Pelvic Health: Doctors Explain Why It's Important

Editor's note: Dr. Jamin Brahmhat is a urologist and robotic surgeon at Orlando Health and past president of the Florida Urological Association..

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The heart keeps blood flowing, the gut processes energy, and the mind holds it all together, but what about the pelvis?

This unsung hero, or heroine, is essential for many bodily functions. The muscles and organs in the pelvic area are essential for fertility, bladder and bowel control, sexual function, and that most provocative of dance moves, twerking. Belly dancing may be a non-surgical treatment For pelvic floor problems.

People often don't realise the importance of pelvic health until they experience problems, such as pain instead of pleasure during intercourse, unexpected leakage of urine when coughing (women and men), or inability to achieve or maintain an erection (men). Understanding how the pelvic floor works and recognising the signs of dysfunction are crucial to maintaining your overall health and wellbeing.

Both men and women have a pelvic floor, but their anatomy and function are very different. Think of the pelvic floor as a supportive hammock. In women, the pelvic floor supports the bladder, uterus, and rectum, and also plays an important role in childbirth. In men, the pelvic floor supports the bladder and rectum, and helps with erectile function and bladder and bladder control.

Overall, about a quarter of women in the United States suffer from pelvic floor problems. National Institutes of HealthWomen between the ages of 20 and 39 are less likely to experience symptoms. Around a quarter of women in their 40s and 50s have pelvic floor problems. This rate increases with age, with more than half of women aged 80 years old having pelvic floor problems.

What about men? Most of the attention is on the women. 16% of men Pelvic floor problems have also been identified, which can affect anyone, regardless of gender.

Aging, surgery, obesity, chronic coughing, heavy lifting, and even high-impact exercise can affect the pelvic floor in both men and women. Increased pressure within the abdomen over time can weaken, strain, and tear the pelvic floor muscles. Preventative measures include practicing pelvic floor exercises (Kegels), maintaining a healthy weight, and learning proper lifting techniques. Vaginal birth directly damages the pelvic floor, but excessive high-impact exercises such as C-sections and jumping can also cause pelvic floor problems over time.

However, this is not an excuse to avoid exercise altogether. Regular physical activity is essential for overall health and can be safely maintained with appropriate modifications and attention to pelvic floor health. These issues can cause similar symptoms in both men and women, highlighting the importance of pelvic health for everyone. However, childbirth adds a unique set of challenges for women, making it a key focus in their pelvic health journey.

During pregnancy and childbirth, the pelvic floor muscles naturally and forcefully stretch and tighten. According to a 2023 study, approximately 56% of women experience some form of pelvic floor dysfunction after giving birth. studyThis can lead to a variety of problems, including urinary incontinence, pelvic organ prolapse, pain during intercourse, etc. Many women feel that all of this is natural, but as healthcare professionals we know that this is not the case if it remains after recovering from childbirth.

Urinary incontinence: Imagine you're watching your favorite sitcom on TV. Suddenly, you laugh too hard and end up with the infamous urinary incontinence. Oops. Of course, this is common after giving birth, but that doesn't mean it's okay. Urinary incontinence is a sign that your pelvic floor muscles, which support your bladder and urethra, need medical attention.

Pain during intercourse: Painful intercourse after childbirth is often dismissed as normal, but it shouldn't be. The discomfort is your body telling you that something is wrong. Similarly, menopause causes changes to the pelvic floor, and declining estrogen levels can lead to vaginal dryness and thinning of the vaginal walls. These anatomical changes can cause discomfort and pain during intercourse.

Pelvic compression and prolapse: Have you ever felt like you had an invisible bowling ball in your pelvis? That heavy pressure or bulge could be a prolapse, a condition in which an organ like the bladder or uterus slides out of its normal position. This is common, but not normal.

Given the prevalence and impact of these issues, maintaining your pelvic floor health is essential to a good quality of life. Pregnancy, childbirth, surgery, and aging can weaken these muscles, leading to the symptoms mentioned above. But there's good news: with the right care at the right time, you can quickly improve your pelvic floor health.

There are many treatments for pelvic floor disorders, including both surgical and non-surgical treatments. One common treatment is pelvic floor therapy, which goes beyond just the well-known techniques. Kegel exercisesPelvic floor therapy includes specialized exercises, physical therapy, biofeedback, and proper breathing and body mechanics. And Kegel exercises to strengthen the pelvic floor muscles are not the only essential exercises. In fact, many people have tight pelvic floor muscles and would benefit from stretching and strengthening. Others should avoid strenuous core exercises. Pelvic floor therapy is not a one-stop shop, but a dynamic intervention that is individualized to the patient, their symptoms, and their future goals.

While much of the discussion around pelvic floor dysfunction focuses on women, men are not immune to these issues. Prostate surgery, and especially diseases such as prostate cancer, can damage the pelvic floor muscles. This can lead to urinary incontinence and erectile dysfunction, similar to the effects childbirth has on women. Pelvic floor therapy can help men regain control and improve their quality of life. Like women, men need to understand that these symptoms, while common after surgery, are not normal and are treatable.

The first step to solving the problem is to know what is not normal and talk about it with your healthcare provider. In my office, I ask general questions to screen for pelvic floor issues, even if a patient comes to see me for another urological issue. I am often surprised to hear a patient answer “yes” to my question and then add, “Well, that's normal for my age.” This is a special situation because I am a urologist, and this is something I actively screen for to help treat. In a general primary care consultation, this may not be done as openly because of the broad focus. That's why you have to speak up.

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