Don’t go to the toilet ‘just in case’ and other pelvic floor wisdom

Especially as we get older, pelvic floor health requires a focus on the big picture. We’re not just talking Kegels.

That big picture includes our bladder and bowels, and how these are affected by issues such as diet, hydration, exercise, stress and breathing.

Most of us are familiar with the basics of our pelvic floor and the way it moves— drawing up when we contract it, and down as we relax it. Note: we need to be able to do both.

Those muscles also contract when we stand up from a chair or cough, and they need to support our pelvic organs when we lift weight. But in the toilet their job is to relax.

While that might sound straight forward, figures from our national body for continence health tell a different story.

About half of Australian women have urinary leakage or pelvic organ prolapse, and one in 10 has fecal incontinence, though that’s likely to be under-reported.

One in 10 men has urinary leakage too, often following prostate removal.

American pelvic floor therapist Sara Reardon calls herself The Vagina Whisperer. She points out that more women have urinary incontinence than osteoporosis, diabetes or high blood pressure, yet these receive more attention. Presumably because we’re still awkward around pee and poo.

Having babies isn’t the only cause of incontinence or prolapse though it heads up the list. If you have younger women in your life who are pregnant or planning to have children, have them watch Reardon’s TED talk.

As she says, we need to talk far more about vaginal health and how to maintain a healthy pelvic floor through and after childbirth.

Menopause can affect the pelvic floor too. The loss of hormones can weaken the muscles and reduce blood flow.

So let’s dive in, starting with pee.

It’s normal to empty our bladder every two to four hours, and up to twice during the night. If we’re drinking too much liquid we’ll need to go more often, which will be a problem for anyone concerned about leaking.

On the flipside, we don’t want to drink too little either. Dehydration can create a range of problems, including UTIs.

Certain food and drink can also irritate the bladder in some of us: spicy food and caffeinated, alcoholic, or fizzy drinks are the main culprits.

Try to rely mostly on water and sip it throughout the day rather than guzzling now and then.

When we pee, it’s important to relax the pelvic floor rather than trying to expel it with force. Sara Reardon calls this ‘power peeing’.

Some of us who’ve been used to multi-tasking and being in a rush have developed the habit of doing everything quickly, including toilet visits.

So slow down. Reardon recommends planting our feet flat on the floor, leaning forward onto our elbows, and taking a few deep breaths. Breathing helps the pelvic floor relax.

Another bad habit is never passing a toilet without stopping in ‘just in case’. Go only when you need to go.

Of course, it’s also not a good idea to keep putting it off. If we keep holding, holding, holding, our pelvic floor muscles become over tense, and we can damage the bladder.

When it comes to poo, we’re after a well-functioning bowel. The straining associated with constipation puts pressure on the pelvic floor, but a constipated bowel can reduce bladder capacity and control as well.

These two are neighbours, so if the bowel is full for long periods it presses up against the bladder. When the bladder can’t expand, we’ll feel the need to pee before we should and have to go too often.

In addition, straining can increase blood pressure and heart attack risk.

If we put a low stool under our feet (or stand up two rolls of toilet paper and put a foot on each) we’ll be in more of a squatting position and our pelvic floor can be more relaxed. Again, try not to hold your breath.

Staying well hydrated, exercising regularly, and eating the recommended amount of plant-food such as vegies, legumes, seeds, and fruit will encourage a healthy bowel in a lot of us, but not everyone.

Be mindful that some medications bring about constipation (e.g. some cancer, blood pressure and pain medications, some anti-depressants, and so on). We’ll probably need laxatives prescribed for that.

Similarly, if we have specific bowel conditions, we’ll have regimes to follow and foods to avoid.

But the bottom line, to use a very ordinary pun, is that constipation is to be avoided.

Exercise is vital for a healthy pelvic floor, and as you’ve worked out, this doesn’t just mean Kegels.

About 23 years ago American biomechanist Katy Bowman happened to say in an interview that squatting ‘as found in nature’ was valuable for pelvic floor strength.

It created a kerfuffle, because everyone knew that Kegels were the way to strengthen the pelvic floor. These were named after American gynecologist Arnold Kegel, and they involve contracting and relaxing the pelvic floor muscles.

They have their place, and we do need to know how to carry out that contracting and relaxing.

But, as Reardon reminds us, those muscles also need endurance and coordination.

She has her patients do them for different lengths of time — a few quick contractions then relax. Then increase the contraction time to 5 to 10 seconds. And do it while standing, sitting, walking, and exercising.

Importantly, again, we need to be able to breathe at the same time. The pelvic floor is rigid when we hold our breath.

What Katy Bowman meant was that Kegels aren’t the whole story.

The pelvic floor muscles are no different from any others. They need different types of movement, and the state of our pelvic floor will reflect the way we move our whole body over time.

When she talked about squatting, she wasn’t particularly talking about gym exercise. She meant everyday gardening, cleaning, getting down on the floor and back up, reaching into low cupboards, playing with pets and children, and so forth (squatting to garden was what I was trying to convey with that photo… are they picking strawberries?).

She meant pushing off with our glutes — our bottom muscles — when we walk, so they get stronger.

She meant using our bodies, living an active life, not sitting for hours.

What’s stress got to do it? As we know, it makes us pee and poo more often, and that becomes a problem when worry or anxiety is ongoing. But stress can also result in more tension in the pelvic floor.

Aside from bladder and bowels, the pelvic floor plays a central role in sex. Research suggests that women with a strong pelvic floor are more likely to be sexually active. And sexual activity boosts circulation in those muscles.

But as we get older, some of us, for a range of reasons, aren’t falling over ourselves to be sexually active. That’s our call, but we want the healthiest pelvic floor possible regardless.

It’s a pity it can still be so hard to talk about this fundamental part of us, even with our GPs. But if you do have any sign of prolapse or leakage, and you haven’t dealt with it, rest assured a visit to a pelvic floor physio can change your life.

Taking care of our pelvic floor, and our pelvic area in general, is a key part of healthy ageing, and the more we can normalise this conversation, the more women — especially older women — can live their lives without shame and embarrassment.

Photo Source: Katy Bowman