Pelvic Floor Health: Leaks, Painful Sex, and Prolapse with Dr. Sara Reardon

Understanding the Pelvic Floor

• 💡 The pelvic floor is a basket of muscles at the bottom of the bony pelvis, acting like a hammock that supports organs such as the uterus, ovaries, bowel, and bladder.
• 🧠 It plays a crucial role in supporting organs and controlling the openings for urine, bowel movements, and sexual intercourse.
• ⚠️ Most women don't realize they have a pelvic floor until an issue arises, often being told these problems are a normal part of aging or childbirth.

Pelvic Floor Issues and When to Seek Help

• 🎯 Common signs of pelvic floor dysfunction include urinary leakage, constipation, painful sex, pelvic organ prolapse, and a feeling of heaviness or pressure in the vagina.
• 📈 Research indicates that nearly 50% of women experience some form of pelvic floor issue, with prevalence increasing with age.
• 🚫 Urinary leakage, even a small amount with a cough or sneeze, is not normal and will not improve on its own without intervention.
• 🩺 Painful sex, often exacerbated by hormonal changes in perimenopause and menopause, is also a sign of dysfunction and should not be accepted as normal.

Strategies for Pelvic Floor Health

• 🚽 To improve bladder emptying and prevent straining, sit down to pee, lean forward, take deep breaths, and avoid "power peeing" or pushing.
• 🏃‍♀️ The "knack" technique, involving a pelvic floor contraction before a cough or sneeze, can prevent leakage.
• 💧 For painful sex, pelvic floor therapy to improve blood flow, using vaginal moisturizers, and lubricants are recommended, alongside potential topical estrogen.
• 🏋️‍♀️ During pregnancy, focus on strengthening in the first two trimesters, lengthening and relaxing in the third, and rehabilitation postpartum.
• 🧘‍♀️ For perimenopause and menopause, a strengthening regimen is key due to natural decreases in muscle mass and collagen.

Addressing Specific Concerns

• 🧱 Pelvic organ prolapse occurs when the pelvic floor muscles weaken, causing organs like the bladder or rectum to drop, which can feel like a bulge or pressure in the vagina.
• 🏥 Pelvic floor physical therapists can diagnose and treat these issues through internal and external assessments, guiding patients with specific exercises.
• 💊 Urinary tract infections (UTIs) can be mimicked by pelvic floor tension or nerve irritation, highlighting the importance of proper diagnosis and screening.
• 🌬️ Relaxing the pelvic floor is as important as strengthening it, achievable through deep diaphragmatic breathing, stretches, and internal massage.

Pelvic Floor and Midlife Changes

• 🌸 During perimenopause and menopause, decreasing estrogen levels affect vaginal lubrication, tissue thickness, and collagen, making proactive pelvic floor strengthening crucial.
• 💪 Incorporating pelvic floor exercises into existing workout routines, such as Pilates or strength training, is recommended.
• 🚀 It is never too late to start strengthening your pelvic floor; like any other muscle, it can be trained at any age.

Debunking Myths and Finding Support

• ❌ The idea that "everybody leaks a little" is a myth; no amount of urinary leakage is normal.
• ❌ Kegels alone do not fix all pelvic floor issues; a nuanced approach is necessary.
• ❌ Pelvic floor issues are not exclusive to women who have given birth; they can affect women at any life stage.
• ✅ There is a right way to sit on the toilet (squatting position) and to poop (bearing down while exhaling).
• ❌ "Just in case" peeing is not good bladder training; only pee when you have the urge, typically every 2-4 hours.
• ✅ Holding your pee is detrimental to pelvic floor health.
• 🗣️ Resources like Dr. Reardon's book, "Floored," and online pelvic floor therapy programs offer accessible information and guidance for women seeking help.