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NAFC is a non-profit offering resources for people struggling with incontinence, adult bedwetting, OAB, SUI, nocturia, neurogenic bladder, and pelvic floor disorders like prolapse. 

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The Pelvic Floor As We Age. A look at how it changes through the different phases of life (pregnancy/menopause/etc.).

Sarah Jenkins

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A Guest Post By Michelle Herbst, PT

Times have changed. The pelvic floor was once considered a taboo subject. As women age their birthing history and overall muscle weakness may catch up with them.  A healthy pelvic floor can be achieved as we age but often times little attention is paid to our pelvic floor until it starts to fail. It can be difficult for women to seek medical attention due to feelings of embarrassment and despair. But, advances in health care and knowledge of the aging process allows today’s women to seek effective treatments.

Let’s step back and take a closer look at the pelvic floor as we age.

The pelvic floor is a sling supporting our abdominal and pelvic organs. It is made up of our muscles and connective tissues which I like to think of as our active and passive pelvic support structures. The pelvic floor muscles, or active pelvic support structures, create a muscular sling whereas our passive pelvic support structures are made of connective tissue called fascia. Fascia is a spider-web like material traveling through and covering the pelvic floor.

The active and passive pelvic support system are one in the same. They are knitted together interlacing creating a dynamic basin of support. Healthy pelvic support system work together controlling our sphincters, limit the downward descent of the pelvic organs and aide in sexual appreciation. Damage or weakness to the pelvic support system may result in symptoms of pelvic floor dysfunctions resulting in leakage and pelvic organ prolapse.

The pelvic floor over time.     

Pregnancy, child birth and the post-partum period is a time of great change. The interlacing nature of the active and passive pelvic floor support systems protect the mother and baby as they both grown. Child birth calls on the pelvic support system to push and slide the baby out into the world. The pelvic floor muscles can heal in as quickly as 6 weeks after delivery. But, the physical strain of living and creating new life can be taxing on the pelvic support system leaving it overstretched and weak.

The prescription is often kegels and post-partum kegels can be hard to do. The muscles are lengthened, very weak and trying to ‘reconnect’ to their nerve supply. In an attempt to ‘get it all done’, the post-partum mom is often multi-tasking while doing kegels. Their brain is preoccupied, sleep deprived and foggy. Despite good intentions, many new mothers ‘muscle their way through’ relying on other muscle groups to assist or do the job of the pelvic floor. Overtime with due diligence and a sleeping baby – the brain fog lifts, kegels are consistent and pelvic floor muscles recover allowing the new mom to return to and enjoy life’s pleasures and adventures.

Life continues to click at a fast pace.  The biological process of aging ticks away. The passage of time can be bittersweet. In the 3rd through 5th decades of a woman’s life, she will begin to experience a gradual loss in overall muscle strength and tensile strength of their connective tissue. In their 4th and 5th decades, peri-menopause ushers in a decrease in circulating estrogen and progesterone. The conclusion of these gradual changes are marked by menopause which is typically complete during the 5th decade. Life starts to catch up with you. The birthing of children, past injuries, the development of chronic health conditions and your family history may predispose the active and passive support system to overall weakening and loss of integrity resulting in leakage, organ prolapse and decline in sexual function.

What to do?

1.     Protect and strengthen your active pelvic support system by engaging in a strength program and doing your kegels. Peak muscle strength occurs in twenties or thirties. And, unless a woman is engaging in a strength program she will begin lose muscle mass and strength.

2.     Protect the passive pelvic support system by avoiding straining during bowel movements and avoid holding your breath while lifting, pushing and pulling. The passive pelvic support system can not ‘fix itself’ and will need to rely strength of the active pelvic support system. So, revisit number 1 again and again and again …

3.     Stay healthy and seek out your doctor’s advice when you are sick or notice your first sign of leakage or prolapse. The treatment often times isn’t as bad as you think it will be.

Michelle Herbst, PT

Michelle Herbst, PT