Pay attention to pelvic floor health and enjoy a healthy and beautiful life

Author: Ma Xia, deputy chief physician of Taizhou Hospital, Zhejiang Province

Reviewer: Jin Xiaoxiao, Chief Physician, Taizhou Hospital, Zhejiang Province

The real voice of the patient: One year after giving birth, due to my fear of pain, I could not find the "pleasure" before giving birth in my sexual life, and even felt that my husband had become a little "sexually cold". What's more embarrassing is that I always leak urine whenever I cough or sneeze hard. Frequent urination and urgency make me look for a toilet as the first thing I do when I go out. Doctor, I want to know what's going on? If I had known that vaginal delivery would have these problems, I might have chosen a cesarean section directly. Is this a pelvic floor dysfunction?

The female pelvic floor is composed of bones, muscles, connective tissue, blood vessels and nerves. It is like a "muscle hammock" and participates in many physiological activities such as maintaining vaginal tightness, defecation and enhancing sexual pleasure. Once the pelvic floor function is damaged, a series of functional disorders such as pelvic organ prolapse, stress urinary incontinence, vaginal relaxation, etc. will occur. Let's learn about what pelvic floor dysfunction is.

1. What are the causes of pelvic floor dysfunction?

During their lifetime, women may suffer from pelvic floor muscle and nerve damage due to pregnancy and childbirth, pelvic vaginal surgery, postmenopausal sex hormone deficiency, obesity, long-term constipation and other factors, which may lead to weak pelvic floor support structure and pelvic floor dysfunction. Although pelvic floor dysfunction is not a fatal disease, it seriously affects the patient's quality of life and physical and mental health. For example, patients with uterine prolapse are affected by lower abdominal distension and perineal foreign bodies, and patients with urinary incontinence often suffer from involuntary urinary incontinence, frequent urination, and urgency.

Figure 1 Copyright image, no permission to reprint

2. What are the clinical manifestations of pelvic floor dysfunction?

Pelvic floor dysfunction can affect women's physical and mental health and quality of life. If not treated early, they may become depressed, which is not conducive to family harmony.

1. Stress urinary incontinence: Coughing, laughing, sneezing, lifting heavy objects, and strenuous exercise can cause urine leakage if you are not careful.

2. Pelvic organ prolapse often causes lower back pain and heaviness. In severe cases, the uterus may protrude from the vaginal opening, and ulcers and infections may occur due to friction.

3. Chronic pelvic pain: long-term burning pain in the vulva, lower abdomen, anus, etc. with unknown cause.

4. Sexual disorders include decreased libido, lack of pleasure, pain during orgasm or intercourse, and avoidance of sexual contact.

5. Vaginal relaxation often results in gas discharge.

6. Urge urinary incontinence is a sudden feeling of holding back urine, an urgent need to go to the toilet, but the amount of urine discharged is not much, and the frequency of urination will also increase.

If you have one or more of the above symptoms, it means that your pelvic floor function may be "in critical condition". Postpartum women and middle-aged and elderly women are at high risk of pelvic floor problems. Once you find yourself having pelvic floor problems, it is recommended that you go to a professional medical institution for consultation and examination in time to get appropriate help and treatment.

3. How to prevent and treat pelvic floor health?

A specialist will conduct a pelvic floor assessment based on your specific situation. After analyzing the results, the doctor will develop a personalized treatment plan, such as electrical stimulation, biofeedback, magnetic therapy, Chinese medicine acupuncture, home training, etc. For those with severe prolapse, surgical intervention is recommended as soon as possible.

Pelvic floor health is related to women's health throughout their lives. It is recommended to regularly evaluate pelvic floor function, with adult women evaluated once a year and middle-aged and elderly women evaluated 1-2 times a year. Pelvic floor rehabilitation can effectively prevent the occurrence of pelvic floor diseases and protect women's health. It is especially recommended for pregnant and postpartum women to perform aerobic exercises, such as swimming and yoga, on the premise of reasonably controlling weight and ensuring the safety of mother and baby, which can also reduce the probability of constipation.

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Standardized pelvic floor function screening is required 42 days after delivery. If there are any problems, rehabilitation treatment should be carried out in time to prevent the occurrence of pelvic floor dysfunction. At the same time, the middle-aged and elderly groups can perform pelvic floor muscle exercises, such as Kegel exercises and abdominal breathing, 3 to 5 times a week, twice a day, for 10 to 20 minutes each time.

4. Six common misunderstandings about pelvic floor rehabilitation

Misconception 1: Natural childbirth will damage the pelvic floor muscles, but there is no risk of pelvic floor muscle damage with cesarean section.

