The pelvic floor in women

One of the keys to successful aging is getting the best support in place and holding onto it for as long as possible. A good example of this is the pelvic floor, which provides vital support to ensure productivity and quality of life. Its muscle and connective tissues naturally form a hammock across the pelvis that holds its contents in place. These muscles also help maintain the functions of our bladder and bowels, and pelvic tone for satisfying sex.

Charged with holding things in place against the pressures of straining and gravity, the pelvic floor is vulnerable to the weight of time. There is also weakening of the connective tissues with aging and damage to the nerves that control muscle tone. Reducing Advanced Glycation End-products (AGEs) and supporting collagen synthesis with glucosamine and chondroitin sulphate can improve the mechanical properties of aging connective tissue.

Factors impacting the pelvic floor as we age

A number of other factors can accelerate the age-related decline in our pelvic floor or make its impact more significant.

The most important preventable factor is increased body weight. Other stresses on the pelvic floor, such as repetitive straining due to constipation, chronic coughing or regular heavy lifting, may also take their toll. Declining androgen levels contribute to a weakening of pelvic floor muscles. Oestrogen has limited effects on pelvic floor strength, but declining levels may contribute to an overactive or jumpy bladder.

Pelvic supports are also torn to a varying extent in most vaginal births, with the risk and extent of injury increasing with every additional delivery. Some women consider an elective Caesarean section (without experiencing labour) to limit this damage. However, this is only partly effective since considerable strain occurs prior to the due date. C-sections also have a number of other health implications for both mother and baby.

Some damage during labor may be prevented by pelvic floor muscle exercises, undertaken during pregnancy and continued after giving birth. It is thought that by increasing the strength of pelvic floor muscles, they are less prone to injury, recover faster and better support the downward pressure of the growing baby. We can become more aware of our pelvic floor muscles by using weighted vaginal cones. When individually introduced into the vagina, these devices are retained by active contraction of the pelvic floor. Essentially we teach ourselves to strengthen our muscles and follow our own progress.  Pelvic floor strengthening may also prevent some of the weakening of the pelvic floor accrued as we age (and have benefits for preserving sexual function).

Causes of incontinence

Yet even when maintaining a healthy body weight and performing pelvic floor exercises, many women experience some sagging of their pelvic floor supports during their lifetime. About every second woman experiences some urine leakage each month, with the frequency and severity increasing with age. The most common form is stress incontinence, where small amounts of urine unintentionally leak with coughing, exercising or other things that put pressure on the bladder. It is usually due to reduced support from the pelvic floor.

An overactive bladder is the second most common cause of urinary incontinence in women. It involves involuntary and inappropriate contractions of the bladder, frequently and suddenly making us feel the urge to urinate.  Sometimes we leak before we can stop it or get to a bathroom (urge incontinence). The bladder can be jumpy like this if it is irritated, such as with an infection, or if it is too full. Caffeine is another common and avoidable trigger. Many women have symptoms of both stress and urge incontinence (known as mixed urinary incontinence).

At its most severe, sagging of the pelvic floor leads to prolapse, whereby pelvic organs (the bladder, rectum or uterus) protrude into the vagina. Up to half of all women will have some prolapse, which may go unnoticed without close examination. However, fewer will experience severe symptoms, such as bladder and bowel frequency, and incontinence problems, bulge symptoms or pain with intercourse.

Incontinence and prolapse should not be seen as an inevitable part of aging. Rather than suffer in silence, it is important to seek help early, as there are now many simple options available to fix any problems.

Treatments for pelvic floor problems

For mild pelvic floor weakness, exercises and pessaries can be useful.  Bladder retraining (behavioral therapy), biofeedback, electrical stimulation and a number of different drugs are also effective for urge incontinence.

For the woman who has a major reduction in her quality of life, it is possible to reinforce the pelvic floor with a sling of mesh tape, without needing major surgery or a destructive hysterectomy. During this minimally invasive procedure, a tape is inserted through tiny incisions in the abdomen and vaginal wall. No sutures are required to hold the tape in place, recovery is fast and the cure is effective for life.

Options for a healthy pelvic floor

Do pelvic floor exercises

  • While in the shower, perform an inner squeeze for 6 seconds and repeat this until you get out.
  • Every time you finish emptying your bladder do 3 strong inner squeezes, holding for 5 seconds each.
  • Practice pelvic floor muscle contractions as you make love. This has the added benefit of enhancing your sex life!
  • Put a note on your bathroom mirror and on the car dashboard to remind yourself to squeeze.

Keep up your androgens with DHEA and other interventions

Declining androgen levels with age contribute to weakening of pelvic floor muscles and can be corrected with good effect.

Keep up your oestrogens, if you have an overactive bladder

HRT or local application of vaginal oestrogens can be effective in some post-menopausal women.

Take glucosamine and chondroitin sulphate to support collagen synthesis

Reduce exposure to AGEs in your diet to promote the flexibility and function of connective tissue

Make an appointment to see your doctor about incontinence – What good is a long life if it means long suffering too? If you have problems, get help today!

Last Reviewed 02/Mar/2014

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Dr Merlin Thomas

Professor Merlin Thomas is Professor of Medicine at Melbourne’s Monash University, based in the Department of Diabetes. He is both a physician and a scientist. Merlin has a broader interest in all aspects of preventive medicine and ageing. He has published over 270 articles in many of the worlds’ leading medical journals
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