Due to multiple births, heavy lifting or an unhealthy lifestyle, pelvic floor weakness can occur, which plays a crucial role in holding back urine and stool. Because the pelvic floor is a well-oiled system of muscles and other tissues, weakness has a variety of consequences, most of which are easily treatable.
What is pelvic floor weakness?
The pelvic floor is a layer of muscle and connective tissue about three centimeters thick that closes off the body at the bottom. The muscles of the pelvic floor are responsible for enabling a person to lift and carry objects without leaking urine or stool, that is, to retain urine and stool and to eliminate them at the proper time. In the case of pelvic floor weakness, the actual tasks of the pelvic floor can only be performed inadequately. This can lead to urinary or fecal incontinence, for example. In a healthy state, the pelvic floor muscles are only relaxed during urination, defecation and when a man has an erection or when a woman has vaginal intercourse. Particularly important is the ability of the pelvic floor to tighten reflexively so that urine does not escape unintentionally when coughing, sneezing or bouncing. In women, weakness of the pelvic floor muscles can lead to a lowering of the uterus or vagina.
Causes
Women who have hereditary connective tissue weakness are particularly at risk for pelvic floor weakness. It is normal that over time the pelvic floor muscles lose some stability, but in old age this can become too much and lead to pelvic floor weakness with all its consequences. But younger women can also suffer from pelvic floor problems. Especially if a woman has given birth to several children within a relatively short period of time, the pelvic floor may weaken due to overstretching of the muscles. Complications during childbirth, such as a perineal tear, can also weaken the pelvic floor muscles. Another possible cause of pelvic floor weakening is heavy physical labor. Chronic coughing can also weaken the muscles in the pelvic floor over time. Likewise, lifestyle factors such as smoking or obesity play a role in the development of pelvic floor weakness that should not be underestimated.
Symptoms, complaints and signs
Pelvic floor weakness mainly affects women, so it belongs to the field of gynecology. Its typical symptoms include mild to moderate incontinence due to weakening of the tissues and muscles. Affected women usually first notice pelvic floor weakness by the fact that the bladder sphincter no longer functions reliably and small amounts of urine can pass uncontrollably and unwantedly. This very often occurs when coughing, laughing or even during sports, when the body is exposed to major vibrations. Pelvic floor weakness is particularly common in the weeks following childbirth, but it can also occur in women of advanced age and after multiple births. Painful symptoms are not observed, but those affected often report a feeling of physical insecurity. Weakening of the muscles is noticeable and increases over time. Some patients also report a feeling that can be most closely compared to circulatory problems. The region around the pelvic floor is undersupplied with blood and feels as if it has “fallen asleep.” If the blood circulates better again, feelings of uncomfortable warmth are often reported. Purely external signs of pelvic floor weakness are not observed except for urinary leakage. Psychological problems and fears of the side effects may also occur as a result of pelvic floor weakness.
Diagnosis and course
Although promising treatment options exist, especially for milder forms of pelvic floor weakness, it is not uncommon for women to wait a long time before seeing a doctor. In most cases, this can be explained by the fact that topics such as incontinence still represent social taboos and are often hushed up. When a diagnosis is made, a medical history is first taken. This is followed by a gynecological examination. A urinalysis is performed to rule out any urinary tract infections as the cause of the symptoms. In addition, an ultrasound examination of the pelvic organs is performed.If necessary, the pressure in the bladder and urethra can be determined with the help of a catheter. Sometimes it is also helpful if the patient keeps a micturition diary and shows it to the doctor. In it, it is noted how often incontinence episodes occur, what the drinking habits are and so on.
Complications
Women who suffer from pelvic floor weakness face different complications in some cases. A said pelvic floor weakness causes incontinence in many cases. Since this symptom is still a taboo subject in today’s society, the final visit to the doctor is often put on the back burner. This can lead to further complications such as depression. Other complications that can occur in connection with pelvic floor weakness also include severe cramps and abdominal pain. Sufferers can obtain relief in this context by taking painkillers. In rare cases, fecal incontinence can also occur, which can also be treated with appropriate medication. Since pelvic floor weakness can also be caused by a lack of exercise, in many cases those affected are significantly overweight. For this reason, enormous blood pressure problems can occur during pelvic floor weakness, as well as restrictions in individual movements. One thing is certain: The individual complications that can be caused by pelvic floor weakness are generally limited. However, this varies greatly from patient to patient. If a patient lives a very unhealthy lifestyle, for example, further complications are to be expected. These include a susceptibility to infections, fever or even general muscle weakness.
When should you see a doctor?
