It starts off as a minor inconvenience. An accidental leak while exercising or sneezing. Passing wind unexpectedly when lifting groceries. Sex feels less satisfying. But for some women, these little signs of pelvic floor issues could add up to something much more serious.
One woman found herself using up to 10 rolls of toilet paper every week in a desperate attempt to manage her urine leaks. Then, there are others who discovered their entire uterus bulging outside their body – a condition that can occur when the pelvic floor muscles are too weak to hold it in place.
These are real-life cases that experts have seen when pelvic floor problems are left untreated. Yet, many women suffer in silence – too embarrassed or unsure of where to seek help.
But the good news is that just like any other muscle group, your pelvic floor can be strengthened.
Whether in your twenties, post-pregnancy or after menopause, it is never too early – or late – to give these crucial muscles care and attention.
In women, the pelvic floor is a group of muscles and connective tissues that hold the bladder, uterus and bowel in place. These muscles form a “sling” stretching from the pubic bone to the tailbone.
“Imagine it as having a strong bowl to hold all your organs in place,” said Dr Jay Lim, consultant urologist at PanAsia Surgery. “One crucial function of the pelvic floor is to keep the valves (in the pelvis) tightly closed, preventing urine leakage when you sneeze, cough or carry heavy weight.”
The pelvic floor muscles are like a strong bowl that hold the bladder, uterus and bowel in place and prevent urine leakage when you sneeze or carry heavy things. (Photo: iStock/ttsz)
Stress urinary incontinence – when urine leaks occur involuntarily during activities that increase pressure in the abdomen – is among the most common issues troubling women in Singapore, he told CNA Women.
Dr Eliane Hong, associate consultant with the division of urogynaecology and pelvic reconstructive surgery at National University Hospital’s (NUH) Department of Obstetrics and Gynaecology, added that a weak pelvic floor is also associated with pelvic organ prolapse.
This occurs when the pelvic organs, such as the uterus, bladder, rectum, vagina, descend into a lower position in the vagina, causing a bulge that may even protrude out of the body.
These conditions don’t just have physical repercussions. “Women with either of these conditions may be more self-conscious of their body and this can negatively affect sexual function. They may also leak urine during sexual intercourse, putting them off sexual activities,” Dr Hong said.
Dr Lim said that some patients stop venturing out of their comfort zones or homes, worried about wetting or soiling themselves in public.
While pelvic floor muscles weaken naturally with age, certain factors can speed up this process. Pregnancy, childbirth, obesity, having a chronic cough or straining due to constipation, standing for prolonged periods or a job that involves heavy lifting may also strain these muscles.
“As with any other muscle in the body, if you don’t use it, you will lose it,” warned Dr Lim. “The pelvic floor is a commonly missed and hard-to-train muscle. Unless you try to tone it, it can weaken over the years.”
Pregnancy and childbirth play a significant role in pelvic floor health.
Dr Lee Wai Yen, consultant obstetrician and gynaecologist, and urogynaecologist at Foundation Women’s Centre, explained: “As the baby grows, the increasing weight places pressure on the pelvic floor muscles. During pregnancy, the relaxin hormone is released to soften ligaments in preparation for childbirth, which may also weaken the pelvic floor muscles.”
Pregnancy and childbirth can affect the pelvic floor muscles, regardless of whether you delivery vaginally or via a Caesarean section. (Photo: iStock/globalmoments)
Dr Lee said that women who deliver their babies vaginally often experience higher mechanical stress (such as episiotomy) to the pelvic floor, compared to C-sections. An episiotomy is a surgical incision made in the perineum (the area between the vagina and anus) during childbirth to allow more space for passage of the baby and to guide tears away from the anus.
However, Dr Lee emphasised that regardless of the delivery method, hormonal changes and pressure from a growing baby can still affect the pelvic floor.
Does the birthing position – upright or lying down – matter? According to Dr Lee, there is no perfect position for childbirth to reduce the risk of pelvic floor disorders.
