muscles.
I do the homework exercises Ruth gave me religiously.
They’re are easy to do and no-one needs to know when I am doing them.
When you get given exercises too, identify an activity you do a few times each day (depending how often you’ve been told to do them) and use this as a trigger to do your moves.
Examples I give my clients are:
- Brushing your teeth
- Every time your car stops at a red light
- If you listen to the radio, each time the DJ changes
- Putting the kettle on
On subsequent visits, Ruth has checked my progress and also introduced variations, combining those fast and slow twitch fibres.
The variation in the picture below is actually my ‘favourite’ – a fast contraction up to a peak and then controlled descent.
This is particularly good for me as it makes sure I am letting that pelvic floor relax completely…my weakness.
Visiting a female health physio is one of the best things I did last year.
I have been astounded by seeing and feeling just how involved our pelvic floor is in everything we do.
I’m now so much more in tune with my body and aware of some of my sub-conscious habits.
Just recently actually, I’ve been feeling particularly tired (managing my boys, starting a new business, plus usual work with my husband away) and I’ve noticed this affect how my pelvic floor feels.
My most recent visit showed a higher than usual level of fatigue through my pelvic floor.
Revelation – if you’re feeling really tired…your pelvic floor probably is too!
If you’ve recently had a vaginal delivery or C-section, it’s essential that you be aware of the fact that pregnancy, hormones, and the weight of your baby have directly impacted – and quite possibly damaged – your pelvic floor.
Then there’s the new-found tiredness of motherhood.
Give yourself a break, literally! Lie down and rest when you can. Prop your hips up on some pillows – so you’re in the glute bridge position – to take the weight off your pelvic floor for five minutes at the end of each day. Housework can wait!
If you have any concerns regarding your ‘undercarriage’ PLEASE seek assurance and support. It’s out there, waiting for you.
As for me, I will continue having my pelvic floor checked regularly and recommend the same to all of my female clients.
Hopefully this article has answered some questions and allayed any concerns you may have on getting your pelvic checked and seeking support for any change in sensation.
There is SO much more to your pelvic floor than post-natal exercises and stress incontinence. Pelvic floor issues can also contribute to lower back pain, fatigue, stiffness and other aches and pains.
If in doubt, seek advice – like me, it may be the best thing you do for yourself!
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 Pregnancy, delivery and pelvic floor disorders. Aukee, Tihtonen