What causes Pelvic Floor Weakness?

Before the birth of my daughter, running was my go to exercise; it would pump my body full of endorphins and help keep my anxiety in check. I honestly loved nothing more than being present in the moment; feeling my feet pounding along the pavement, as my heart beats faster and body temperature rises, and having such a great sense of achievement once completed. What I didn’t realise was that whist running was great for my mindfulness, without proper care and/or attention to my pelvic floor muscles it was exacerbate another problem by creating pelvic floor weakness.

So, what causes pelvic floor weakness?

The full causes of pelvic floor muscle weakness are still unknown, but problems can occur when the pelvic floor muscles are stretched, weakened or too tight. Some people have weak pelvic floor muscles from an early age, whilst others notice problems after certain stages in life such as pregnancy, childbirth or menopause. Others experience weakness by being overweight or completing high intensity exercises and repeat heavy lifting. Even having a long-term cough and chronic constipation can cause pelvic floor muscle weakness, so it’s always worth getting checked out by your Doctor.

Whilst I don’t know the exact cause of my pelvic floor muscle weakness, I would attribute it to years of high intensity exercise, followed by a difficult childbirth. As a result, not only do I have an extremely weak pelvic floor, but it also resulted in the prolapse of both my bladder and bowel.

The good news is that pelvic floor muscles can be strengthened like any other weak or damaged muscles (although this does take time) by completing pelvic floor exercises daily, just ensure you are doing them correctly to prevent further damage, and you will see an improvement in incontinence and prolapse symptoms, as I have done.


What is the Pelvic Floor?

In all honesty, I didn’t know much about the pelvic floor before I was diagnosed with a prolapse, and I certainly didn’t realise its importance. Prior to childbirth, I was an avid runner and loved high intensity exercises, but I never paid much attention to my pelvic floor muscles or core.

Years later, when I became pregnant with my daughter, I was told by my midwife and health care professionals to keep up with my “Kegel exercises”, so my pelvic floor muscles would be “nice and strong” for the birth and to reduce incontinence afterwards. This was the first time I had ever heard of the word Kegels and I wasn’t exactly sure what I needed to do or even how to contract those muscles.

I decided to give it a go anyway; doing them every now and then when I remembered. However, as it turns out, I was actually completing the exercises incorrectly (which is easily done!) and as a result I was bearing down through my pelvic floor, which basically stretched and strained my pelvic floor tissues further making the problems worse.

In hindsight, I should have paid a lot more attention to those muscles and should have taken the time to see a woman’s health physiotherapist to explain to me how the pelvic floor muscles work and how to exercise them properly.

So, what is the pelvic floor?

The pelvic floor is a group of muscles and ligaments that stretch from the tailbone to the pubic bone and act as a supportive sling for the pelvic organs – the bladder, bowel, womb and vagina protecting them from damage.

And, why are your pelvic floor muscles important?

The pelvic floor muscles provide support from below to counteract the forces from above.

Strong pelvic floor muscles lead to increased sensitivity during sex and stronger orgasms, as well as preventing pelvic floor disorders such as incontinence (the involuntary loss of urine or a bowel movement) and/or pelvic organ prolapse (lack of support).


What is Pelvic Organ Prolapse?

Many of us will not have heard of the term prolapse until we experience the feeling of “things feeling different down there” and this was certainly the case for me. But developing a mild prolapse after childbirth is, in fact, very common. There is just a complete lack of awareness, dialogue and support for women, who have this pelvic health condition, from their health care professionals.

When the Doctor informed me that I had a prolapse at my 8-week postpartum check, I almost broke down in tears. I asked the Doctor, what does this mean? But they didn’t really provide me with much information, they just skirted around the issue and told me that it’s common and to come back if the symptoms became worse. It was then that I realised that pelvic health was a taboo subject and it was abhorrent that despite going through an extensive amount of trauma in childbirth, that no further pelvic floor care is given to most new mothers after their postpartum check.

Not convinced by the advice of my Doctor, I decided to take matter into my own hands. Why did I have to wait for something to go wrong before I could receive help? I didn’t want to be one of those women who just accepts that this is normal and then ends up suffering in silence for years, with bladder incontinence and/or pelvic organ prolapse. This was when I decided to do my own research and see a woman’s health physiotherapist privately. I wanted to find out exactly what I was dealing with and what I needed to do to make things better.

So what exactly is a prolapse?

Pelvic Organ Prolapse (POP) is when one or more of the pelvic organs, such as the bladder, bowel, rectum or uterus shift or pull from their normal position and bulge into the vagina causing a feeling of vaginal heaviness and dragging. The bulge may be felt inside or outside the vagina and the prolapse may cause bladder, bowel or sexual dysfunction.

A prolapse can be mild, causing little or no bother or it may be severe causing many problems and affecting your quality of life. It is common for a prolapse to vary from day to day and within a single day; on some days your symptoms may be worse and on others you may not be aware of them at all. Prolapses are graded according to their severity, so it’s always worth seeing a woman’s health physiotherapist, so you can have a better understanding of your prolapse. From experience, it always feels a lot worse than what it is, especially if you are experiencing other pelvic floor disorders, such as muscular tension and holding. In short, the grades are outlined below:

  • Grade 0: no prolapse.
  • Grade 1: the uterus or vaginal walls have dropped slightly. At this stage many women may not be aware they have a prolapse. It may not cause any symptoms and is usually diagnosed as a result of a routine examination e.g. for smear test.
  • Grade 2: the uterus or vaginal walls have dropped further into the vagina and the bulge can be seen at the vaginal opening.
  • Grade 3: most of the uterus or vaginal wall has fallen through the vaginal opening.
  • Grade 4: the uterus or vaginal wall has completely fallen through the vaginal opening .

As mentioned above, prolapses can also be caused or exacerbate by other pelvic floor disorders, including dysfunctional patterns of muscular tension and holding, long-standing alignment issues, myofascial restrictions, adhesions, scar tissue, and problems with intra-abdominal pressure management. Any of these concerns can cause (and/or perpetuate) pelvic organ shifts.

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