Pelvic floor weakness is a not uncommon consequence of pregnancy and can also occur with age. Since the patient with this condition is no longer able to eliminate urine and stool in a controlled manner, he should see the doctor as soon as possible. It is possible that simple exercises can help to improve the stability of the pelvic floor again. However, these must be shown to the patient and he must know how they feel when he does them correctly – in other words, in such a way that the muscles of the pelvic floor are really exercised. In addition, the doctor can check whether pelvic floor exercises are having the desired effect. In addition, pelvic floor weakness can mean that the affected person can no longer lift heavy. Only the doctor can tell him how heavy he can still lift safely. In the case of severe pelvic floor weakness, it may even be advisable to surgically stabilize the pelvic floor. This may give the patient a better quality of life. Often, however, the medical examination is also about showing an affected person how to deal with the consequences of pelvic floor weakness in everyday life. Many people are understandably uncomfortable about not being able to control their bladder and possibly bowels properly. The doctor can show them aids for everyday life and how to deal with them so that they feel more comfortable again.
Treatment and therapy
When treating pelvic floor weakness, conservative therapy is started first. The content of this therapy depends entirely on the causes of the problems. The first measure for pelvic floor weakness is pelvic floor training with professional guidance. Biofeedback devices can also help to learn to tense the muscles of the pelvic floor in a targeted manner. Weight reduction and giving up cigarettes can also bring the desired success; this can be done, for example, as part of behavioral therapy. If the pelvic floor weakness occurs during menopause, the hormone deficiency that leads to thinning of the tissue can be counteracted by hormone therapy. If the conservative therapy approaches do not show the desired effect, surgery is necessary. Depending on the initial situation, this involves correcting, for example, subsidence of the uterus or bladder.
Outlook and prognosis
Pelvic floor weakness results from a weakening of the holding apparatus. Therefore, for a good prognosis, it is important to take appropriate measures to strengthen the pelvic floor again and refrain from activities that weaken it. Regular exercise is beneficial, especially endurance sports such as walking, cycling, swimming or running. It is better to refrain from lifting heavy loads, because it tends to promote uterine prolapse.Women who are heavily overweight should work on reducing their body weight to relieve the pelvic floor. Regular pelvic floor training has a particularly positive effect because it strengthens the pelvic floor and improves or effectively prevents accompanying symptoms such as incontinence problems. However, the exercises must be performed correctly, and if necessary they should be practiced under expert guidance. During menopause, the weakening of the pelvic floor may also be caused by the hormone deficiency, which weakens the connective tissue in general. In this case, appropriate hormone treatment can improve the symptoms. In most cases, these measures are sufficient to improve the outlook in the long term, but in more severe cases it may be advisable to stabilize the pelvic floor surgically.
Prevention
To prevent the pelvic floor from weakening in the first place, there are various measures that effectively strengthen the muscles. Thus, pelvic gymnastics can also be effective prophylactically and not only at the first appearance of symptoms. Pelvic floor exercises can also be done at home. However, the training is usually more effective when performed under professional guidance. As a preventive measure, sports that increase the pressure on the pelvic floor and can thus weaken it should be avoided, including sports such as tennis or jogging. To prevent weakening of the pelvic floor muscles, it is also helpful not to push unnecessarily during bowel movements and to avoid constipation.
Aftercare
Pelvic floor weakness can be treated in a variety of ways. However, aftercare is the same for most treatment methods. This is because apart from surgery, which also requires wound regeneration, aftercare is basically about the same thing after any therapy: The patient must be made aware of the function of the pelvic floor and learn to discard harmful behaviors and adopt positive ones in everyday life. This is possible in cooperation with the treating gynecologist, but also with the family doctor or an internist. The pelvic floor is muscle that can be trained. Therefore, it is part of consistent aftercare to strengthen these muscles with special exercises. These exercises are easy to learn and to integrate into everyday life. After surgery, they are usually taught by a physiotherapist and can then be continued regularly at home. This contributes to a lasting strengthening of the pelvic floor. Heavy pressing during bowel movements has a negative effect on the stability and holding function of the pelvis. Therefore, digestive regulation can also contribute to consistent follow-up care for pelvic floor weakness. A soft and voluminous stool is achieved by drinking sufficient amounts of fluids and fiber. There are home remedies that support this. One remedy that has proven to work well in this context is psyllium husks, which are ingested stirred into water.
This is what you can do yourself
Among the most effective immediate measures are special insoles, which the trade offers in many different sizes. They adapt to the shape of the body and are not noticeable even in tight pants. In case of severe pelvic floor weakness, a spare pad should always be carried. Somewhat more patience is required for special exercises, which are summarized under the term pelvic floor training. Performed regularly, they stabilize the connective tissue and at the same time strengthen the tendons and ligaments. Since excess weight can also lead to weakening of the pelvic floor muscles, those affected should strive to reduce their weight. In addition to special inserts, cube or ring presses can compensate for pelvic floor weakness. Tampons made of foam also offer effective help to those affected. These must be fitted by a doctor and can then be changed by patients themselves. If the complaints occur during menopause, a hormone deficiency may be the cause. This leads to thinning of the tissue around the vagina, bladder and urethra. The deficiency is diagnosed by a specialist. He can then initiate hormone therapy and strengthen the affected tissues in this way. Pelvic floor weakness does not only affect women. In men, too, the sagging pelvic floor leads to unwanted urine leakage. Even at the slightest sign of weakening of this region of the body, it is important for those affected to train and stabilize it in a targeted manner.