Declining oestrogen levels in the lead up to menopause also leads to weakening and thinning of the pelvic-supporting ligaments, Dr Lee added.
Ironically, some popular workout trends can exacerbate pelvic floor woes, when done incorrectly or excessively.
“Some CrossFit exercises involve high-impact movements that increase intra-abdominal pressure and worsen pelvic floor dysfunction,” said NUH’s Dr Hong, pointing to several studies.
For instance, a systemic review found that 44.5 per cent of female CrossFit practitioners reported urinary incontinence, with 81 per cent suffering from stress urinary incontinence.
Strength training is another risk factor. Studies observe that up to 40 per cent of female athletes who lift weights are affected by stress urinary incontinence, Dr Hong said.
“When done correctly, weight training has health benefits. However, problems may arise if the wrong technique is used or if one tries to lift excessive weights beyond their ability,” she added.
Lifting excessive weights and improper lifting techniques can strain and weaken the pelvic floor over time. (Photo: iStock/kazuma seki)
Dr Hong advised engaging a trainer to ensure correct technique and form; start low and go slow with lighter weights when starting weightlifting.
If there are signs of urinary continence, it means that the pelvic floor has been strained beyond its capacity; consider scaling back on the weights used.
A proactive approach is key. Cammy Tsai, senior principal physiotherapist at NUH’s Department of Rehabilitation, advises adopting a “pelvic floor first” approach when lifting weights or during high-impact activities. This means pre-contracting the pelvic floor muscles first before initiating the movement.
“Women are advised to avoid holding their breath when weightlifting as this may result in additional intra-abdominal pressure and strain the pelvic floor. Instead, they should exhale when performing the lifting manoeuvre,” said Tsai.
Regular pelvic floor exercises, or Kegels, come highly recommended by the experts. These can be done discreetly as part of one’s daily routine even if there are no signs of pelvic floor problems.
Pelvic floor exercises can help improve symptoms of stress urinary continence and it has been shown that women who consistently perform pelvic floor exercise were six times more likely to report being cured or experience improvements, Dr Hong said.
She also suggested trying a manoeuvre called the “knack” by contracting the pelvic floor muscles just before coughing or sneezing. This may help prevent urine leakage in women who are experiencing stress urinary incontinence.
Pelvic floor exercises involve squeezing the pelvic floor muscles at regular intervals. To find the pelvic floor muscles, imagine trying to prevent yourself from passing gas or stopping the flow of urine midstream. However, don’t do this when passing urine.
“If done correctly, you should be able to feel a tightening and lifting sensation around the vagina and anus – without experiencing any straining or pushing downwards,” Dr Hong explained.
You can do Kegels exercises discreetly as part of your daily routine, even on your daily commute, and no one will notice. (Photo: iStock/hxyume)
A beginner’s Kegels workout routine may look something like this:
For women struggling to feel the contraction, Tsai suggested practising while seated, with their front passage pressed against the edge of the chair. When the pelvic muscles are contracted properly, they would feel a tightening and lifting of the front passage and back passage from where they are seated.
Not sure if you are doing their Kegels correctly? Speak to your doctor about pelvic floor exercise physiotherapy.
The key is consistency. Dr Lee encouraged choosing a routine that is easy to remember. “For example, after waking in the morning and before bedtime, after your meals thrice a day, when taking the MRT to work or after work. No one will be able to tell you are doing Kegels and you can do the exercises anytime, anywhere,” she said.
Most importantly, don’t give up. “Just like going to the gym, building muscles takes time. The key is to be consistent and most women will feel some improvement after a few months,” Dr Lee said.
Reach out to a healthcare professional if symptoms do not improve. For more severe cases, medications and treatment options are available.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...
One woman found herself using up to 10 rolls of toilet paper every week in a desperate attempt to manage her urine leaks. Then, there are others who discovered their entire uterus bulging outside their body – a condition that can occur when the pelvic floor muscles are too weak to hold it in place.
