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Have you jumped up and down recently? Been for a run? Laughed until you blew a gasket? Sneezed one of those sneezes that starts from your toes and winds up in your knickers? Then, join the club, sister. The Down Under Knicker Blunder club that an astounding 75 per cent of Australian women belong to… the club that unites most, if not all women at some stage in their lifetime.
Yes, we’re going to talk pelvic floors. But don’t shy away. They are so desperately needful of discussion. An astounding 40 per cent of women live with bladder control problems and 50 per cent suffer pelvic organ prolapse. ‘Scuse the pun, but this ain’t no laughing matter. If you’ve seen my post on Continence Awareness week, you’ll understand that pelvic floor issues are not only common, they are often easily dealt with. There is so much we can do, as women, to improve our awareness on this well-hidden part of our anatomy… and subsequently improve our lives.
When Mary O’Dwyer talks about pelvic floors, you can hear the passion in her calm, modulated voice. This is a woman who has dedicated most of her working life to Down Under therapy.
“Working as a musculo skeletal physiotherapist, I continued to hear women with spinal, joint, balance and mobility problems talk about their poor bladder control,” says O’Dwyer, who was determined to learn more about these all too common female problems.
“After specializing in pelvic floor dysfunction, I had a window into how women’s lives are affected by loss of self esteem, by a limited ability to exercise and the impact on intimate relationships,” O’Dwyer tells Australian Women Online.
“Restoring control of incontinence, improving sexual dysfunction and pelvic joint pain makes a major difference to a woman’s life, so really my patients keep me passionate about this work.”
“..Orgasm is a brilliant work out for pelvic floor muscles, so use it or lose it..!”
O’Dwyer completed her undergraduate studies at the University of Queensland in 1975, then went on to complete post-graduate studies at the University of Melbourne in 2000. Her teaching began at Griffith University on the Gold Coast in 2005, and then onto Bond University in 2007, where she is a Senior Teaching Fellow.
Since completing and implementing her studies into women’s health, O’Dwyer has been overwhelmed by the amount of women affected by pelvic floor dysfunction.
“Research shows that 25 per cent of university aged women and over 40 per cent of elite female athletes leak with sport, 30 per cent of women in the armed forces leak with training, 45 per cent of vaginal birth and 36 per cent of Caesarean section mums report incontinence and prolapse, and up to 55 per cent of older women suffer incontinence,” says O’Dwyer.
An astounding set of numbers, indeed, especially when we consider 50 per cent of women suffer vaginal prolapse problems, from mild to severe.
The causes of pelvic floor dysfunction are many and include habitually poor posture. According to O’Dwyer, slumping in a chair shuts down the action of the pelvic floor and core muscles in the body. Consistent straining to empty the bowel is also a culprit, thanks to our less than perfect, highly refined diet. Injury to the spine or pelvis, heavy lifting, abdominal surgery, pregnancy and childbirth all have the potential to shut down the action of the pelvic floor and trunk core muscles, resulting in a myriad of problems.
“Women are not generally aware of the importance of rehabilitating their pelvic floor and core muscles after these events,” admits O’Dwyer.
Ironically, excessive abdominal exercises strongly increase pressure in the abdomen, which pushes down and can overwhelm the pelvic floor. Obesity, diabetes, chest disease, neurological disorders, irritable bowel syndrome, depression and poor collagen are all associated with a higher rate of incontinence. And, according to O’Dwyer, one of the biggest factors adding weight to pelvic floor problems is something many modern women are guilty of.
“Habitually sucking in the waist to make it smaller also creates unnecessary internal pressure down onto the pelvic floor,” says O’Dwyer.
Uh-oh.
Like many women, I’ve personally experienced the effects of many perineum-damaging habits, particularly the waist-sucking exercise. It’s no wonder, then, that I join most women in the Down Under Knicker Blunder club. But seriously, the following side effects of perineal dysfunction are no laughing matter. Maybe you can tick some of these boxes:
- Stress and urge incontinence
- Pelvic organ prolapse
- Bowel incontinence
- Sexual dysfunction (painful intercourse from too tight muscles or loss of vaginal sensation and orgasm)
- Painful trigger points in external and internal pelvic muscles
“Pelvic floor muscles are amazing,” O’Dwyer tells AWO. “They maintain continence, contract with the deep abdominals to protect the spine against injury, support our pelvic organs when we lift or crouch, and provide sexual sensation and orgasmic strength.”
Despite the decline in quality of life that many women experience due to pelvic floor issues, less than a quarter of women report problems to their GP. Emotional, religious and abuse issues may cause women to view their pelvic floor in a less than glamorous light.
