What is the pelvic floor?
The pelvic floor is comprised of a group of muscles which support the pelvic organs and contribute to bowel and bladder function. When these muscles become stretched from a variety of causes, including hysterectomy, age, chronic constipation, pregnancy or vaginal delivery, you may experience:
- Pelvic bulge or laxity
- Urinary incontinence
- Difficulty with bowels
- Change in sexual function
Fortunately, these changes are not inevitable. There is a LOT that you can do to ensure that your pelvic floor muscles can do their job throughout your entire lifetime. Principles of good health and good voiding habits can prevent or mitigate many of these effects:
- Stop smoking
- Stay well hydrated
- Empty your bladder regularly (Avoid ‘holding’)
- Regular exercise & Maintain healthy weight
- Avoid / manage constipation
Pelvic Health in Your 20’s & 30’s
Incontinence is very common in this age group, most commonly as a result of childbearing or childbirth. In fact, many women will experience urine leakage during pregnancy or just after delivering their baby. Whether you have leakage or not, it’s never too early to start pelvic floor exercises. Most people have heard about ‘kegel’ exercises and there are lots of great resources on the internet.
Additionally, many women find that core exercises can be helpful in optimizing pelvic floor function.
Furthermore, lots of women experience changes in sexual function, changes in libido, and even pain with intercourse during these decades. These may be treatable by identifying and addressing physical issues, working with a sex therapist or counselor, changing certain medications in addition to treatment with medications which treat low libido.
Physical therapists who specialize in pelvic floor health can be a great resource for any woman and especially new moms after the stress to the pelvic floor that can be associated with vaginal childbirth.
40’s & 50’s
Urine leakage in this age group may be characterized by more difficulty holding urine, particularly as estrogen levels start to decline around peri-menopause and menopause. Many women will find that simple behavioral strategies are effective to reduce symptoms, focusing on completely emptying the bladder, limiting caffeine intake and avoiding holding urine for too long. Women who have had menopause might benefit from topical estrogen supplementation. Sexual function and discomfort during intercourse also become more prevalent during these decades. This is a perfect time to establish pelvic health habits that can endure, including pelvic floor exercises which can have a huge benefit for leakage as well as helping to promote and maintain satisfying sexual function.
50’s and Beyond
Most women will experience cessation of menses by their early 50s (menopause), precipitated by a change in hormones, most significantly a decline in estrogen levels. The vaginal mucosa and a portion of the bladder are quite estrogen sensitive and thus, can be severely impacted by the decline in circulating estrogen. This is commonly associated with a condition called Genitourinary Syndrome of Menopause, or GSM, which is associated with a combination of vaginal and urinary symptoms and often accompanied by difficulties with lubrication and prominent discomfort with penetrative sexual intercourse. Although this is an extremely common condition, it is very often under or misdiagnosed and, consequently, many people simply ‘tolerate’ the effects, including limiting or eliminating sexual activity because of pain. This has obvious significance for patients’ quality of life, sense of well-being & health as well as clear potential implications for partners and relationships. The irony is that GSM, once diagnosed, is actually quite responsive to treatment; alternatives include both hormonal and non-hormonal treatments as well as prescription medications and supplements utilized in tandem with other lifestyle modalities such as pelvic floor PT.