Unfortunately, we live in a society in which women’s bodies have been all but ignored in modern health. “Historically, women have been excluded from clinical trials and biomedical research because researchers considered the presence of menstruation rendered the biological processes within female bodies too variable to glean reliable results, and/or because of fears of harming the prospects of a future pregnancy,” notes a recent study that looked at sex and gender gaps in medicine and the androcentric history of medical research. “Thus, most research data have been collected from males and generalized to females, intersex people, transgender people, or gender nonconformists.”
Because of this, many of us are wildly unaware of our bodies and the alarm signals it tries to send us. When it comes to the pelvic floor, this is especially true. “Many women feel embarrassed or do not know who to turn to when they experience urine leakage, a feeling of heaviness in the pelvis, or discomfort during sexual intercourse,” Lola Ibáñez Piñero, a physiotherapist specializing in the pelvic floor notes.
Luckily, this is starting to change. More and more women are becoming better informed about the importance of pelvic health and are seeking help. In that spirit, here’s a look at some important things to know about this under-discussed health topic.
The function of the pelvic floor
The pelvic floor is a group of muscles that support the bladder, uterus, prostate (in men), and rectum. These muscles form a sling at the base of the pelvis and play a crucial role in certain bodily functions, including bowel and bladder control, sexual function, and core stability.
To help visualize how the pelvic floor works, Piñero invites us to imagine a firm, elastic hammock strapped across the bottom of our lower abdomens. Its function plays an essential role:
- Support function—It protects the organs from abdominal pressure.
- Sphincter control—It allows us to avoid incontinence. Without the pelvic floor, we couldn’t cough, laugh, or jump without leaking urine, gas, or feces.
- Sexual function—The pelvic floor provides sensitivity and responsiveness, influencing lubrication and the intensity of orgasm in women as well as erection and ejaculation in men.
- Reproductive function—Supports the developing fetus during pregnancy, adapting to the growing uterus. Thanks to its capacity for elongation and relaxation, it allows the passage of the baby during childbirth.
- Postural and respiratory function—Together with the diaphragm, transversus abdominis, and multifidus, the pelvic floor helps to stabilize the trunk. It is also involved in the regulation of intra-abdominal pressure, which is key for protecting the internal organs and lumbar area. (It is reflexively activated by diaphragmatic breathing and core movements.)
What causes pelvic floor problems?
With all these essential functions, maintaining proper muscle tone in the pelvic floor is important—either too much or too little can have serious consequences. “Hypertonic pelvic floor muscles remain contracted instead of being relaxed and activated when necessary—even at rest,” says Piñero. “Paradoxically, this makes the area weak and painful.” Among the typical consequences? Urinary incontinence, pain during intercourse, frequency of urination, difficulty evacuating, constipation, a feeling of pelvic blockage, and perineal, vaginal, or anal pain.
On the contrary, a hypotonic pelvic floor is when the muscles are flaccid and not very reactive. In this case, the muscles lose their capacity to support and close the sphincter and also blunt sexual enjoyment because sensitivity is “turned off.” This also leads to incontinence, prolapse, vaginal heaviness, and less sexual satisfaction.
Stress, a sedentary lifestyle, being overweight, and experiencing a chronic cough or chronic constipation can all contribute to problems with the pelvic floor. And though men can certainly have pelvic floor issues, it’s more common in women due to anatomical, hormonal, functional, and sociocultural factors:
- Women have a wider pelvis with three orifices: the urethra, vagina, and anus.
- During pregnancy, there is pressure on the pelvic floor; women are also at risk for obstetric trauma.
- During menopause, the drop in estrogen causes collagen and elasticity to suffer, making tissues more fragile, dryer, and less toned, ultimately contributing to weakness and genitourinary syndrome.
5 pelvic floor warning signs not to ignore
Lots of factors can contribute to a damaged pelvic floor. “Pregnancies, surgery, poor form during exercise, chronic cough, constipation, a rigid diaphragm, stress, emotional or sexual trauma, poor posture, or the simple habit of holding the urge to go to the bathroom can each cause problems,” says Piñero, who shares five signs that you may need to see a specialist:
- Leaking urine, gas, or feces when straining, coughing, or laughing.
- Frequent urgent need to urinate.
- Constipation or incomplete emptying.
- Pain or loss of pleasure with intercourse.
- Dribbling or “almost leaking” sensation when sneezing.
How to take care of the pelvic floor at every age
Taking care of the pelvic floor is essential for quality of life—especially as we age. “The pelvic floor can and should be trained and cared for throughout our lives. With professional assessment and personalized guidelines we can avoid the discomfort that should never have to be part of being a woman,” Piñero says.
In other words, it’s possible to improve pelvic floor issues. “When we take care of it, we recover not only continence and pelvic health, but also well-being, pleasure and confidence,” assures Piñero, who says each stage of life requires different types of care.
For example, during childhood and adolescence, the most important thing is learning good posture and proper form during sports and exercise. “In childbearing age, it becomes important to avoid constipation, not to push or hold urine, and to be sure to manage intra-abdominal pressures during exercise,” Piñero says. “Assess the pelvic floor before pregnancy. Include perineal massage during pregnancy and rehabilitation after childbirth to recover the CALP, or abdomino-lumbo-pelvic girdle,” she says.
During and after menopause is when women tend to suffer greater dysfunction and need more help. “It is a sensitive subject, but we have to be participants in our health, talk to our gynecologist, and inform ourselves as much as we can,” Piñero says. To that end, she says it’s important to keep the following tips in mind:
- Don’t normalize pain—If you’re experiencing discomfort, visit your gynecologist and seek help from a pelvic floor physiotherapist. “Your gynecologist can guide you, but it is also key to have a physiotherapist who specializes in the pelvic floor. They can help you recover the function of this area and avoid discomfort,” says Piñero. “Your physiotherapist will give you personalized treatment to improve the tissue and guidelines that will help your muscles function again.” Follow the prescribed exercise program at least three times a week.
- Maintain an active sex life—Vulvovaginal hydration and orgasms are medicine for your vagina, says Piñero: “Studies show that women who are more sexually active suffer less from genitourinary syndrome.” Don’t currently have a partner? Self-love works, too.
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