Pelvic Floor Health and Exercise

Uncategorized Aug 08, 2020

Pelvic floor health issues are extremely common, particularly in the female population. Exercise is known to sometimes exacerbate the symptoms of pelvic floor dysfunction. Though on the other hand, exercise is crucial to good health. Unfortunately there is insufficient research in this area to make broad, definitive statements in regards to the connection between exercise and the pelvic floor. This blog will therefore provide an overview of the pelvic floor and make exercise recommendations based on our understanding of the current evidence.

 

 What is the Pelvic Floor?

The pelvic floor muscles lie at the base of the pelvis. The main roles of these muscles are support of the pelvic organs, bladder and bowel control and sexual function.

 

 What are Pelvic Floor Health Issues?

Females are much more likely to experience symptoms of pelvic floor problems, due to their anatomy and physiology. Some of the common experiences of pelvic floor issues are:

  • Urinary Incontinence
    • Stress Urinary Incontinence - Accidentally leaking urine when sneezing, coughing or exercising
    • Urge Urinary Incontinence - Needing to go to the toilet in a hurry and perhaps not making it there in time.
  • Pelvic Organ Prolapse
    • This is where the pelvic floor is not strong enough to support one or more of the pelvic organs and they descend in the pelvis causing a sensation of bulging into the vagina, heaviness or discomfort, or a feeling of pulling, dragging or dropping down.
  • Pelvic Pain
  • Sexual Pain

 

Why is there sometimes concern around exercise and the pelvic floor?

When there is an increase in intra-abdominal pressure, there is increased downward force on the pelvic organs and therefore pressure on the pelvic floor muscles. Intra-abdominal pressure is constantly fluctuating during daily life. In fact, many activities increase intra-abdominal pressure more than exercise. For example, coughing, having a bowel motion and rising from a chair causes a significant increase. However, the fact remains that exercise, particularly high impact movements increase intra abdominal pressure and put extra load on the pelvic floor. This can be problematic for women who have a compromised pelvic floor leading to symptoms such as urinary incontinence.

So we know that exercise can contribute to symptoms like urinary incontinence but what effect does exercise have on the actual pelvic floor integrity in the long term? Based on the scientific evidence we have at this point, the inconvenient answer is that we’re not entirely sure.  There are two opposing theories regarding this - On one hand, exercise might strengthen the pelvic floor, just like it does with other muscles. On the other hand, the increased intra-abdominal pressure from exercise might have a detrimental effect on the pelvic floor. This is perhaps the only area of the body where the benefits of exercise are not unequivocally clear.

 

Should we be worried about exercise after a procedure that compromises the Pelvic Floor?

Just like operations on other body parts, surgeons commonly give patients restrictions following gynaecological and pelvic floor procedures. The reason being to limit the amount of load being placed on the healing pelvic floor muscles and reduce the risk of complications like pelvic organ prolapse. Of course, this is a sensible approach for the recovery period following surgery - though it’s reassuring to know that research has shown that many of the restricted activities like lifting 20lb from a bench, lifting 13lb from the floor or doing abdominal crunches don’t increase intra-abdominal pressure more than daily activities like standing from a chair. The problem however, is that these restrictions will often be kept in place for the rest of their patient’s life in order to reduce risk.

Activity restrictions maintained in the long term present several problems:

  1. Because we don’t have enough research to make clear recommendations, the restrictions given are often needlessly restrictive. 
  2. When activity restrictions limit exercise like resistance training we miss out on a lot of the well established health and fitness benefits of exercise.
  3. Lastly, some restrictions are simply unrealistic. As mentioned above, many activities of daily life like coughing, or standing from a chair can increase intra abdominal pressure more than lifting heavy objects.

At present, there is not enough evidence to make firm recommendations regarding exercise following pelvic floor and gynaecological operations. We would suggest having a discussion with your surgeon about the risks vs benefits or restricting certain activities. 

 

What sort of exercise should I do if I have a compromised Pelvic Floor?

We know that there are many benefits of exercise like resistance training and aerobic activity and these are equally important for women with pelvic floor issues.

We suggest starting any exercise program with exercise you can do very comfortably and gradually building up over time. A resistance training program that has you performing movements that mimic everyday life is important. This will help improve your capacity to do everyday tasks. Just start at a level manageable for you. With things like lifting weights it's important to remember that the effort required to lift an object is relative to your level of strength - so as you get stronger a given weight will require less exertion. For example, if you are already lifting grandkids or bags of mulch in the garden, resistance training will make you stronger and thus better prepared for those lifts, meaning less effort required.

If you are unsure about any exercise or you start noticing symptoms of pelvic floor issues, you should have a discussion with a specialist pelvic floor physiotherapist or your doctor.

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