Let’s be honest. Any woman who has ever wet her pants “just a little bit” in public knows that having a strong pelvic floor is nothing to sneeze at. Unfortunately, most women are too embarrassed to speak up about their pelvic floor problems. So we turned to the experts to find out everything you need to know about this far-too-taboo topic — and why pelvic issues are far more treatable than you think.
First things first: Stop suffering in silence. If you wake up two or three times a night to go to the bathroom, you aren’t alone. If you have discomfort during sex, you aren’t alone. If you wet your pants after jumping on a trampoline with your kids, you aren’t alone. In fact, according to a report published by UCLA Health, one in three women will experience a pelvic floor disorder during her lifetime.
“Even with current societal norms, it’s a taboo conversation topic,” says Helai Hesham, MD, a specialist in female pelvic medicine and reconstructive surgery at Columbia University Irving Medical Center. “We talk about high blood pressure and diabetes at the dinner table, but hardly bring up prolapse [sagging of the organs], incontinence, or pelvic pain. Some still have a view that these topics should carry a level of shame, which leads to patients being hesitant to talk to their friends, families, and doctors.”
However, as Dr. Hesham is quick to point out, there is absolutely no reason for anyone to feel ashamed of any of this. Pelvic floor disorders are far more common than we’re led to believe, which is exactly why it’s so important to be educated, both about preventive care and treatment options if problems do arise. DailyOM turned to the experts to find out everything you need to know about pelvic floor health, as well as the answers to those questions you’ve always had but were too embarrassed to ask.
What Is Your Pelvic Floor?
Simply put, your pelvic floor consists of key muscle groups and connective tissues that support the organs in your pelvis like your bladder, large intestine, and internal reproductive organs. These muscles hold the organs in place, providing the flexibility, along with other muscles in your core, to help you control your bowel and bladder functions. They also absorb outside pressure when you cough or lift objects and protect your spine and internal organs.
“Your pelvic floor is a group of muscles and connective tissue that hold your vagina, bladder, and rectum,” says Hesham. “These muscles work together for normal sexual, urinary, and bowel habits.”
Interested in learning more? Check out Strengthening Your Pelvic Floor
What Causes a Weak Pelvic Floor?
Pelvic floor dysfunction can occur for a wide variety of reasons. Pregnancy, childbirth, and aging are some of the factors that can impact your pelvic floor. But ultimately, the outcome is the same. The pelvic floor muscles are stretched, weakened, or too tight and women wind up suffering from one or more pelvic floor disorders.
“There are a number of risk factors that affect the pelvic floor,” says Larissa Rodríguez, MD, director of the Center for Female Pelvic Health at Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York City. “These include vaginal deliveries, weight, diabetes, and aging. All these may contribute to abnormalities of the pelvic floor and the development of incontinence and prolapse.”
How Do You Know if Your Pelvic Floor Is Weak?
Symptoms of a weak pelvic floor can include leaking urine when you’re coughing, sneezing, or laughing. Women with pelvic floor dysfunction can also have reduced vaginal sensation, chronic constipation, and stool leakage.
Other signs of pelvic floor dysfunction might surface as prolapse, when one or more of your organs “falls” into your vagina, creating a bulge, pain or discomfort during sex, vaginal flatulence when you bend over or lift something, and a frequent need to urinate.
How Do You Know if Your Pelvic Floor Is Working?
It may seem obvious, but if you don’t feel any discomfort or pain, odds are that your pelvic floor is probably in pretty good shape. “If you don’t have to think about your pelvic floor, that is a good sign that things are working well,” says Hesham. “By that, I mean you aren’t planning your life around your urinary and bowel function. You haven’t stopped yourself from going for a run because you may have urinary leakage or a sensation of bulge in the vagina. You essentially aren’t changing your day-to-day activities or limiting yourself based on your pelvic health.”
How to Improve Your Pelvic Health
The most important thing is to seek help straight away if you think you have a problem. “Most people who suffer from pelvic floor disorders think these disorders are normal after vaginal deliveries or with aging,” says Dr. Rodríguez. “This is not the case. Although advanced age may increase the risk of suffering from one or many of these disorders, they are by no means a normal part of aging. They are treatable and people should not suffer in silence.”
Hesham couldn’t agree more. “Keep up to date with annual examinations and pap smears. Learn pelvic floor exercises for both strengthening and relaxing the muscles in the pelvis,” she says. “Learn healthy bowel and bladder habits like limiting bladder irritants in your diet and using the bathroom when you feel the urge to empty rather than ‘just in case,’” which is urinating when you don’t feel the need to — say, before you leave the house.
Although treatment options can include everything from minimally invasive surgery to nerve stimulation to oral medication, in most cases you can improve your pelvic health simply by changing your lifestyle.
What Is Pelvic Care?
Seeking advice from a qualified medical professional like a pelvic floor physical therapist or a board-certified physician specializing in female pelvic medicine and reconstructive surgery is essential for proper treatment of pelvic health disorders. Pelvic healthcare can include anything from one-on-one instruction for proper kegel form to breathing exercises to toileting advice.
Seek help if you think you have a pelvic floor problem. These issues are treatable and people should not suffer in silence.
“You should always get evaluated by a physical therapist specializing in pelvic issues,” says physical therapist Nancy Silva-Mullins, supervisor of Northwell Health’s STARS Pelvic Rehabilitation Program in East Meadow, New York. “You may think that you only have one issue, but a pelvic floor physical therapist will be able to assess if there are other contributing factors and formulate a specific program for your needs.”
How Do I Strengthen My Pelvic Floor?
Great news: There are countless ways to strengthen your pelvic floor. You can perform breathing exercises, do stretches, and make dietary changes. But unsurprisingly, one tip in particular kept coming up over and over again during interviews with our experts: kegels.
“Kegels, when performed correctly and consistently, can be very effective,” says Rodríguez. “Working with a pelvic floor physical therapist to develop strategies to strengthen the pelvic floor is also very helpful.”
How Do I Find a Pelvic Therapist?
Finding a qualified pelvic floor physical therapist may seem like a daunting task, but there are plenty of resources available through your community. Try asking your gynecologist’s office for a referral, or see if your family or girlfriends have a recommendation for a great physical therapist they can share.
“Your best bet to start would be your local gynecologist,” says Hesham. “They’ll know what resources are available both near and far and can guide you in the right direction. If physical therapy isn’t enough, a urogynecologist can find other possible treatment options that may work for you.”
The Bottom Line
Always talk to your doctor first if you think you may be suffering from pelvic floor dysfunction. Seek help promptly and don’t be afraid to speak up — without any shame — to keep your lady parts in great condition. Practicing preventive care is also key to keeping your pelvic floor functioning properly, so don’t forget to schedule those annual checkups with your gynecologist and implement kegels into your daily workout routine.
“The biggest misconception is that treatment should only start once someone is having an issue,” says Hesham. “Taking care of your pelvic floor is just like taking care of any other part of your body. Preventive care is key in ensuring a healthy future. The more knowledge we have about our pelvic floor, the better we can care for it. Don’t be afraid to ask your healthcare provider for help. These topics shouldn’t be taboo!”
