THE ROAD TO HEALTH SERIES: Pelvic Floor Muscles – How to Protect Them? E. Litwiniuk

In the multitude of daily duties, plans and workouts, we forget what is most important – our own health. The problem that we discuss today in the series “The Road to Health. Do you know that…?” is often overlooked and for many women it is also embarrassing, so they do not decide to fight it. If you want to learn a bit about pelvic floor muscles, about the habits that help protect them, and find out why their proper functioning is so important, you’ll find the answers in this article ?

 

Pelvic floor muscles are the ones that we should pay special attention to during motherhood. In my opinion, everything starts with them. A mother’s comfort, quality of life and a flat stomach after childbirth. The topic is huge but I will try to include the most crucial information here to increase the awareness of women, especially young mothers who are very close to my heart.

 

What are pelvic floor muscles? A bit of anatomy

In colloquial language they are called “Kegel muscles”. The name comes from the gynecologist Arnold Kegel, who described the exercises of this body part in the 1950s to treat a common problem among women after childbirth, which is urinary incontinence.

Pelvic floor muscles are several different muscles that together form the support of a woman’s internal organs on the pelvic floor. There are 3 layers of the pelvic floor:

1. pelvic diaphragm (diaphragma pelvis) – formed by the muscles and the fascia that cover them:

– double levator ani muscle, which is the larger front part of the pelvic diaphragm,

– double coccygeus muscle, forming a smaller posterior part, and the upper and lower fascia of the pelvic diaphragm (fascia diaphragmatis pelvis superior et inferior).

2. urogenital diaphragm (diaphragma urogenitale) – formed by:

– single deep transverse perineum muscle (m. transversus perinei profundus),

– single urethral sphincter (m. sphincter urethrae) and upper and lower fascia of the urogenital diaphragm (fascia diaphragmatis urogenitalis superior et inferior).

3. superficial muscles of the perineum – formed by:

– double superficial transverse perineum (m. transversus perinei superficialis),

– double bulbous-spongy muscle (m. bulbospongiosus),

– double sciatic cavernous muscle (m. ischiocavernosus).

 

In addition, the group of superficial muscles of the perineum includes the odd external anal sphincter muscle (m. Sphincter or externus), which is sometimes classified as the pelvic floor muscle, or its structure and function are discussed together with the structure and function of the pelvic floor. In simpler terms, the pelvic floor muscles are like a hammock that supports our internal organs, closing the pelvis at the bottom.

The pelvic floor muscles are made of two types of fibers:

I  —  oxidative (70%), przystosowanych do utrzymywania napięcia przez długi czas, pełniących funkcję podporową;

II — glycolytic (30%), responsible for a short-term response with a rapid and strong contraction, fulfilling the sphincter function in the event of a sudden increase in pressure in the abdominal cavity.

 

Why is it worth paying attention to them and what is their function?

The lack of strong pelvic floor muscles can cause urinary or faecal incontinence, especially in later years, in menopause, in women suffering from chronic cough or constipation, in women who have had multiple vaginal births, or in overweight women. 

Weak pelvic floor muscles in this group may cause the genital organs to drop and prolapse, i.e. to disturb the statics of the reproductive organ. In women who have never given birth as well as those who are postpartum, weaker muscle function may reduce sexual satisfaction during intercourse. Well-trained pelvic floor muscles can facilitate vaginal delivery to some extent.

 

Conditioning

Healthy European women, compared to healthy Arab women and women from the Philippines, India and Pakistan, have significantly larger dimensions of the urogenital hiatus, which is also a factor that increases the risk of developing pelvic floor diseases. The hiatus may be significantly widened in stress urinary incontinence and disturbances in the statics of the internal genitalia, not only due to the excessive stretching of individual levator bundles in the second stage of labor (the so-called microtrauma), but in 19-36% of cases as a result of intrapartum detachment of their attachments from the periosteum (macro trauma).

 

Factors 

The main factors that increase the risk of the weakening of pelvic floor muscles are:

• vaginal childbirth, 
• use of obstetric forceps,
• extended 2nd stage of labor,
• large fetal head circumference.

Immediately after delivery, levator ani dysfunction occurs in up to one in four primiparas. It has been documented that some of the bundles of the pubic peritoneal muscle may disappear over time. Damage to the pelvic floor during vaginal and late delivery is the sum of various neuromuscular injuries.

Recently published studies compared the trophic condition of the pelvic floor a few months after childbirth with the condition 2-3 years after delivery, where it was found that the damage to the levator ani and dilated hiatus do not regress spontaneously.

 

 

What is stress urinary incontinence?

Unfortunately, up to 60% of women may experience stress urinary incontinence. Stress urinary incontinence is defined as the involuntary passing of urine during exertion, sneezing or coughing when intravesical pressure exceeds maximum tubular pressure. This condition causes a social and hygienic problem and affects the quality of women’s life. 

The research of Seim and colleagues shows that nearly half (49%) of patients with urinary incontinence who came to the doctor had been suffering from incontinence for more than 5 years!

