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Weak Pelvic Floor and Incontinence

Written by: Becki Murray

Updated by: Becki Murray

Last Updated: 1 February 2024

In recent years, there’s been an important increase in conversations around the pelvic floor – especially pelvic floor weakness and its related incontinence. Significantly, it’s a condition that affects more people than you may think, especially women, with the consequences of a weak pelvic floor ranging from the irritating to the potentially lifestyle and mental health-affecting especially if it becomes severe. Luckily, there are some things you can do to help. Read our FAQs to discover what your pelvic floor actually is, what may cause it to become ‘weak’, and the exercises and tweakments that can help you strengthen it, so you don’t have to deal with its consequences, including incontinence, alone.

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What is the pelvic floor?

The pelvic floor refers to a group of muscles, ligaments, and connective tissues that form a supportive hammock-like structure at the base of the pelvis. Stretching from the pubic bone at the front of the pelvis to the tailbone at the back, it plays a crucial role in supporting the pelvic organs, including the bladder, uterus in women, and rectum.

The pelvic floor is essential for maintaining urinary and bowel continence and preventing pelvic organ prolapse. In particular, the pelvic floor muscles help control the openings of the urethra, vagina, and anus, while also preventing the pelvic organs from descending into the vaginal canal. They work in coordination with other core muscles too, to stabilise the pelvis and spine, particularly during standing, walking, and lifting; and they play a role in sexual function, contributing to arousal and orgasm.

What causes a weak pelvic floor?

A weak pelvic floor is a condition where the group of muscles, ligaments, and connective tissues that make up the pelvic floor become lax or lose strength. Several factors can contribute to it, including:

  1. Pregnancy and childbirth: The strain placed on the pelvic floor during pregnancy and the stretching that occurs during childbirth can lead to muscle weakness, especially after multiple pregnancies.
  2. Ageing: The pelvic floor muscles weaken, losing tone and elasticity with age, leading to issues such as incontinence and pelvic organ prolapse.
  3. Hormonal changes: Changes in hormone levels, particularly in women during menopause, can impact the strength and elasticity of pelvic floor tissues.
  4. Chronic constipation: Straining during bowel movements over an extended period can contribute to pelvic floor muscle weakness.
  5. Obesity: Excess body weight can place additional strain on the pelvic floor muscles, contributing to their weakening over time.
  6. Chronic coughing: Conditions such as chronic obstructive pulmonary disease or persistent coughing can strain the pelvic floor too.
  7. Prostate surgery: While men are less prone to pelvic floor issues, certain medical conditions can contribute to pelvic floor dysfunction, including prostate surgery.
  8. Genetics: Some individuals may also be genetically predisposed to conditions that weaken the pelvic floor.

 

How to tell if your pelvic floor is tight or weak?

Pelvic floor weakness can commonly manifest as symptoms such as urinary incontinence, fecal incontinence, pelvic organ prolapse, or sexual dysfunction. However, it’s important to note that experiencing these symptoms – which are explained in more detail below – could also be caused by other factors, so if you experience them, you should speak to your doctor to discover if a weak pelvic floor is the true root cause.

Urinary incontinence: This is the involuntary leakage of urine – which can range from very mild to severe. When linked to a weak pelvic floor, it can become most apparent during activities that increase abdominal pressure (aka stress incontinence). That’s why you may ‘leak’ after coughing, sneezing, laughing, or lifting. Frequent or urgent urination can be a related symptom too.

Bowel issues: Another sign of a weak pelvic floor is fecal incontinence, the inability to control bowel movements, and difficulty emptying the bowel completely.

Pain: Alongside other symptoms, pain or discomfort in the pelvic and lower back regions can be a sign of a weak pelvic floor too.

Pelvic organ prolapse: If pelvic floor muscle laxity is severe it may lead to pelvic organ prolapse – the descent of the pelvic organs into the vaginal canal. This can be characterised by a feeling of pressure or bulging in the region.

Sexual dissatisfaction: Finally, a weak pelvic floor can lead to sexual dissatisfaction. This may include pain or discomfort during sex, and reduced feelings of arousal.

What is incontinence?

Incontinence refers to the involuntary loss of urine or feces from the bladder or bowel, ranging from occasional leakage to a complete loss of bladder or bowel control. It is a condition that can affect people of all ages, although it is more prevalent in older adults.

There are different types of incontinence:

Stress incontinence: the leakage of urine during activities that increase abdominal pressure, such as sneezing

Urge incontinence: sudden and intense urges to urinate, often leading to involuntary leakage

Overflow incontinence: inability to empty the bladder fully, leading to frequent urine dribbling.

Is incontinence a disability?

For a long time, some degree of incontinence was just ‘put up with’ as people aged, especially by women post-childbirth. However, it can be severely lifestyle-affecting. For example, individuals with severe incontinence may need accommodations made at work and easy access to public toilet facilities. Incontinence may also affect someone’s mental health and influence their social interactions. That’s why incontinence is increasingly being discussed, if not as a disability, as at least a recognisable health concern and you should be encouraged to seek medical advice to help manage the condition if required.

