The silent Pee in Pelvic Floor

Welcome to the latest installment from my pregnancy blog series, where we talk about different topics and I share my personal journey.

For this, my second post, I thought I’d firstly start with the anatomy of the pelvic floor and explain exactly what it is, to provide some context - before we dive deeper.

In the most general sense, the pelvic floor consists of a group of sling like muscles. Some men may be surprised to discover they have them too whilst many women are all too aware of them - sometimes for reasons they'd rather not discuss.

Let’s explore this subject together: the anatomy, the symptoms of a dysfunctional pelvic floor, and helpful tips to improve your pelvic floor health.

Located between the coccyx (tailbone) and pubic bone you will find your pelvic floor, acting as a supporting sling to the internal pelvic organs. In males, the pelvic floor supports the bladder & bowel - the urethra (the tube to urinate) and anus, which all also pass through the pelvic floor. In women, the same again, however the vagina also passes through the pelvic floor.

Speaking broadly, the pelvic floor muscles have two major functions;

1. Acting as a support or sling for the abdominal viscera, including the rectum.

2. As a constrictor and continence mechanism, to urethral, anal and vaginal orifices (in females).
   

The support for the above comes from the connections with the bony pelvis and its attached muscles.

As a group of muscles they can be categorised into superficial and intermediate layers which include, the urogenital diaphragm, muscles (perineal, bulbocavernosus and ischiocavernoso) and the deep layer (Levator Ani muscle group and coccygeus muscles). The pelvic floor also contains connective tissues, such as the endopelvic fascia, ligaments, nerves and blood vessels. All which maintain the integrity and function of the pelvic region.

They are often associated with becoming ‘weaker’ in postnatal, pregnant and menopausal women, although these are only some of the reasons this may occur. During pregnancy, the pelvic floor experiences significant changes to accommodate the growing foetus and prepare for childbirth. The increasing weight and pressure of the uterus can weaken the pelvic floor muscles and lead to pelvic floor dysfunction. Hormonal changes during pregnancy also affect connective tissues, making them more elastic to allow for easier delivery. Lesser spoken about is the fact the pelvic floor can also become too tight, which is a common incidence amongst those who are keen on sports or who may have suffered trauma. Also it's a common misconception that the pelvic floor isn't affected if you have had a caesarean, this is not true.

Conditions associated with pelvic floor dysfunction may include; pelvic organ prolapse, urinary incontinence ( be that stress or urge incontinence) and fecal incontinence.

So, what are the common symptoms of pelvic floor dysfunction?

• leaking whilst coughing or sneezing.

• A feeling of heaviness in the vagina

• Painful sex

• Lower back pain

• Recurrent UTI's (both in men and women)

• A bulge at the opening of the vagina (or sensation as if a tampon is present).

• Erectile dysfunction or inability to orgasm

• Flatulence whilst lifting or bending over.

• Inability to full empty bowels/ conversely inability to control bowel movement.

These symptoms can be extremely embarrassing and difficult to talk about for some people, and also debilitating - making it increasingly difficult for women to talk about and seek help. As women, we're often led to believe these symptoms are just part of the process of having a baby and something we should 'put up with' for the rest of our lives. Although these symptoms may be common, they're not normal & you shouldn't have to live with them.

Ladies, if prenatal, and if you haven’t already, I encourage you to inspect your vaginas (no really!), get familiar with what your "bits and pieces"look like. That way you will be empowered and know, postnatally whether there have been any changes. Things can look quite different on the other side of birth and it’s good to become familiar with what was what beforehand. It will help you to advocate for yourself if you do have any concerns.

After I had my daughter, I was extremely worried about what was happening down below.

In honestly, I had no idea what it'd looked like in the first place. I remember asking my husband if he'd mind having a look - and was dismayed when he told me he didn’t know what he was looking for!

So I held up hope for the 6-8 week postnatal check with our local GP surgery. However, once in the appointment the nature and structure of it felt more like a tick box exercise, as lovely as the practitioner was. I had to ask for her to physically assess and observe to see whether I was exhibiting any signs of prolapse, or if anything was healing incorrectly - something I was worried about. Afterwards I felt silly having had to ask.

After speaking to friends and other women at baby groups, I realised I wasn't alone in this experience. This was one of the reasons I wanted to ensure that women have better resources available to them and also understanding what’s normal and what is not.

Be mindful that things will look different after birth, hormones also play a massive role and this is completely normal. Also remember - the openings of a vagina are like any other muscle, it is not an inelastic orifice. Remember the pelvic floor is comprised of muscular bands (which have stretched to give birth) and it takes time for them regain their resting tone, so things can look a bit bigger/ different.

A slight plug but, this is where the Mummy MOT consultation can help you to identify whether you are suffering from any signs and symptoms of pelvic floor dysfunction, and allows a open platform for you to discuss anything worrisome you may be experiencing. I know for me personally, I really benefited from having this type of assessment done.

If you'd like to understand more about the anatomy, and are a visual learner (like me!) have a little look at this link -

https://www.youtube.com/watch?v=C4iFG20zdlo - From 5.15 minutes Dr Bri gives a great presentation and explanation of the pelvic floor.

Stay tuned for the next installment,

G x

References:

Raizada, V. and Mittal, R.K. (2008) ‘Pelvic floor anatomy and Applied Physiology’, Gastroenterology Clinics of North America, 37(3), pp. 493–509. doi:10.1016/j.gtc.2008.06.003.

Sapsford, R.R. et al. (2008) ‘Pelvic floor muscle activity in different sitting postures in continent and Incontinent women’, Archives of Physical Medicine and Rehabilitation, 89(9), pp. 1741–1747. doi:10.1016/j.apmr.2008.01.029.

Raizada, V. and Mittal, R.K. (2008) ‘Pelvic floor anatomy and Applied Physiology’, Gastroenterology Clinics of North America, 37(3), pp. 493–509. doi:10.1016/j.gtc.2008.06.003.

Pelvic floor muscle activity in different sitting postures in continent and incontinent women

Ruth R Sapsford 1, Carolyn A Richardson, Christopher F Maher, Paul W Hodges

Perucchini, D. and DeLancey, J.O. (2008) ‘Functional anatomy of the pelvic floor and lower urinary tract’, Pelvic Floor Re-education, pp. 3–21. doi:10.1007/978-1-84628-505-9_1.