These are real-life cases that experts have seen when pelvic floor problems are left untreated. Yet, many women suffer in silence – too embarrassed or unsure of where to seek help.
But the good news is that just like any other muscle group, your pelvic floor can be strengthened.
Whether in your twenties, post-pregnancy or after menopause, it is never too early – or late – to give these crucial muscles care and attention.
THE MULTITASKER THAT HOLDS MULTIPLE ORGANS IN PLACE
In women, the pelvic floor is a group of muscles and connective tissues that hold the bladder, uterus and bowel in place. These muscles form a “sling” stretching from the pubic bone to the tailbone.
“Imagine it as having a strong bowl to hold all your organs in place,” said Dr Jay Lim, consultant urologist at PanAsia Surgery. “One crucial function of the pelvic floor is to keep the valves (in the pelvis) tightly closed, preventing urine leakage when you sneeze, cough or carry heavy weight.”
The pelvic floor muscles are like a strong bowl that hold the bladder, uterus and bowel in place and prevent urine leakage when you sneeze or carry heavy things. (Photo: iStock/ttsz)
Stress urinary incontinence – when urine leaks occur involuntarily during activities that increase pressure in the abdomen – is among the most common issues troubling women in Singapore, he told CNA Women.
Dr Eliane Hong, associate consultant with the division of urogynaecology and pelvic reconstructive surgery at National University Hospital’s (NUH) Department of Obstetrics and Gynaecology, added that a weak pelvic floor is also associated with pelvic organ prolapse.
This occurs when the pelvic organs, such as the uterus, bladder, rectum, vagina, descend into a lower position in the vagina, causing a bulge that may even protrude out of the body.
These conditions don’t just have physical repercussions. “Women with either of these conditions may be more self-conscious of their body and this can negatively affect sexual function. They may also leak urine during sexual intercourse, putting them off sexual activities,” Dr Hong said.
Dr Lim said that some patients stop venturing out of their comfort zones or homes, worried about wetting or soiling themselves in public.
WHAT WEAKENS THE PELVIC FLOOR?
While pelvic floor muscles weaken naturally with age, certain factors can speed up this process. Pregnancy, childbirth, obesity, having a chronic cough or straining due to constipation, standing for prolonged periods or a job that involves heavy lifting may also strain these muscles.
“As with any other muscle in the body, if you don’t use it, you will lose it,” warned Dr Lim. “The pelvic floor is a commonly missed and hard-to-train muscle. Unless you try to tone it, it can weaken over the years.”
Pregnancy and childbirth play a significant role in pelvic floor health.
Dr Lee Wai Yen, consultant obstetrician and gynaecologist, and urogynaecologist at Foundation Women’s Centre, explained: “As the baby grows, the increasing weight places pressure on the pelvic floor muscles. During pregnancy, the relaxin hormone is released to soften ligaments in preparation for childbirth, which may also weaken the pelvic floor muscles.”
Pregnancy and childbirth can affect the pelvic floor muscles, regardless of whether you delivery vaginally or via a Caesarean section. (Photo: iStock/globalmoments)
Dr Lee said that women who deliver their babies vaginally often experience higher mechanical stress (such as episiotomy) to the pelvic floor, compared to C-sections. An episiotomy is a surgical incision made in the perineum (the area between the vagina and anus) during childbirth to allow more space for passage of the baby and to guide tears away from the anus.
However, Dr Lee emphasised that regardless of the delivery method, hormonal changes and pressure from a growing baby can still affect the pelvic floor.
Does the birthing position – upright or lying down – matter? According to Dr Lee, there is no perfect position for childbirth to reduce the risk of pelvic floor disorders.
Declining oestrogen levels in the lead up to menopause also leads to weakening and thinning of the pelvic-supporting ligaments, Dr Lee added.
