You need to focus on your pelvic health. A doctor explains why
Dr. Jamin Brahmbhatt, CNN
(CNN) — The heart keeps our blood flowing, the gut processes our fuel and the mind — that’s what keeps it all together. But what about the pelvis?
This unsung hero — or heroine — is essential for so many of the body’s functions. The muscles and organs within the pelvis are vital for fertility, urinary and bowel control, sexual function and even that most provocative of dance moves, “twerking.” Some studies even suggest movements like twerking or belly dancing may be a nonsurgical treatment for pelvic floor issues.
We often don’t realize the importance of pelvic health until something goes wrong — like pain instead of pleasure with intercourse or that first unexpected leak when coughing (in women and men) and the inability to get or maintain an erection (in men). Understanding how the pelvic floor works and recognizing the signs of dysfunction is crucial for maintaining overall health and well-being.
The pelvic floor
While both men and women have a pelvic floor, the anatomy and functions differ significantly. Think of the pelvic floor as a supportive hammock. For women, the pelvic floor supports the bladder, uterus and rectum, and it also plays a vital role in childbirth. For men, the pelvic floor supports the bladder and rectum and aids in erectile function and urinary and bladder control.
Pelvic floor issues are common
Overall, nearly a quarter of women in the United States develop pelvic floor issues, according to the National Institutes of Health. Women ages 20 to 39 are less likely to experience symptoms. About a quarter of women in their 40s and 50s have pelvic floor issues. The percentage increases with age, with over half of all 80-year-old women having pelvic floor problems.
What about men? Even though most of the attention is on women, 16% of men have also been identified with pelvic floor issues. This problem is genderless, anyone can be affected.
Causes of pelvic floor disorders
Aging, surgery, obesity, chronic coughing, heavy lifting and even high-impact exercise can impact the pelvic floor in both men and women. Increased pressures inside the abdomen over time can lead to weakening, straining or even tearing of the pelvic floor muscles. Preventive measures include practicing pelvic floor exercises (Kegels), maintaining a healthy weight and having proper lifting techniques. While vaginal childbirth can directly damage the pelvic floor, a C-section or excessive high-impact activities like jumping can also contribute to pelvic floor issues over time.
However, this is no excuse to avoid exercise altogether. Regular physical activity is essential for overall health and can be safely maintained with proper modifications and attention to pelvic floor health. These issues can lead to similar symptoms in both genders, underscoring the importance of pelvic health for everyone. However, childbirth adds a unique set of challenges for women, making it a critical focus in their pelvic health journey.
The challenges of childbirth
During pregnancy and delivery, the pelvic floor muscles are stretched and strained, some naturally and some forcibly. Some 56% of women experience some form of pelvic floor dysfunction postpartum, according to a 2023 study. This can lead to a host of issues such as urinary incontinence, pelvic organ prolapse and pain during intercourse. Many women feel this is all just natural, but as health care providers, we know it is not if it’s something that remains after you’ve recovered from the childbirth.
What is normal versus abnormal
Urinary incontinence: Imagine you’re watching your favorite comedy on television. Suddenly, you laugh a bit too hard, and there it is — the infamous leakage. Oops. Sure, it’s common after childbirth, but that doesn’t make it OK. Urinary incontinence is a sign that your pelvic floor muscles, which support the bladder and urethra, need some medical attention.
Pain during intercourse: Pain during sex after childbirth is often brushed off as normal, but it shouldn’t be. That discomfort is your body’s way of saying, “Hey, something’s not right down here.” Similarly, menopause can cause changes to the pelvic floor with decreased estrogen levels causing vaginal dryness and thinning of the vaginal walls. These anatomical changes can contribute to discomfort and pain during intercourse.
Pelvic pressure and organ prolapse: Ever feel like there’s an invisible bowling ball in your pelvis? That heavy pressure or bulge might be organ prolapse, where organs like the bladder or uterus slip out of their normal positions. Though common, it is not normal.
Why focus on pelvic floor health
Given the prevalence and impact of these issues, maintaining pelvic floor health is vital to a good quality of life. Pregnancy, childbirth, surgery or aging can weaken these muscles, leading to the symptoms listed above. But here’s the good news — pelvic floor health can be improved with the right care at the right time — sooner rather than later.
What can be done to help the pelvic floor
There are many treatment options, both surgical and nonsurgical, for pelvic floor disorders. One common treatment is pelvic floor therapy, which isn’t just about doing the well-known Kegel exercises. It involves specialized exercises, physical therapy, biofeedback and learning correct breathing and body mechanics. And Kegels, which strengthen pelvic floor muscles, aren’t the only essential pelvic floor exercises. In fact, many people can have tight pelvic floor muscles that can benefit from stretching and lengthening. Other people should avoid strenuous core exercises. Pelvic floor therapy is not a one-stop shop, it’s a dynamic intervention that is personalized to the patient, their symptoms and future goals.
The lesser-acknowledged struggle in men
While much of the discussion around pelvic floor dysfunction focuses on women, men are not immune to these issues. Prostate surgery, particularly for conditions like prostate cancer, can disrupt the pelvic floor muscles. This can lead to urinary incontinence and erectile dysfunction, like how childbirth affects women. Pelvic floor therapy can help men regain control and improve their quality of life. Just like women, men need to understand that while these symptoms are common after surgery, they are not normal and can be treated.
Breaking the silence on pelvic health
The first step to fixing the problem is knowing what is not normal and speaking up about it with your medical providers. In my office, even if a patient is seeing me for another urologic problem, I still ask general questions to screen for pelvic floor issues. I’m often surprised to hear patients say “yes” to my questions and then add, “Well that’s normal for my age.” This is a unique situation because I’m a urologist, and this is something we actively screen for to help treat. This may not happen as openly at a general primary care visit since the focus is broader — hence why you have to speak up!
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