Pelvic floor – The pelvic floor muscles are located between your legs, and run from your pubic bone at the front to the base of your spine at the back. They are shaped like a sling and hold your pelvic organs (uterus, vagina, bowel and bladder) in place.
The majority of my clients come to me with pain. More often than not, it’s a pain they have ignored for a very long time. To ignore a problem until it gets too bad is part of human nature, and often seen as practical: aside from all the other issues around fitting in physio appointments, affording them and committing to exercises, if it’s ‘just not that bad’ it’ll invariably go to the bottom of the Life List.
However, a niggle anywhere in the body is always a sign that something’s not right, and the sooner it gets sorted, the fewer problems will occur as a result. The pelvic floor (the muscles supporting your organs at the base of your pelvis i.e., your ‘undercarriage’) complex of muscles often gets neglected for decades, with men often asking me whether they have one (answer: Yes) and women simply laughing about how terrible theirs is. But the truth is, pelvic pain, dysfunction and incontinence is a real problem that affects at least 1 in 3 women in their lives. The true figure for women, and any figure for men, can only be guessed at, seeing as it remains such a taboo.
So here’s a few things to consider when tuning out of the daily scramble for a moment, and what your own experiences and sensations might be telling you…
Dribble While You Work – The Pelvic Floor Could Be Struggling
Any leakage of urine is a sign that one way or another, your pelvic floor is struggling. Even if it’s only happened once or twice, this insidious problem can progress subtly over the years, especially after childbirth. It’s common when lifting heavy things, coughing or even just laughing.
There are two main types- stress incontinence – SI – (leaking under load) and urge incontinence – UI. Urgency can start with SI and progress it to almost ingenious heights. Urgency is when you ‘just’ need to visit the bathroom before heading out, and barely make it to the loo on returning home again… having just popped to the shops for 15 minutes. Urgency is planning your day in ever-increasing detail so you can be near a toilet. Urgency can be heard in coffee shops country-wide – “I was up in the night to the bathroom five times last night… must be getting old”. Experts suggest it may be little to do with age, and more to do with a battle between your muscles, your mind and your lifestyle.
The causes and symptoms can be mixed. A weakened pelvic floor by childbirth or even a chronic cough can lead to stress incontinence, which leads to concern about getting to the loo, which exacerbates urgency incontinence. Some people never had stress incontinence, but due to a high caffeine intake, sitting in long meetings or being in high pressure situations regularly, has led to the mind taking over the body with its concern for comfort and regular voiding. From an early age, we are told to go ‘just in case’ and this often stays with us. We forget that we learned to become masters of our own bladders when we were small… and we may need to do the same again now.
Continence issues aren’t the only sign of a struggling pelvic floor. In fact the opposite could be true – constipation is inextricably linked to pelvic floor issues. It could both cause and be the consequence of pelvic floor muscle dysfunction: either too weak to support the bowel properly and allow the correct alignment for evacuation, or too tight and unwilling to let go of your daily load.
Sometimes the signs are subtle.
Can’t pee in a straight line? One side of your pelvic floor might be weaker than the other.
Your flow stopping and starting without your say-so, or incomplete emptying and having to pop back to the bathroom having just left? Your bladder may not be fully supported or resting in the wrong position.
Lower back pain that no one can seem to fix? It could be your pelvic floor passing on its duties to a stronger team-mate, the lower back muscles, or even the pelvic fascia (connective tissue), which are starting to show signs of strain.
You may also experience pain during sex, or vaginal dryness.
Painful sex is often the result of pelvic muscles that are too tight – and this can even be the result of something as innocuous as running, if you happen to be running with weak glute (bottom) muscles. It can also be related to something as serious as blocked memories of abuse, or grief, or physical trauma. Our pelvic floor are our deepest muscles, and really do react when we are stressed, or upset, or over-tired. It’s easy to see in this context that ‘doing your Kegel exercises’ may actually be making your problem worse.
Though dryness can be mostly hormonal and associated with the menopause, the change in hormones can happen at any age and often is the result of a fast-paced lifestyle or a stressed-out headspace, or the result of coping with other related issues like painful sex or incontinence. Our minds and bodies are one, which makes me wonder how our pelvic floor feels when we joke about or dismiss our pelvic issues.
So it’s worth considering what exactly your issue is. There are so many symptoms that could be caused by a number of things. You could spend time and money going for a blanket approach, hoping something will work, but end up getting nowhere. It is usually best to identify exactly what the problem is, so it can be tackled directly.
Are You Ready?
Even if you have read this blog, even if you recognise your symptoms here, even if it really is becoming a problem for you, sometimes it’s still difficult to pick up the phone, or book yourself in online. It’s such a private thing, to talk about toilets, sex, and how the two can even clash dramatically with upsetting consequences, with a complete stranger.
So, if you will, please consider two things. Firstly: the main reason for older people going into care homes is incontinence. Not dementia or even illness. The patterns we build around our toilet throughout our changing lives, the disconnect society seems to have with all things pelvic, the taboo of talking about our sexual problems, all contribute to this shocking statistic. I don’t want you to be one of those people. I am absolutely passionate about this subject, I want to spread the word and empower people with knowledge. If my enthusing gives them a nugget of enlightenment, or a practical tip that might change something, that will make all the difference.
Secondly: Cost. Quite rightly, budgets are not limitless, and going down a rabbit hole of appointments after a mysterious problem that has no set end-point can be daunting. So, to reassure you, the NICE guidelines state that you should expect to commit around 3 month of rehabilitation to see significant changes. That’s about the same as a shoulder injury or sports-related problem. In my experience, you should see changes in less time than that, and the vast majority is work (i.e. exercises, habit-changing) that you will be doing for yourself, rather than paid-for time in the clinic. However, overcoming injury for any part of the body has to be a lifelong change, which is why I’m asking whether you are ready for it.
So have a think. Think about what you can put towards your health, your present, your future. Set your budget. Ensure you’re happy with it. Put yourself first, if only for one appointment. You’ll gain a great deal of knowledge, reassurance and create a clear plan for you to overcome your symptoms. Plus you’ll be helping me change the world. One lady at a time…
Ready to book your appointment?
£68 for 60 minutes Women's Health Physio Initial Assessment
£58 for 60 minutes Physiotherapy Initial Assessment
£40 for 30 minutes In Person or Virtual Follow Ups