Don’t ignore your pelvic floor!

Many people feel uncomfortable talking about pelvic health and find that it is a difficult conversation to bring up. Pelvic floor dysfunction affects both men and women and can have a significant impact on quality of life, so it’s important that you seek medical advice if you have any of the symptoms described below.

The pelvic organs in women include your bladder, womb, bowel, and rectum, all of which are held in place by a layer of muscles which help to join your pelvic organs to your pelvis, this is called a pelvic floor. Your pelvic floor helps ensure these organs remain up inside your pelvis. However, the muscle can often become torn or stretched. In men, your pelvic floor muscles and ligaments are responsible for keeping your bladder, bowel, and prostate in place. While pelvic organ prolapse is more common in women, men do suffer from a range of pelvic floor disorders¹.

Evidence indicates that pelvic organ dysfunction is common and is seen in 50% of women who have given birth and up to 40% of the general female population aged 45 to 85 years², but it can also affect much younger women too³. The prevalence of stress urinary incontinence reported in the literature during pregnancy is 20-67%⁴. A further one in 10 women experience faecal incontinence post-delivery Pelvic floor dysfunction encompasses a wide variety of clinical conditions, including:

urinary incontinence • emptying disorders of the bladder • faecal incontinence • emptying disorders of the bowel • pelvic organ prolapse • sexual dysfunction • chronic pelvic pain⁵.

Without strong support, pelvic organs may bulge down into the birth canal, this is called a prolapse.

The symptoms that they cause vary, depending on the type of prolapse but can include:

a feeling of heaviness around your lower tummy and genitals • a dragging discomfort inside the birth canal • feeling like something is coming down into the birth canal – it may feel like sitting on a small ball • feeling or seeing a bulge or lump in or coming out of the birth canal Difficulty emptying your bladder or bowel

Pelvic organ prolapse is caused by several factors, including pregnancy, childbirth, congenital or acquired connective tissue abnormalities, constipation, ageing, weakness of the pelvic floor and menopause^2,6.

However, with lifestyle changes and exercises to develop balance and co-ordination between the pelvic floor, deep abdominal and hip muscles, many pelvic floor problems can be significantly improved. Evidence shows that supervised pelvic floor muscle training for at least three months is as effective as surgery for around 50% of women with stress urinary incontinence⁷. Women with urinary incontinence (UI) 3 months postpartum who performed pelvic floor exercises were 40% less likely to report any UI 12 months after delivery than those who did no pelvic floor exercises or usual postpartum care⁸.

Whilst many people have weak pelvic floor muscles, others have overactive muscles and contract them without realising it. This leads to discomfort, muscle fatigue, and tightness and potentially leading to bladder and bowel symptoms and dyspareunia (pain during sexual intercourse). Pelvic floor muscle strengthening would be inappropriate for these people, but by downtraining the pelvic floor through relaxation, stretches, breathing exercises and on occasion manual therapy, symptoms improve, and balanced pelvic floor function is restored.

If you are experiencing any of the symptoms mentioned, please contact your GP for further advice.

What are AHPs doing to support staff at RWT?

RWT AHPs planned a Pelvic Health Campaign from 27^th June to 1^st July 2022. There were live and recorded educational sessions via Teams, educational posters, and face-to-face sessions with experienced physiotherapists who specialise in pelvic floor disorders, as part of our wider public health initiative. The aim is to educate our staff on the importance of taking care of their pelvic floor to reduce the risk of pelvic floor dysfunction and prolapse and how to recognise symptoms early.

Figure 1: Lisa Hastie and Ria Moran at our “don’t ignore your pelvic floor” event

The team approached this opportunity with their usual enthusiasm and were pleased to speak to many staff members from all areas as they passed by the stall situated by Greggs. A number of information leaflets were taken by staff and several questions were answered.

Overall, the team feel this was a huge success in raising awareness and will help make pelvic floor dysfunction easier to talk about and less of a taboo.

Ria’s experience

The support and encouragement from our management team in highlighting the importance of ‘promoting’ the awareness of pelvic health with a prevent rather than cure ethos, has been wonderful. Allowing us a full week of ‘Promoting Pelvic Health’ across all sites covering all areas and including men has been invaluable. The idea that the webinars were run over the lunchtime period to allow more participants to attend and making the recording available for ALL staff to be able to gain access to it ensures inclusivity. The face-to-face promotions at New Cross and Walsall Hospitals went extremely well. Resulting in a number of staff contacting the team for further information.

I’d like to thank Ros, Nicky and the wider management and communications team for all their help in pulling this Pelvic Health ‘Week of promotions’ altogether. I am committed to continuing to educate people about Pelvic Health, working alongside midwives and health visitors for pre/post-natal care awareness. My aim is to educate within schools to ensure we promote the importance of pelvic health at an early age and break down some of the taboos around the subject.

*Note: the term ‘women’ is used throughout this article, but this should be taken to include those who do not identify as women but who have female pelvic organs.

By Dr Ros Leslie, Steph Turner, Lisa Hastie, Ria Moran, and Dr Nicky Eddison

References

MacLennan AH, Taylor AW, Wilson DH, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG. 2000;107(12):1460-1470. doi:10.1111/J.1471-0528.2000.TB11669.X
Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;(12). doi:10.1002/14651858.CD003882.PUB4/MEDIA/CDSR/CD003882/
Weintraub AY, Glinter H, Marcus-Braun N. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int Brazilian J Urol Off J Brazilian Soc Urol. 2020;46(1):5. doi:10.1590/S1677-5538.IBJU.2018.0581
Brown SJ, Donath S, MacArthur C, McDonald EA, Krastev AH. Urinary incontinence in nulliparous women before and during pregnancy: Prevalence, incidence, and associated risk factors. Int Urogynecol J. 2010;21(2):193-202. doi:10.1007/s00192-009-1011-x
National Institute of Clinical Excellence (NICE). Pelvic floor dysfunction?: prevention and non-surgical management. 2021;(December).
Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 1998;25(4):723-746. doi:10.1016/S0889-8545(05)70039-5
Overview | Urinary Incontinence and Pelvic Organ Prolapse in Women: Management | Guidance | NICE.; 2019. Accessed May 23, 2022. https://www.nice.org.uk/guidance/ng123
Boyle R, Hay-Smith EJC, Cody JD, Mørkved S. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women: A short version Cochrane review. Neurourol Urodyn. 2014;33(3):269-276. doi:10.1002/nau.22402