Pelvic Floor

What is the pelvic floor?

The pelvic floor is a group of muscles in the pelvic area that support the bladder, bowel and uterus (womb). These muscles are important in helping to control your bladder and bowel, and play a role in sexual function. Pelvic floor muscles can become weakened through pregnancy and childbirth, constipation, heavy lifting, and being overweight.

When the pelvic floor is strong, it supports the pelvic organs to prevent problems such as:

• incontinence (the involuntary loss of urine or faeces)
• prolapse (lack of support) of the pelvic organs (where the uterus drops into the vagina, or the bladder or bowel bulge into the vagina)

Why do pelvic floor muscles get weak?

Pelvic floor muscles can become weak by:

• not keeping them active
• pregnancy
• childbirth - particularly following delivery of a large baby or pushing for a long time during delivery
• being overweight
• constipation (excessive straining to empty your bowel)
• heavy lifting
• coughing for a long time (smoker's cough, bronchitis or asthma)
• changes in hormonal levels at menopause
• getting older

It is important to keep your pelvic floor muscles strong. Women of all ages need to have strong pelvic floor muscles.

Pelvic floor muscle training can help you:

• with stress incontinence
• during pregnancy to help the body cope with the growing weight of the baby - health, fit pelvic floor muscles before the baby is born will return to normal more easily after the birth
• after the birth of your baby
• as you age - hormone changes after menopause can affect bladder control and weaken the pelvic floor muscles

What is urinary incontinence?

Urinary incontinence is the involuntary leakage of urine. It is a common problem, with nearly a quarter of the population affected. Urinary incontinence affects both women and men - it is more common in women.

There are several different types of urinary incontinence. The three most common types are:

• stress incontinence - involuntary loss of urine after laughing, coughing, sneezing, lifting or jumping
• urge incontinence - the loss of urine accompanied by a sudden and strong desire to pass urine
• mixed incontinence - a combination of both stress and urge incontinence

If you experience any level of incontinence (from small accidental leaks to complete loss of control of your bladder) it is a good idea to seek help from a doctor. Your doctor will talk to you about your symptoms and arrange some further tests - this may include a urine sample or an ultrasound.

It can be helpful to keep a bladder diary. A bladder diary records how much urine you pass and how often, and whether you had any leakage episodes. An example of a bladder diary can be found on the Continence Foundation of Australia website.

How do I manage urinary incontinence?

All types of incontinence can generally be improved by pelvic floor muscle training. You can see a pelvic floor physiotherapist or a nurse continence adviser to make sure you are doing the exercises correctly. Here are some links to websites which explain how to do pelvic floor exercises:

• www.thewomens.org.au/health-information/pregnancy-and-birth/a-healthy-pregnancy/the-pelvic-floor
• www.continence.org.au/pages/pelvic-floor-women.html
• www.bladderbowel.gov.au/assets/doc/brochures/06PelvicFloorWomen.html

What is pelvic organ prolapse?

Pelvic organ prolapse is where the pelvic organs (the uterus, bladder or bowel) drop or bulge in the vagina. You might feel this as a bulge or a heavy or dragging sensation in your vagina. Other symptoms can be pelvic pain, difficulty emptying your bladder or bowel, and pain or difficulty having sex. Pregnancy and childbirth are strong risk factors for getting pelvic organ prolapse, but other causes can be increasing age, menopause, ongoing constipation, heavy lifting and long-lasting cough.

If you think you have a pelvic organ prolapse and it is causing you symptoms, it is a good idea to see your GP or a Family Planning clinic. The doctor can examine you and discuss ways to help you. These might include weight loss, avoiding constipation and seeing a pelvic floor physiotherapist for advice about pelvic floor exercises. Other options may include wearing a pessary (a plastic or rubber device that you wear in the vagina to give internal support to the pelvic organs) or surgery.

How can I prevent weak pelvic floor muscles?

To prevent damage to your pelvic floor muscles, avoid:

• constipation and straining with a bowel motion
• heavy lifting
• repetitive coughing and straining
• putting on too much weight

Make your pelvic floor training part of your everyday life by:

• tightening your pelvic floor muscles every time you cough, sneeze or lift
• doing regular activity such as walking
• doing your pelvic floor muscle exercises regularly - when you are stopped at a red light is a good time

If you aren't sure whether you are exercising your pelvic floor muscles correctly or you have urinary problems, make an appointment with a pelvic floor physiotherapist or a nurse continence adviser.

For more information

Family Planning NSW Talkline - www.fpnsw.org.au/talkline or 1 300 658 886

National Relay Service (for deaf people) - 13 36 77

TIS National's interpreting service - 131 450

Visit you nearest Family Planning NSW clinic - www.fpnsw.org.au/clinics

Continence Foundation of Australia - www.continence.org.au

National Continence Helpline - 1800 330 066