What causes incontinence?

A weak pelvic floor can be a common cause of (especially stress) incontinence, but there are other reasons it may occur too:

  • Ageing: Incontinence can become more common as we age, for both men and women.
  • Pregnancy: As well as its effect on pelvic floor strength, pregnancy can cause increased pressure on the bladder due to the growing uterus.
  • Nerve damage: Conditions such as diabetes, multiple sclerosis, or injuries that affect the nerves that control bladder or bowel function can lead to leaks.
  • Prostate issues: In men, an enlarged prostate or related surgery can contribute to incontinence.
  • Urinary tract infections (UTIs): Infections can cause temporary incontinence.
  • Certain medications: Some medications may affect bladder or bowel function. This side effect should be raised by your doctor before you start a prescription.

Is incontinence a ‘normal’ part of ageing?

Incontinence is a common condition that affects people of all ages. According to the World Health Organization, it is estimated that over 200 million people worldwide experience some form of urinary incontinence. But, while it does become more prevalent with age, it doesn’t mean it has to become an accepted part of getting older. In fact, there are various treatment options and management strategies available to address incontinence, and you should not be worried to speak to a medical professional about any concerns you have.

How to stop incontinence?

The treatment of incontinence depends on the underlying cause and may include lifestyle changes, pelvic floor exercises, medications, tweakments, or surgical interventions. Most importantly, individuals experiencing incontinence should first speak to their doctor to determine the cause of their own symptoms, so an appropriate treatment plan can be decided upon.

How to improve a weak pelvic floor?

Pelvic floor exercises, often referred to as Kegel exercises, are commonly recommended to strengthen a weak pelvic floor, reducing the risk of incontinence and other related concerns. These exercises involve contracting and relaxing the pelvic floor muscles in a controlled manner and while there are plenty of videos on YouTube explaining how they can be done, if you are unsure, it is best to seek the guidance of a healthcare professional.

Pregnant individuals and perimenopausal women in particular can benefit from engaging in pelvic floor exercises. Additionally, seeking guidance on proper pushing techniques during childbirth and postpartum pelvic floor rehabilitation can be beneficial in managing and preventing the condition.

Can I improve pelvic floor weakness through my lifestyle? 

Maintaining a healthy lifestyle, including regular exercise and keeping a consistent body weight, can also contribute to good pelvic floor health. Avoiding habits like smoking, which can lead to coughing, may play a role too, while proper posture supports the alignment of the pelvic floor muscles and contributes to their effectiveness.

How much, on average, would treating the concern cost?

Treating a weak pelvic floor can be fairly affordable, considering that Kegel exercises offer a free option for strengthening your muscles in the area. Surgery however can reaches into the many thousands, and the latest tweakments focusing on the area are an investment too. For example, you can expect to pay around £2000 for a series of EMSELLA sessions.

What tweakments are available for a weak pelvic floor and incontinence?

EMSELLA Chair: Reviewed in detail in Tweak of the Week,  the EMSELLA is a completely non-invasive way to strengthen your pelvic floor. You simply sit on the chair as high intensity focussed electromagnetic energy (HIFEM) is used to build up strength in your pelvic floor muscles, with a tightening and toning effect that prevents leaks.

Radiofrequency: Radiofrequency can also be used to treat pelvic floor weakness, although it is very important you see a suitably trained practitioner. InMode’s EmpowerRF provides a safe and customisable treatment for stress, urge, and mixed urinary incontinence as well as for pelvic floor weakness.

Intravaginal EMS: Electrical muscle stimulation can help rehabilitate weak pelvic floor muscles especially when used intravaginally. VTone by InMode is a gentle, safe and pain-free technology with a two-sided tip inserted into the vagina that can strengthen the muscles and improve symptoms of urinary incontinence.

Are there surgical treatments for a weak pelvic floor and incontinence?

Surgical procedures tend to be considered only if other non-invasive options are unsuccessful. The right treatment depends on the specific type of pelvic floor disorder you are struggling with and its underlying causes:

  • Pelvic Floor Reconstruction Surgery: This surgery aims to repair the pelvic floor area using grafts and sutures to provide additional support to the weakened structures.
  • Pelvic Organ Prolapse Repair: If the pelvic organs, such as the bladder, uterus, or rectum, descend into the vaginal canal, anterior and posterior colporrhaphy, can lift the organs back to their normal positions.
  • Sacrocolpopexy: Used to treat pelvic organ prolapse, a surgeon attaches a mesh to the top of the vagina and secures it to the bone at the base of the spine for support.
  • Midurethral Sling Surgery: This procedure is commonly used to treat stress urinary incontinence. The sling provides additional support to the urethra to reduce urine leakage.
  • Bladder Neck Suspension: Involves lifting and securing the neck of the bladder to provide better support.
  • Colpocleisis: A surgical procedure that involves the closure of the vaginal canal to treat prolapse in women who no longer desire vaginal intercourse. It is considered when other treatments are not be suitable.
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