“I find many of my patients are disconnected from their pelvic floors and may even consider it to be ‘dirty’ when they cannot control loss of fluids, wind or solids from their body,” says O’Dwyer. “Unfortunately, some women associate shame with their pelvic floor as a result of family, social or cultural teachings. In both men and women, derogatory terms and ribald jokes are associated with the female pelvic floor.”
O’Dwyer, and other professionals in her field, aim to change this. It’s of enormous importance that we teach our daughters how to look after their perineal health, but of course, mums have to become educated first. Taking the following steps can help make a start:
- Sit and stand tall every day – this action will keep the pelvic floor muscles switched on
- Avoid constipation by adding more daily fibre, fluid and exercise
- Find the gentle lifting action of pelvic floor muscles from underneath the body and train them every day
- Avoid heavy lifting and prolonged coughing
- Relax any excessive waist tension and learn the pelvic floor and deep abdominal action to effectively flatten the stomach
- Avoid excessive sit ups; abdominals should be trained to brace just like they do when we cough, lift, push or pull and object
- Make learning and repeating daily pelvic floor exercises a priority in your life (just like teeth cleaning)
- Orgasm is a brilliant workout for pelvic floor muscles, so use it or lose it!
Not surprisingly, these tips are simply not enough for some women. Some need guided help from a Women’s Health Physiotherapist.
“Not all pelvic floors work the same,” says O’Dwyer. “Some are very slack and stretched, and so will benefit from strength exercises. Other women may have overly tight pelvic floor muscles from ongoing anxiety, excessive abdominal training or a history of abuse. Pelvic floor strength exercise would make their symptoms worse. It’s important to have a correct diagnosis of pelvic floor muscle disorders.”
There are many areas women can go to for all-important pelvic floor support. Doctors, physiotherapists, the Continence Foundation and Continence Nurse Advisors all have the names of Women’s Health Physiotherapists.
“The only problem is, these physiotherapists are in relatively short supply and are not located outside of major towns,” says O’Dwyer. “I’m therefore excited to be associated with a new online women’s health club for pregnant and new mums – www.pregnet.com.au. Through the internet, I’ll be able to give advice and direct members to appropriate professionals for treatment. Many women who live in the country do not have access to this advice.”
“…Every woman needs to know what’s in this book…” – Dr Christiane Northrup, M.D.
In 2008, O’Dywer published her first book – My Pelvic Floor (Flaw) – aimed to educate women on pelvic floor function and dysfunction. She has since re-released this book under the new title Hold it Sister.
This comprehensive book should be a staple on every woman’s bookshelf, and indeed, has been recommended by world-renowned women’s health professional, Dr Christiane Northrup M.D, who has said “Every woman needs to know what’s in this book”.
Hold it Sister contains a goldmine of information designed to both educate and improve the quality of life for women everywhere, by demystifying a vital part of our anatomy. Comprehensive chapters and clear diagrams support a wealth of practical information from introducing us to our nether regions, right through posture, correct breathing, even how to poop correctly.
O’Dwyer also covers the broad range of women experiencing a variety of perineal dysfunction from athletes to new mums and menopausal women. She also provides a resources chapter and an all-important glossary of terms.
According to O’Dwyer, the importance of Hold it Sister lies in educating women and increasing their awareness of the central role this incredible group of pelvic muscles plays, not to mention the impact dysfunction can have on their emotional and physical health.
“I believe when this information becomes well known among women, it will not only improve their lifestyle but provide substantial savings to the health care system,” says O’Dwyer, who has recently taken Hold it Sister to the US and UK, with wonderful results.
O’Dwyer, herself a supreme example of balanced and healthy living, has high hopes for the health of Australian women – above and beyond a healthy pelvic floor.
“My hope is that we achieve satisfaction and happiness through healthy relationships (self, family, friends, work, food) and recognise our purpose… because our physical health is intertwined with our emotional and spiritual health.”
When asked about her own personal secrets to a healthy and balanced life, O’Dwyer smiles enigmatically. “The old basics I ignored for many years,” she laughs. “Regular sleep, some exercise every day, fresh food prepared with ‘lurve’, positive thinking and fish oil.”
Just as O’Dwyer’s list puts my own health regime to shame, I’m heartened by the addition of her final health secret… “Almost forgot chocolate!”
My Pelvic Floor (Flaw) is available at Australian bookshops or online at www.redsok.com. Hold it Sister is available as a paperback or ebook (for those with a sense of urgency!) through www.holditsister.com or www.redsok.com.
PregNet is the first online centre of its kind in the world. This brilliant healthcare initiative is linking up leading specialists with pre- and post-pregnant women all over Australia. Head to www.pregnet.com.au.
To find a women’s health professional, or for advice, contact: The Continence Foundation – www.continence.org.au or 1800 33 00 66