Urinary incontinence and other pelvic floor disorders: what causes them?

Until recently, we did not hear about physiological conditions that affect the pelvic floor, or at least, it was considered taboo, ignored or silenced, especially in the case of women, although lately also in men.

It is important to be aware of the changes that occur in the pelvic floor from an early age, particularly in women, in order to prevent or treat pathologies or symptoms early while still facilitating their treatment or cure before it becomes irreversible.

Be careful with the perineum

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According to Professor Raquel Leirós Rodríguez,  PhD assistant in physiotherapy from the University of León, Spain, uro-gynecological and sexual diseases such as urinary incontinence, gas, discomfort during sexual intercourse and prolapses (organ prolapse) are the result of muscular alterations of the perineum or pelvic floor, the anatomical region corresponding to the pelvic floor, made up of the set of soft parts that close the bottom of the lesser pelvis downwards, the pelvic excavation.

As a first step, it is necessary to become aware that the perineum, like any other muscle group, must contract and relax at will.  As long as this is achieved without additional effort, it will be an indicator that the perineal musculature is preserved.

A simple way to check if the perineal muscle group is toned is that when contracting the perineum, no changes in tension should be felt in the glutes, adductors (inner thigh muscles) and/or abdomen. These muscle groups could act as parasites as they should not be activated because they do not actually increase continence, but they trick the person into feeling that they are contracting their muscles properly.

Habits to maintain perineum health throughout life

Our daily behavior has a lot to do with the health of this area of ​​the body.  Professor Leirós recommends that the first and simplest thing is

• “Respect the urge to void”, that is, go to the bathroom and evacuate as soon as you feel the need, without putting it off until you can no longer hold it. Once you have respected the urge, evacuation should be passive and complete; you should not use active force to evacuate and you should wait until the bladder is completely emptied.

• The stop-pee test is not recommended . The technique consists of voluntarily interrupting the urinary stream and then resuming it after a few seconds. Previously, this procedure was considered to “train” perineal strength, but in reality, it alters the sequence of reflexes defined by Mahony based on automatism. That is, the continuous repetition of this technique alters the sequence of muscular and nervous actions and automatism that occur naturally during urination. Therefore, it could cause and aggravate processes of urinary incontinence and bladder hyperactivity. ( article )

• The correct defecation posture. Perhaps one of the reasons for pelvic floor disorders is that we evacuate our bodies in bathrooms that do not allow us to maintain the correct posture.  To achieve the correct posture, the hips must be flexed more than 90º, that is, the knees must be higher than the hips.  In this position, the muscles responsible for continence and fecal discharge relax and it is not necessary to exert as much force to defecate.

A person who defecates in a biomechanically incorrect position or suffers from chronic constipation will be forced to strain excessively. The additional force causes harmful increases in intra-abdominal pressure.

On a smaller scale, something similar happens when coughing.  In this case, the increases in intra-abdominal pressure are smaller and shorter.  However, in the case of chronic respiratory problems, the recurrence is much more frequent throughout the day, which can have consequences.

Treat constipation

When the pressure inside the abdomen increases, this force compresses the pelvic organs (mainly the intestines, uterus, vagina and bladder) downwards. The movement towards the feet pushes the pelvic floor, which gradually becomes deformed and weakened.

To avoid the negative consequences of living with constipation, it is important to maintain healthy nutritional guidelines in order to prevent uro-gynecological and sexual pathologies. 

Improving constipation through food and other habits

• Reduce consumption of ultra-processed foods

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• Consumption of foods rich in fiber abundantly

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• Maintain adequate water consumption

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• Physical activity (yoga, aerobic exercises)

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Obesity and cigarettes are harmful factors for the pelvic floor

Obesity, and especially weight around the abdomen, increases the pressure (due to the weight of accumulated fat) on the pelvic diaphragm.

Cigarette smoking has been linked to a higher incidence of perineal disorders due to the toxic substances it contains, which facilitate the degeneration of connective or fascial tissue.

The main substances in tobacco smoke that cause illness are nicotine, carbon monoxide, tar, nitrosamines and oxidising substances. It also contains irritating gases and metals that, although found in relatively low doses, cause harm.

The nicotine present in cigarettes damages the connective tissue and skin fibers, resulting in weaker skin with little elasticity.  The skin is no longer strong enough to stay toned with weight fluctuations.

Furthermore, connective tissue accounts for more than 70% of the cells that make up the perineum. That is, even if you maintain a good level of muscle strength in general, the fascia and ligaments in the pelvic floor area cannot function properly and become vulnerable to pathologies.

The pelvic floor during pregnancy

Professor Leirós emphasizes the importance of preventing perineal disorders during pregnancy and postpartum.  Regardless of whether the pregnancy ends in vaginal delivery or a Caesarean section, pregnancy involves a risk factor for pathologies for the woman and her pelvic floor. What is known as overweight or the weight of the belly on the perineum weakens it progressively as the months of pregnancy progress.

Of course, during childbirth, dilation to make way for the baby involves an overexertion of the entire pelvic structure, in addition to the risk of being in the supine position, the use of certain medical instruments such as forceps and suction cups, interventions such as episiotomy or the development of certain complications such as muscle tears.

If you would like to learn more about perineal care and precautions during pregnancy, you can access Professor Leirós' full report here .

Tips

It is important to always keep in mind that our hygiene habits are crucial to prevent diseases and pathologies of our body. To prevent urinary incontinence try to:

- Perform pelvic exercises daily

- Quit smoking

- Do the appropriate exercises (some present in Yoga and Pilates postures) that strengthen the lower abdominal area.

- When lifting, do so with proper form. If you need to carry a child or lift shopping bags, for example, tighten your pelvis before and during lifting.

- Try to lose excess body weight since carrying accumulated weight around the abdomen weakens the pelvic floor and puts pressure on the bladder.

- Reduce caffeine consumption as it is a diuretic and excessive consumption irritates the bladder.

- Reduce alcohol consumption, which is also a diuretic, to avoid so many trips to the bathroom.

- Reduce consumption of citrus and spicy foods to avoid irritating the bladder.