WHEN WORKING OUT WORKS AGAINST YOU
Ironically, some popular workout trends can exacerbate pelvic floor woes, when done incorrectly or excessively.
“Some CrossFit exercises involve high-impact movements that increase intra-abdominal pressure and worsen pelvic floor dysfunction,” said NUH’s Dr Hong, pointing to several studies.
For instance, a systemic review found that 44.5 per cent of female CrossFit practitioners reported urinary incontinence, with 81 per cent suffering from stress urinary incontinence.
Strength training is another risk factor. Studies observe that up to 40 per cent of female athletes who lift weights are affected by stress urinary incontinence, Dr Hong said.
“When done correctly, weight training has health benefits. However, problems may arise if the wrong technique is used or if one tries to lift excessive weights beyond their ability,” she added.
Lifting excessive weights and improper lifting techniques can strain and weaken the pelvic floor over time. (Photo: iStock/kazuma seki)
Dr Hong advised engaging a trainer to ensure correct technique and form; start low and go slow with lighter weights when starting weightlifting.
If there are signs of urinary continence, it means that the pelvic floor has been strained beyond its capacity; consider scaling back on the weights used.
PROTECT THE PELVIC FLOOR BY SQUEEZING THE RIGHT MUSCLES
A proactive approach is key. Cammy Tsai, senior principal physiotherapist at NUH’s Department of Rehabilitation, advises adopting a “pelvic floor first” approach when lifting weights or during high-impact activities. This means pre-contracting the pelvic floor muscles first before initiating the movement.
“Women are advised to avoid holding their breath when weightlifting as this may result in additional intra-abdominal pressure and strain the pelvic floor. Instead, they should exhale when performing the lifting manoeuvre,” said Tsai.
Regular pelvic floor exercises, or Kegels, come highly recommended by the experts. These can be done discreetly as part of one’s daily routine even if there are no signs of pelvic floor problems.
Pelvic floor exercises can help improve symptoms of stress urinary continence and it has been shown that women who consistently perform pelvic floor exercise were six times more likely to report being cured or experience improvements, Dr Hong said.
She also suggested trying a manoeuvre called the “knack” by contracting the pelvic floor muscles just before coughing or sneezing. This may help prevent urine leakage in women who are experiencing stress urinary incontinence.
HOW TO DO KEGELS CORRECTLY
Pelvic floor exercises involve squeezing the pelvic floor muscles at regular intervals. To find the pelvic floor muscles, imagine trying to prevent yourself from passing gas or stopping the flow of urine midstream. However, don’t do this when passing urine.
“If done correctly, you should be able to feel a tightening and lifting sensation around the vagina and anus – without experiencing any straining or pushing downwards,” Dr Hong explained.
You can do Kegels exercises discreetly as part of your daily routine, even on your daily commute, and no one will notice. (Photo: iStock/hxyume)
A beginner’s Kegels workout routine may look something like this:
- Squeeze the pelvic floor muscles for one second, then release. Repeat five times.
- Squeeze the pelvic floor muscles for five seconds, then release. Repeat five times.
- Perform five sets of this routine (1 and 2) three to four times a day.
For women struggling to feel the contraction, Tsai suggested practising while seated, with their front passage pressed against the edge of the chair. When the pelvic muscles are contracted properly, they would feel a tightening and lifting of the front passage and back passage from where they are seated.
Not sure if you are doing their Kegels correctly? Speak to your doctor about pelvic floor exercise physiotherapy.
The key is consistency. Dr Lee encouraged choosing a routine that is easy to remember. “For example, after waking in the morning and before bedtime, after your meals thrice a day, when taking the MRT to work or after work. No one will be able to tell you are doing Kegels and you can do the exercises anytime, anywhere,” she said.
Most importantly, don’t give up. “Just like going to the gym, building muscles takes time. The key is to be consistent and most women will feel some improvement after a few months,” Dr Lee said.
Reach out to a healthcare professional if symptoms do not improve. For more severe cases, medications and treatment options are available.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...