Why You Need to Strengthen Your Pelvic Floor Now

From maintaining continence, keeping you upright, and delivering babies, your pelvic floor is one of the most integral parts of your body.

You may have heard of your pelvic floor—maybe an instructor made a passing comment about it in a workout class as you exercised your core, or OB-GYN referenced it during a visit.

Unfortunately, a lot of people (women in particular) don’t learn about their pelvic floor, and the importance of keeping it healthy, until too late in the game. A strong pelvic floor helps you sit and stand up straight, maintain continence, have penetrative sex comfortably, along with a number of other essential functions. But by the time you reach perimenopause (the years-long stage leading up to menopause that can start in your thirties), you might already have issues with your pelvic floor, which might leave you wondering: how, when, and why is this happening?

“It goes back to what girls are taught in schools about their bodies and what women are taught about their bodies related to childbirth… which is, a little bit, but not enough,” says Gillian McCormick, a Vancouver-based physiotherapist specializing in pelvic health and host of the podcast Small Conversations for a Better World. When women start to experience things like mild incontinence, “Often, women are just told ‘well, you’re an aging woman and you’ve had a baby, what do you expect?’”

Here’s everything you need to know about your pelvic floor, issues and symptoms that affect your pelvic floor, and how to take care of it even before you experience any problems.

What is your pelvic floor and what does it do?

Your pelvic floor is a group of muscles at the base of your pelvis, right at the bottom of your core. It makes a sort of bowl-like structure that runs from your pubic bones in the front to your tailbone in the back.

Its main functions include posture support and helping you to stand and sit upright, holding up your pelvic organs (which include the bladder, uterus, and large intestine/rectum), and assisting with circulation in your lower extremities. Your pelvic floor also helps you have penetrative sex, hold pee in, and deliver a baby vaginally.

(Related: Your Guide to a Leak-Free Workout. Yes, We’re Talking About Pee

What are some common pelvic floor issues?

“When most people think ‘pelvic floor’ they think about weakness and want to strengthen their pelvic floors, but we actually see an equal amount of people with pelvic floor tightness as pelvic floor weakness,” explains Jessica Metcalf, a registered physiologist at Toronto Physiotherapy. “Some people need strengthening; others need the opposite, to learn to release pelvic floor tension.” Both tightness and weakness can lead to symptoms in the pelvic region.

There are three main categories of symptoms that are specific to perimenopause, says Metcalf. Genital symptoms (like dryness, burning, irritation), sexual symptoms (like discomfort or pain during sex, and altered sexual function), and urinary symptoms (like urgency, frequency, and more UTIs).

Another common symptom is pelvic organ prolapse, which is when a pelvic organ (usually the bladder) drops from its normal position in the body and pushes against the walls of your vagina. “We see this quite commonly in cases where a woman has had a hysterectomy, so she’s lost that kind of structural sling of support from the cervix and the uterus to hold her bladder in place,” explains Erika Burger, a Halifax-based physiotherapist specializing in pelvic floor health. Pelvic organ prolapse is also fairly common postpartum, though it usually resolves itself then.

What causes these symptoms?

A number of things. According to Michiko Caringal, the owner of Happy Down There, a pelvic floor physiotherapy clinic in Toronto, trauma is the number one reason for pelvic floor symptoms. Delivering a baby vaginally, for example, causes a lot of physical trauma in the pelvic region, but issues are usually short-term. Other forms of trauma can lead to more long-term symptoms and pain.

Sexual trauma, for example, can lead to pain and a lower pain threshold. “In that case, your brain is involved, as well as your central nervous system. You’ve become so sensitized that the vicious cycle of pain happens,” explains Caringal. In other words, your body begins to anticipate pain anytime your pelvic region is stimulated. This is, unfortunately, common for survivors of sexual abuse—according to a study published in Southern Medical Journal, people with a history of sexual abuse were more likely to have chronic pelvic pain.

