Q: I have trouble with leakage (no trampolines for me!) and I’m seeing signs of pelvic organ prolapse. Can I stop it from getting worse, or is this inevitable?
The muscles along the pelvic floor hold up organs like the bladder, uterus and colon, and need to be kept strong, just like other muscles in the body. If they become deconditioned, a variety of complications could occur — from organ prolapse to difficulty with bowel movements and urinary incontinence.
People often associate pelvic floor dysfunction with vaginal birth (to the point where some women ask for Caesarean sections to avoid it) — and after long labours where the head sits in the pelvis for a prolonged period, the issue can indeed be worse. But there’s good evidence that shows it’s pregnancy itself that increases the risk, not the method of delivery. Nerve damage is the most likely cause of pelvic floor weakness, and carrying a person on top of those muscles for 40 weeks doesn’t help. Genetics also plays a role, as do lifestyle factors.
Women who don’t have children can have problems with their pelvic floor, too. The hormone drop that comes with perimenopause and post-menopause can cause irritability of the bladder and the muscles that control it. Other times, good ol’ gravity is at fault; as things settle and we become weaker in general, those pelvic floor muscles are vulnerable as well.
The good news is there’s a lot you can do both before and after you notice problems. Ask your doctor about pelvic floor workouts. Kegels — contract-and-release exercises you can do anywhere — are a good place to start. (To find the muscles, try stopping urination midstream. Those are the muscles you’re trying to engage.) Women of every age can do Kegels as a preventive exercise, and once you get the hang of them, you can do reps while you’re standing in line at the grocery store or at the bank machine.
For women who experience symptoms, pelvic physiotherapy with a trained professional is more involved and very effective at teaching people to control pelvic floor muscles. Other options include a pessary (which is put inside the vagina to hold the organs up) or surgery as a last resort.
If you do Kegel exercises regularly and correctly, you’ll be able to feel those internal pelvic floor muscles getting stronger. You don’t have to do them all day long — just build a couple of sets of 10 into your routine, and as you get stronger, try holding the contractions longer. Eventually, you might be able to cough standing up without worry!
Danielle Martin is a family physician and vice-president, medical affairs and health system solutions, at Women’s College Hospital in Toronto