'Women have said they're not aware they even have a pelvic floor'
It's not a topic that is openly discussed, but pelvic floor dysfunction (PFD) commonly affects women and some men. A lack of understanding and embarrassment mean the condition can go untreated. By Ailin Quinlan
A LACK of understanding amongst young women about the importance of the pelvic floor - which, if weakened during childbirth can cause incontinence - is being linked to problems later in life, according to the latest research.
A yet-to-be-published study of just under 1,000 female students at University College Cork, which is to be presented at a prestigious international conference later this year, warns that lack of knowledge about the pelvic floor has been associated with higher levels of pelvic floor dysfunction (PFD), a condition which can result in urinary incontinence.
Better understanding of the pelvic floor can result in better prevention of problems and increased willingness to seek treatment, according to the study, which found a "low level" of knowledge about the pelvic floor among the women surveyed.
Co-authored by UCC Professor Barry O'Reilly and final-year medical student Leah Falvey, the report found that while many respondents exercised regularly, they didn't exercise the pelvic floor, which is one of the most important muscle groups in the body.
"It is clear that low levels of knowledge of the pelvic floor are associated with a high prevalence of PFD, and that by simply increasing awareness of the pelvic floor and pelvic floor muscle exercises, we can reduce symptoms of PFD and thus improve quality of life," said the report, What Does Your Pelvic Floor Do For You?: Knowledge of the Pelvic Floor in Female University Students.
The findings will be presented to the annual conference of the International Urogynecological Association in Nashville, Tennessee in September.
Pelvic floor dysfunction can be caused by a number of factors, says Prof O'Reilly:
"Childbirth is the primary cause," he says, adding that the condition is also exacerbated by factors such as weight gain, heavy lifting in terms of manual work such as farming, chronic constipation, chronic coughing as in emphysema, asthma, previous pelvic surgery, ageing and even menopause.
Pelvic floor dysfunction can cause urinary incontinence, which comes in two forms; an overactive bladder (OAB) or stress urinary incontinence, explains Prof O'Reilly.
Symptoms of an overactive bladder include the need to run to the loo all the time, he explains.
"In effect, it's key-in-the-door urgency. You drop everything and run to the loo; you're getting up in the middle to the night to go to the toilet.
"Stress urinary incontinence (SUI) involves leakage as a result of coughing, sneezing or exercise," he says.
On average, one in seven older adults - men and women - experience incontinence, but it's twice as common in women, explains Lisa Smyth, Consultant Urologist at Tallaght University Hospital. She says a recent study at the hospital showed about 30pc of patients were suffering from incontinence. Research has shown, Smyth reveals, that simply performing the correct exercises can cure stress urinary incontinence in 30pc of patients. Stress urinary incontinence, Smyth adds, is also a side effect for males who have had their prostate removed as part of the treatment of prostate cancer.
However, unlike France, where any woman who has delivered a baby automatically gets a prescription for 10 free physical therapy sessions to "re-educate" her pelvic floor, many Irish women are unaware of its importance.
Cathy O'Sullivan, Interim Director at the Centre for Midwifery Education at Cork University Maternity Hospital and a midwife with more than 30 years' experience, says lack of awareness about the need to care for the pelvic floor - or even, awareness of its presence in the body - is a significant issue:
"A lot of women are not aware of it until they start experiencing problems," reports O'Sullivan, who trains the providers of antenatal training.
"Many women don't realise the weight of pregnancy can affect their pelvic floor," says O'Sullivan, who routinely demonstrates the burden carried by the pelvic floor during pregnancy, by filling a towel with sandbags approximating the totality of a woman's weight gain during pregnancy.
"The pelvic floor supports the womb, the bladder and the bowel, along with all the extra weight as demonstrated by the towel."
Women are surprised, she observes: "They're usually not aware of the strain this puts on their pelvic floor.
"In fact, women have said to me that they're not aware they even have a pelvic floor, let alone the fact that they need to care for it, or what will happen if they don't.
"A lot of women don't know about the anatomy of their bodies."
