Your Pelvic Floor, Menopause & Incontinence - What's the Connection?
Today marks the beginning of World Continence Week, an opportunity to shine a light on the issue of incontinence.
Whilst this topic is often shrouded in shame and taboo, it is something that impacts more than 300 million people world wide. 1 in 3 women will experience some form of incontinence during their lifetime, and this not only happens to women who have just given birth or the elderly – it happens to yoga practitioners, ballerinas, athletes and those transitioning through perimenopause and menopause. Sadly, many will suffer in silence, embarrassed to seek support. But understanding the causes of incontinence and the ways we can strengthen our pelvic floors can empower us to navigate this common, but challenging, situation.
What is the pelvic floor and where is it?
The pelvic floor is a dynamic and complex layer of muscles that support the pelvic organs and stablise the pelvis. Stretching like a muscular trampoline from the tailbone to the pubic bone (front to back) and from one sitting bone to the other sitting bone (side to side). Like any muscle in our body a healthy pelvic floor contracts and lengthens, is able to support weight, has full range of movement and a balance of tone and elasticity. The pelvic floor works as a team with our core and back muscles to absorb force, support breathing and move and support the pelvic bones. They allow for sexual function, sensation and pleasure and birth new life into the world. They also control elimination - which is why the weakening of the pelvic floor muscles is one of the main causes of incontinence.
What causes a weak pelvic floor?
Weakening of the pelvic floor muscles is one of the main causes of incontinence. Pregnancy and childbirth are undoubtedly two of the most common reasons women find the strength of their pelvic floor is compromised, as this incredible part of your body is pushed to its limits. Whilst you’re pregnant, your body releases hormones that loosen your pelvic floor muscles, allowing your baby to grow and be delivered safely. This natural phenomenon - whilst incredible! - can leave many new mothers experiencing pelvic floor dysfunction, which can lead to incontinence during the postpartum stage and beyond.
But, it’s important to remember that your pelvic floor health can be impacted, even if you have not had a baby. A 2016 Swedish study revealed that 1 in 5 women over 45 - who had not given birth - reported symptoms of incontinence. Stress, emotional trauma and physical injury can all have a detrimental effect on the functionality of your pelvic floor, as well as your day to day activities.
Spending the majority of your day sitting down - which many of us have experienced during lockdown - can be another root cause of pelvic floor dysfunction. Like any muscle, our pelvic floor needs to be active and mobile to allow our blood and energy to effectively flow to it. Spending 8 hours a day sitting at a computer is common for many of us in today’s working world. However, this lack of activity compresses our pelvic floor reducing its mobility. Whilst we are concentrating on our work, our attention is taken away from the way we are holding our body and we can often put strain on our pelvic floor muscles - by constantly tensing - without realising it.
Your Pelvic Floor and Menopause
Whilst incontinence can affect women of all ages, our pelvic floor health is also intrinsically interlinked with the menopause. Our vaginal canal, bladder, urethra and pelvic floor all play a role in preventing incontinence - and are all impacted by the hormonal changes that come with the menopause. These areas of the body are all lined with oestrogen receptors and as we begin to enter perimenopause in our 40s, oestrogen levels begin to fluctuate and then decline in menopause. The decrease in oestrogen can mean the tissue of this complex area is not as happy or healthy as it once was - and therefore not as robust. This transition can lead to menopause related continence in a few different forms.
The thinning of the vaginal walls can lead to Atrophic Vaginitis and manifest itself in various symptoms including vaginal dryness, pain during sex and urinary leakage during sex, which is something thought to effect around 25% of women who experience incontinence. Our pelvic floor muscles - weakened by both the decrease in oestrogen and natural ageing process - may no longer be able to provide as much support as they once did. This can lead to stress incontinence - where you leak when you cough, laugh or sneeze. As the tissue of our bladder becomes weaker you may find that the frequency and urgency that you need to go to the toilet may increase - this is called urge incontinence.
Whilst the above illustrates how the hormonal changes our bodies experience during menopause can create a perfect storm for incontinence, it is not something you need to accept as your new normal. There are many things you can do to improve your pelvic floor health and reduce your risk of leaks, no matter what age or life stage you are at.
A Healthy Pelvic Floor
When it comes to the resilience of our pelvic floors, prevention is better than cure. It is much easier to maintain healthy pelvic floor muscles than repair ones that have been damaged. This is why it’s so important to move consciously and look after our bodies during our 20s and 30s, so that when you transition into menopause your pelvic floor is already toned and healthy.
However, it is never too late to make a positive change and improve your pelvic muscle health. The pelvic floor is intricate and complex, but like any muscle in our body it simply needs to be exercised, toned and cared for to maintain its functionality. When we leave our muscles dormant for too long they lose their range of movement and elasticity. A healthy pelvic floor has capacity to lengthen and contract, to relax and to turn off when not needed and turn on when needed. When all this happens the connective tissue of pelvic floor muscles have more sliding and muscles can work independently and effectively - this is what we want to achieve when looking to reduce the risk of incontinence.
Why Kegels may not be right for everyone
One of the most highly popularised methods of strengthening your pelvic floor are kegel exercise, and for good reason. They are simple, quick and easy to integrate into your daily routine - however, they may not be the right course of action for everybody. For some women, they have a weak pelvic floor from too much stress and tension - so repetitive tensing with kegels may actually be detrimental to their recovery. Imagine - if you were trying to strengthen your legs muscles after an injury, would you go straight in with doing 100 lunges a day?
When muscles are weak and dormant, we need to wake them up - which is something kegels do very effectively. However, we also have to help them to relax. If our pelvic floor muscle is always “on” from doing kegels or clenching from stress, it can get tense, fatigued and worn out. Not only can this reduce its range of movement, but it can also cause compensation from other muscles, which will lead to disruptive movement elsewhere in the body. Putting too much pressure on your pelvic floor can also result in devastating further damage including prolapse, which is why it’s so important to listen to your body and understand what it needs.
When trying to strengthen and repair any damage in the body the key is not to make muscles that are already habitually tight more tight. Instead you want to relax those muscles, give them a rest and articulate other muscles that are not worn out - which is where key poses in yoga have an effective impact.
To find our more about how yoga can reduce the risk of incontinence, check out our blog post “Yoga for a Healthy Pelvic Floor” or get in touch to book a free discovery call.