 

Natural childbirth and pelvic floor muscles

Unfortunately, natural childbirth, as I mentioned before, does not have a positive effect on the condition of the pelvic floor muscles. The most common damage to the pelvic floor muscles occurs during the second stage of labor. It is related to the maximum stretching of the tissues of the birth canal, including the pelvic floor muscles by the frontal part of the fetus. 

The most stretched parts at this stage of labor are the medial branches of the anterior part of the levator ani muscles, which are involved in the compression of the urethra. Tissue damage in the second stage of labor promotes premature activation of the abdominal pressing station, i.e. at the moment before the leading part will be in the pelvic floor.

Premature pressure in the second stage of labor induces a reflex contraction of the pelvic floor muscles and the clenching of the labia with the abdominal press, which delays the process of the eruption of the fetal head and further labor progress, and this condition promotes tissue damage.

During childbirth, the pelvic floor muscles are damaged by direct tearing, stretching, compression of the vulva nerve or muscle fibers, e.g. in case of too fast delivery or too long pressure on the pelvic floor tissue caused by the prolonged second stage of labor.

This problem strongly affects the psychophysical condition of women and can cause severe stress, lower self-esteem, increase the feeling of loneliness, and increase the risk of depression. It can also significantly reduce social and sexual life and professional life.

In addition to problems with urinary incontinence, defecation disorders, and disorders of the statics of the internal genitalia as well as pelvic floor injuries are also associated with chronic pain in the smaller pelvis.

 

Other consequences of weakened pelvic floor muscles

In addition to stress urinary incontinence, weakened pelvic floor muscles often cause a decrease or prolapse of the female reproductive organ.

It is very difficult to estimate the frequency with which this disorder occurs, because women are ashamed to talk about their ailments and thus do not use a doctor’s help. Estimates show that approximately 5% of women aged 20–59 suffer from one of several degrees of uterine depression. 

Factors that increase the risk of this type of disorder are:

• numerous and long-lasting births,
• congenital defect of connective tissue,
• obesity,
• chronic constipation,
• weakened pelvic floor muscles.

Weakened pelvic floor muscles can also cause back pain.

 

Daily habits which help protect your pelvic floor muscles

1. When sitting on the toilet, place a stool under your feet to change the angle between your thighs and your body line. Then the pubo-rectal muscle relaxes and you do not need to push to defecate. Try to do this always, especially after childbirth, or when you have constipation, urinary incontinence or hemorrhoids.

2. Also, never persuade your children to pee or poo in advance, or force them when they don’t feel like it, because the bladder can become overactive and they will need to go to the toilet more often.

3. Visit the bathroom when your bladder is full, but also don’t hold your pee.

4. Try not to do the squat position, because then all muscles are tense and you have to push to do it. Let the urine flow out by itself.

5. Do not hold back your urine flow (do not exercise) while peeing, as you may develop cystitis or other unpleasant conditions.

6. When sneezing or coughing, straighten up, tighten your pelvic floor muscles, gently twist your torso and sneeze/cough into a bent elbow. You can also additionally cross your legs.

7. Do not perform exercises that increase intra-abdominal or mediastinal pressure too early after giving birth. These include jumping, running, crunches, planks and others .

8. Do not run while pregnant and do not lift heavy things. The pelvic floor muscles are stressed enough.

9. In a more advanced pregnancy, do most of the exercises while sitting or lying on your side.

10. Do not use any dietary supplements or geisha balls. Supplements for problems with the pelvic floor muscles do not work, and the balls can only harm. It’s more or less like exercising your biceps with your arm constantly bent (muscle tight), without straightening your arm. When exercising your pelvic floor muscles, the relaxation phase is just as important as the contraction (tension) phase.

11. After giving birth, do not use any slimming belts that compress your belly. They are very unhealthy and can lead to many problems related to the muscles of the pelvic floor, the work of internal organs, and even back problems. 

12. And finally the MOST IMPORTANT thing! Do not be shy, do not delay your visit to the urogynecological physiotherapist or doctor if you are worried about something.

 13. Pelvic floor exercises performed correctly during pregnancy reduce the percentage of urine loss during pregnancy and immediately after childbirth, and are able to cure up to 50% of stress urinary incontinence, especially mild incontinence long after birth.

 

And now a few interesting facts

Do you know that:

• among all the muscles mentioned above, the strongest and thickest are mm. levator ani;
• for unknown reasons, in the vast majority of healthy women, including nulliparous women, the right levator ani muscle is thinner than the left one;
• healthy black women have levator ani muscles that are thicker and more voluminous than healthy white women. Hence, just being a white woman is a natural risk factor for developing stress urinary incontinence;
• The pelvic floor muscles are not only part of a woman’s body structure, but are also found in men. In addition, pelvic floor exercises for men can reduce problems associated with erectile dysfunction.

 

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Edyta Litwiniuk

Personal trainer, dietitian, academic lecturer, owner of the 'Extreme Academy Sports and Training Academy'; and a mother of three daughters. Until recently, the editor-in-chief of 'SHAPE' magazine. She helps women stay fit and not go crazy during motherhood.