If a woman doesn't perform the recommended pelvic floor exercises, the experienced midwife warns, she can experience pelvic floor weakness resulting in leakage, an inability to control the passing of wind, or a prolapse of the internal organs such as the bladder or bowel.
"People are utterly embarrassed about this. It's not like talking about a broken ankle."
An overactive bladder is mainly treated with medication, avoidance of caffeinated drinks and the practice of fluid restriction, as well as pelvic floor exercises, says Prof O'Reilly.
Treatment for stress urinary incontinence includes physiotherapy, pelvic floor exercises, or surgery - the controversial 'mesh' or 'sling' treatment, which is now 'on pause' in Ireland following controversy about the negative effects some women are alleged to have suffered as a result of having the procedure.
"This pause will hopefully be lifted, as so many women are suffering because they're waiting for this operation," says O'Reilly, who has pioneered a successful new form of treatment for stress urinary incontinence. Trans-vaginal laser treatment is a non-surgical, walk-in, walk-out procedure, which aims to rebuild and restructure the damaged tissue of the vagina walls through collagen and elastin recovery stimulation.
Meanwhile, Smyth, who has established a clinic specialising in pelvic floor dysfunction at Tallaght University Hospital, says many patients are slow to seek help because of embarrassment about their incontinence:
"Many patients don't report it to their GP because they're embarrassed about it, but it has negative effects on their quality of life.
"It can affect your working day, your ability to function socially or attend exercise classes.
"The message is to be proactive about it and to be aware that there's nothing to be ashamed of, so report it to your GP. Incontinence is also often part of the ageing process and can be solved - there are lots of treatment options available."
Aoife, a businesswoman in her early 50s, did attend classes about the pelvic floor in hospital following the birth of her two children - but, she confesses, she didn't do the exercises, and until recently, didn't make the link with the incontinence she has suffered since her mid-30s.
"Women need to talk about this more," said Aoife. "I don't think there is a single mother in the country who has not suffered this in some form or another - everyone is suffering from it and we don't want to talk about it at all, but we should be far less embarrassed about it."
"When I was having my children, the hospital encouraged us to attend a talk about the pelvic floor, but I didn't do the exercises and I put it out of my mind and forgot about it.
"I didn't make the link for a long time. However, I believe the problem started back then, even though it didn't impact for some years after the births of my children," she said.
Aoife explains that during her 40s, the problem became very noticeable: "If I laughed or sneezed, I would leak."
She didn't opt for the now-controversial 'mesh' or sling treatment, she says, and by her early 50s, the problem was dominating her lifestyle. She started using pads any time she went out, was waking up frequently during the night to urinate, and eventually ended up organising everything she did around her proximity to a toilet. "By now, I had a mixture of both types of incontinence, and my days were planned around toilet breaks. If I wanted to go for a walk, I'd have to visit the loo twice before I left," she says, adding that if she had to travel for business, she had to plan a route that would make sure she could visit a bathroom.
Eventually, she heard about trans-vaginal laser treatment, and had three treatments, the last of which took place in June of this year.
The results were fantastic, she says: "For years, my whole day was planned around the loo and now I don't have to do that. There are no pads in the house anymore, and my quality of sleep at night is much better as I'm no longer getting up to go to the loo. It's wonderful."
Pelvic Floor: the facts
■ The pelvic floor is a layer of muscles that runs from your pubic bone at the front of your body to your lower spine at the back.
■ It has been likened to a hammock or trampoline which supports and holds your pelvic organs - including your uterus or womb, vagina, bowel and bladder - in place. These react automatically when you cough or sneeze by squeezing and stopping you from leaking urine.
■ Pelvic floor muscles come under strain during pregnancy and childbirth; sometimes they don't squeeze well after birth and are less effective at controlling the bladder.
■ If your pelvic floor muscles are weak, you may leak urine when you sneeze, cough and exercise during pregnancy and afterwards. Pelvic floor or Kegel exercises help strengthen these muscles. All pregnant women should do pelvic floor exercises.