Whether it is a vaginal birth or a cesarean section, the pregnancy process causes inevitable damage to the female pelvic floor muscles, resulting in anatomical and functional abnormalities in the pelvic floor support structure. Pregnancy and abnormal labor conditions, such as large fetus, polyhydramnios, excessive weight gain in pregnant women, prolonged labor, dystocia, vaginal delivery, severe perineal injury, etc., can make the pelvic floor muscles more seriously damaged. Therefore, during pregnancy, weight management, a proper diet, and appropriate exercise should be done.

Misconception 2: Kegel exercises are just contracting the levator ani muscles, and you can just practice them at home!

If the female pelvic floor muscle strength training method is incorrect, the effect may be counterproductive, thus damaging the pelvic floor muscles. After pelvic floor electromyography assessment, if the self-training requirements cannot be met, rehabilitation techniques can be used to improve, such as electrical stimulation, magnetic stimulation, triggered electrical stimulation, biofeedback, etc. Electrical stimulation can promote local microcirculation, repair damaged muscle tissue, and achieve the effect of improving pelvic floor muscle strength; biofeedback can reflect the state of the pelvic floor muscles in real time, assist patients to complete autonomous exercise, and enhance urination and defecation control ability. For patients who cannot actively contract the pelvic floor muscles, electrical stimulation training combined with biofeedback is recommended. Passive contraction should be performed first, and then autonomous exercise should be performed after mastering the correct method.

Misconception 3: The effectiveness of postpartum rehabilitation is not guaranteed. I insisted on two courses of rehabilitation after giving birth, but now I still have uterine prolapse and urinary incontinence!

Although 42 days to 6 months after delivery is the "golden period" for pelvic floor muscle rehabilitation, self-management is still required afterwards, that is, continuous pelvic floor muscle exercise, lifestyle adjustment, and avoidance of increased abdominal pressure (such as coughing, constipation, jumping), etc. The end of postpartum care is not the end of pelvic floor muscle rehabilitation, but the beginning of pelvic floor rehabilitation self-management.

Kegel exercises are simple, safe, and effective. They are not limited by occasions and are widely used in clinical practice. The correct method: Lie flat on your back, with your upper limb muscles not resisting any gravity or resistance. Contract your buttocks muscles and lift your anus upwards. Keep your pelvic floor muscles contracted for 5 seconds, then slowly relax. After resting for 5 to 10 seconds, repeat the contraction exercise. Keep breathing at a constant speed during the process. Exercise gradually from supine position, sitting position to standing position. As your muscle strength improves, you can place vaginal dumbbells in your vagina, increase the weight of the vaginal dumbbells from light to heavy, and gradually train your muscle strength.

Misconception 4: If a woman in her sixties suffers from urinary incontinence, will pelvic floor rehabilitation be useful?

The guidelines for the treatment of stress urinary incontinence point out that pelvic floor muscle training for at least 3 months under the guidance of a therapist is the first-line treatment for stress urinary incontinence (Grade A recommendation), along with lifestyle interventions, including weight loss, smoking cessation, and alcohol cessation.

Misconception 5: How could I have uterine prolapse if I haven’t given birth yet?

Factors that increase abdominal pressure, such as habitual constipation, chronic cough, heavy physical labor, wearing tight underwear all year round, and excessive obesity caused by overnutrition, should not be ignored; at the same time, metabolic diseases cause nutritional deficiencies, leading to muscle relaxation; genetic factors, such as Marfan syndrome, lead to congenital pelvic floor tissue dysplasia; direct damage from iatrogenic surgery, such as hysterectomy, causes direct damage to the pelvic floor muscles and nerves, leading to pelvic floor function damage. In addition, with age, female estrogen secretion will also decrease with ovarian dysfunction, causing weakness and relaxation of the pelvic floor muscles, making uterine prolapse more likely. Therefore, every woman should pay attention to pelvic floor health.

Misconception 6: I regularly exercise, skip rope or play ball 5 times a week. Will I still get uterine prolapse?

Exercises that increase abdominal pressure can increase the risk of pelvic organ prolapse, such as weightlifting, skipping, playing badminton and other jumping exercises. You can choose aerobic exercises such as yoga and swimming.

In short, we should get rid of the misunderstanding about pelvic floor rehabilitation and pay attention to pelvic floor health. Postpartum pelvic floor rehabilitation is a key step in pelvic floor health. Don't miss the golden period of postpartum pelvic floor muscle rehabilitation (42 days to 6 months after delivery). It is recommended that every woman do a pelvic floor function assessment and get corresponding guidance. Let's pay attention to pelvic floor health and enjoy a healthy and beautiful life!