Changes in hormonal levels can also affect the health of your pelvic floor—especially during perimenopause. “Progesterone and estrogen have a large role to play in how our bodies make and use the tissues of our pelvic floor,” says McCormick “Within that whole area, there are a ton of estrogen receptions, so that tissue gets fed by estrogen. When your estrogen levels are all over the map, and maybe low, we can start to see changes in tissue elasticity.”

(Related: 9 Questions About Menopause You’ve Been too Embarrassed to Ask)

What happens during perimenopause?

Ultimately, it all has to with the state of your muscles, which are affected by hormone changes during perimenopause as well as other biomechanical factors, like your posture. During perimenopause, your body produces way less estrogen, leading to fewer ovulations and changes in your pelvic region, like changes to your tissue’s elasticity.

In a hypotonic muscle situation (where the muscles are longer and weakened), your muscles are softer and mushier. “So, you need to strengthen the muscles in order to not have any kind of fecal incontinence,” says Caringal. “But, if you have urinary urgency, then you’re probably on the other side of the spectrum and hypertonic.” In that case, your muscles are tighter and shorter and you need to release the tension. Some symptoms caused by a hypertonic pelvic floor include pelvic pain, a burning sensation in the vagina, painful sex, and dryness.

What is pelvic floor physiotherapy? What can you expect at an appointment?

Pelvic floor physiotherapists are licensed physios who have additional qualifications in pelvic floor health. They’re super knowledgeable on how to assess and treat this muscle group. The treatment you receive at from a pelvic floor physio can also be very intimate and vulnerable. “So, it needs to feel safe and be very inclusive,” says Caringal. “That’s the basic foundation.”

Every practice, and every patient’s needs, are different. But generally, this is how it goes: At your first appointment, your physio will do an assessment of region. This might include an assessment of your diaphragm, abdominal muscles, hips, inner thighs, glutes, and legs. Then, your physio will take a look at your external genitalia and assess the health of the skin. “I look to see if it’s healthy, or if it’s patchy, blistering, anything of that sort,” Caringal says. After that, the physio will do a Q-tip test. Essentially, inserting a long Q-tip and touching certain parts of the labia and assessing if there’s any numbness, burning, tingling, or anything of that sort. They’ll then move on to a finger test, where they’ll insert one or two fingers into the vaginal wall and move around to feel if there are any tender points of weird sensations. If the vagina is too painful, the physio may conduct this assessment rectally.

Once the assessment is done, the physio may teach you pelvic floor exercises, like Kegels, breathing exercises, or stretches to do at home. There might also be manual massage therapy component, like myofascial release and connective tissue work to relieve symptoms, says Burger. “Like, someone who has repetitive UTIs or a lot of bladder urgency or pain deep in the pelvis during intercourse, we could do a lot of manual work on the muscles and fascia to normalize tension in that tissue and decrease the symptoms.”

They might also talk to you about other parts of your body. “Your pelvic floor muscles are just one muscle group in the middle of your body and they work in conjunction with the rest of your body,” says McCormick.

(Related: 14 Ways to Enjoy Better Sex as You Age)

What can you do at home to keep your pelvic floor healthy?

“I think a common thing is people pee and poo and strain it. That’s the worst thing you can do,” says Caringal. “The toilet is supposed to be relaxing! I say number one healthy pelvic floor tip: just relax on the toilet.”

Another tip to keep your pelvic floor healthy: be aware of it. Caringal suggests breathing deeply and paying attention to how your diaphragm and pelvic floor moves. Burger suggests taking a look down under to check out what the tissue looks like. “Check for any changes in your vaginal tissue, look at the vulva, look for any discolouration, changes in pigmentation, loss of muscle mass, any changes in how the skin looks,” she says. “Has the skin become shiny? Or has it become white, or red? Those are all signs that we should see our physician.”

Next: 5 Changes to Your Diet to Help Ease Perimenopause and Menopause Symptoms

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Originally Published in Best Health Canada