The pelvic floor, disorders and contributing factors

Here we are again… first of the month and another research spotlight email landing straight in your inbox. 

 

If you missed last month’s email covering the hip and the pelvic floor I recreated the content into a super digestible podcast version. Click here to listen.

 

Tim S, Mazur-Bialy, A. The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor. Life 2021;11, 1397 – LINK – The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor – PubMed (nih.gov)

 

So this month isn’t much of a ‘study’ as such, but is a fantastic narrative review of the pelvic floor, its function, the common disorders it presents with and factors that contribute to its function. 

 

Now it’s a fairly decent read so I am only going to share my favourite parts of it and use it to highlight that urinary incontinence or pelvic organ prolapse is not a concern JUST during pregnancy or in the postnatal period. (I am sure you already know this, but I’m going to share it anyway). 

 

Let’s begin with a direct quote:

“PF plays an important role in continence, pelvic support, micturition, defecation, sexual function, childbirth, and locomotion, as well as in stabilizing body posture and breathing, and cooperates with the diaphragm and postural muscles. In addition, PF associates with distant parts of the body, such as the feet and neck, through myofascial connections. Due to tissue continuity, functional disorders of muscles, ligaments, and fascia, even in the area distant from PF will lead to PF disorders, including urinary incontinence, fecal incontinence, prolapse, sexual dysfunction and pain. Dysfunctions of PF will also affect the rest of the body”

 

I mean WOW. What a muscle. And the sad part is most of your clients will think the only time something is wrong with the pelvic floor is when pee accidentally comes out. 

 

The review goes into the role the pelvic floor plays in stabilization of the trunk through its connection with the abdominal wall, the diaphragm and glute muscles and how tension in the abdominal wall ultimately impacts the pelvic floor. It talks about the tension of the pelvic floor playing a role in tension of the deep hip rotators and other muscles surrounding the hip influencing the alignment and biomechanics of the leg. 

 

Then it covers the role the pelvic floor plays during breathing via its fascial connection to the muscles of the abdominal wall, thoracolumbar fascia and intercostals. The cyclic nature of respiration along with the interplay between all of these muscles is what maintains intra-abdominal pressure which is an important concept in the world of pelvic floor dysfunction.

 

The Review goes on to really highlight the fact that the pelvic floor must work in synergy with other muscles as well as fascia in order to perform it’s functions and therefore requires correct myofascial tone of the entire chain system, proper functioning of internal organs and appropriate hormonal balance. 

Now let’s dive into the factors that affect pelvic floor. To me, this is where the true goods are for really understanding how the pelvic floor can be a problem AT ANY POINT OF THE FEMALE LIFECYCLE. 

 

1. 1. The obvious one – pregnancy, childbirth and postpartum. There are clear structural changes to the pelvic floor over the course of pregnancy, hormonal changes that impact the pelvic floor and support structures, birth experience and interventions can impact the pelvic floor, delivery types will impact the pelvic floor (including cesarean section deliveries) and obviously no real postpartum recovery can leave women with very poor pelvic floor function with a variety of symptoms.
   2. Age related hormonal changes – Estrogen declines will drastically impact many components of the female reproductive and urinary systems so this includes many changes to the pelvic floor that include loss of tissue integrity and muscle atrophy. Not only are hormonal considerations a problem during perimenopause and menopause, but we can also see pelvic floor issues change throughout the menstrual cycle due to fluctuating hormones.
   3. Obesity and metabolic syndrome. This has a lot to do with increased intra-abdominal pressure down onto the pelvic floor and support structures potentially resulting in weakness, but has implications for glycemia disturbances that damage vessels and nerves of the pelvic area. Think of it as peripheral neuropathy but of the pelvic floor.
   4. Respiratory disease. Chronic coughing is not only high amounts of intra-abdominal pressure but can weaken the abdominal wall and affect the biomechanics of the respiratory system. 
   5. Chronic constipation. Pelvic floor dysfunction can cause dyssynergy of the pelvic floor during bowel movements, meaning it contracts instead of relaxes in an attempt to defecate. This is a huge risk for pelvic floor weakness and potentially even prolapse due to the nature constant straining has on the tissues of the pelvic region. General constipation (without PFM dyssynergy) has a similar effect when it comes to straining the pelvic floor.
   6. Eating Disorders. Maybe not considered as a problem but the lack of nutrient availability to maintain muscle mass and function affects all muscles, including the pelvic floor. There are also hormonal considerations in those who move into amenorrhea and digestive complaints affecting bowel health.
   7. Connective tissue diseases. Things like Ehlers-Danlos Syndrome, marfan syndrome and hypermobility syndrome will impact connective tissue including those in the pelvic region.
   8. Gynecological disorders. The 2 biggest ones here are hysterectomies and Endometriosis. Both have different impacts on the health of the pelvic floor and surrounding structures.
   9. Myofascial disorders whereby there is asymmetry in the system of myofascial disturbances that impact alignment of the system that ultimately feed into the pelvic floor.
   10. Trauma injuries like pelvic fractures, blows to the pelvis, falls or anything that has caused trauma to the area will impact the pelvic floor and how it functions.

This list is definitely a big one and I am hoping this very brief summary of a big paper really highlights that no matter where a woman (or a man) is in the lifecycle there are many factors that could be affecting their pelvic floor and causing pelvic floor dysfunction, not just having a baby.

I see so many professionals advertising ‘pre and post natal pelvic floor health’ and often wonder how many women read this and think ‘oh that’s not for me’ because they do not fall into this category and yet have major pelvic floor concerns?

 

This is another big reason I created the mentorship program and why it’s a 6 month program. The pelvic floor is very extensive and every module inside the program covers the many different ways it presents across the different life phases along with it’s integration into many of the body systems. It isn’t as simple as assess and prescribe for pelvic floor weakness, or assess and reduce tension in the case of a high tone pelvic floor. You need to consider so many things in order to identify what other components you would need to include in your program for the client. 

 

If you want to take the plunge and learn all of this jump on the waitlist for the 2024 intake. It will open in December to kick start in January. 

Otherwise stay tuned for bite size pelvic floor education coming in 2024.

 

Until next time… keep an eye out for all the different people you see in your work environment. They might actually be a pelvic health client but they just don’t know it.

 

P.S. Thanks so much for being part of my community, if you find value in the content I share I would appreciate you sharing this with someone you think might find it valuable. Plus it helps me achieve my big goals of growing a community of wicked health and fitness professionals.