What every woman should know about pelvic floor health

Dr Marie Subrayan, an obstetrician, gynaecologist and aesthetic gynaecologist, has spoken extensively about pelvic floor health, highlighting how this area of women's wellness is often misunderstood. In an interview with Independent Media Lifestyle, Subrayan explained that while Kegel exercises are commonly associated with strengthening the pelvic floor, they are not the sole solution and are frequently performed incorrectly, limiting their effectiveness. Pelvic floor exercises can be broadly categorized into two types: those designed for a "hypotonic" pelvic floor, where the muscles are too weak, and those for a "hypertonic" pelvic floor, where the muscles are overly tight. Subrayan emphasized that these conditions are not universal and vary significantly among individuals. Understanding the specific nature of each condition is crucial for determining the appropriate treatment approach. For a hypertonic pelvic floor, the muscles remain constantly tense, akin to being in a state of perpetual vigilance. This condition is often linked to heightened anxiety levels, which can manifest in various physical symptoms. These include bruxism (teeth grinding) during sleep, frequent headaches, and gastrointestinal issues such as irritable bowel syndrome. Individuals with a hypertonic pelvic floor may also suffer from chronic lower back or hip pain and find comfort in adopting a curled posture, reminiscent of the fetal position. Menstrual cycles may become more painful, and sexual activity could be uncomfortable or even painful. Inserting a tampon or menstrual cup might pose challenges. Subrayan noted that these symptoms can stem from both personal experiences, such as past trauma including sexual assault, and inherent personality traits, such as a predisposition toward anxiety. Even certain athletic activities, like ballet or horseback riding, can contribute to this condition. Addressing the root causes, whether physical, emotional, or psychological, is essential alongside muscle relaxation techniques. Conversely, a hypotonic pelvic floor involves weakened muscles that struggle to provide adequate support to the pelvic organs. This condition is frequently observed in women who have endured challenging deliveries, such as those involving forceps or vacuum extraction, or who have experienced significant tissue damage. Excess body weight or substantial fluctuations in weight can further exacerbate the issue by placing additional stress on the muscles. There is also a genetic factor at play, with studies indicating that Caucasian women are more likely to develop pelvic floor prolapse compared to women of other ethnicities. Identifying a weak pelvic floor can present several signs. Common indicators include urinary incontinence, such as leakage during laughter, coughing, or jumping, and difficulty controlling bowel movements. Some women may notice that tampons or menstrual cups fail to remain in place, and sexual satisfaction may decrease due to insufficient muscular engagement. A sensation of heaviness within the vaginal canal can signal that the bladder or uterus is beginning to descend, unable to be adequately supported by the weakened muscles. Subrayan stressed the importance of recognizing these symptoms early to seek timely intervention.