Beyond the occasional Kegels exercise, many of us barely give our pelvic health a thought.
But the pelvic floor is central to a wide variety of ailments - from problems with sex and pelvic pain to leakage and pregnancy-related conditions - and its health can be profoundly influenced by factors ranging from stress to bowel habits, experts say.
Here are a few things two pelvic health physios want you to know. (Your pelvic floor will thank us.)
Stress and anxiety can affect your pelvic floor
The pelvic floor can be influenced by stress and anxiety, says says Shan Morrison, a specialist pelvic health physiotherapist and founder of a Melbourne-based physiotherapy practice. She's seen an increase in patients with overactive pelvic floor since COVID-19 and lockdowns began, and attributes the rise to widespread stress and anxiety in the community.
"The pelvic floor is almost like the [nightclub] bouncer protecting the crown jewels in the pelvic area because of how important those organs are," she says.
"It's about the link between the mind and the body. And I think it really manifests when people are stressed and anxious; they often really hold their tension in that area."
For that reason, treatment for some pelvic floor issues involves dealing with associated emotional and mental health factors - such as seeing a psychologist as part of treatment for overactive pelvic floor.
You don't have to accept pelvic pain or leakage as 'your lot in life'
Many Aussies put up with leakage, pelvic pain, prolapse or other issues thinking they're 'normal'.
But Angela James, a physiotherapist and founder of a Sydney pelvic clinic, wants women to know these conditions, while common, are not an inevitable side effect of ageing (or childbirth).
These conditions are all treatable and "really should get investigated with the right healthcare professional", says Ms James.
"That is a cultural thing in Australia; I don't know why but Australian women put it off and they have this acceptance of symptoms," she adds.
"You don't have to think, 'I have to accept this. I've had a baby, now this is my lot.' We've had that cultural attitude for too long."
She wants readers to know there's no need to be embarrassed.
"When patients say things like 'I go to fart and I soil my pants' - we're all over that stuff" and don't bat an eyelid, she says.
"There are professionals out there who are deeply interested, and caring, and want to know and want to help, and have a good evidence base behind [what they do]."
Incontinence and pregnancy
Pregnancy itself is more likely to cause stress incontinence than your method of delivery.
Having a caesarean doesn't guard against incontinence
Many women don't realise they can still have pelvic floor dysfunction if they had a caesarean section rather than vaginal birth, says Ms James.
While an elective caesarean may reduce the risk of stress incontinence in the short term for some, there's no guarantee it will prevent this problem altogether.
"The rates of incontinence between vaginal and caesarean birth are the same once you get to menopause, [so] you still need to strengthen your pelvic floor" before, during and after pregnancy, says Ms James.
That's because "the weakness and stretch that occurs during the pregnancy" is largely to blame for this later incontinence, not so much the mode of delivery, she explains.
Your bowel movements have a big impact on your pelvic floor
Constipated? You could be harming your pelvic floor.
"We know for an absolute fact that straining on the toilet to have a bowel movement can weaken your pelvic floor and contribute to prolapse," says Ms Morrison.
"Apart from pregnancy and birth, it is probably the biggest risk factor contributing to pelvic floor problems."
Her patients are often surprised to hear that "very commonly what the bowels are up to affect the bladder."
She regularly talks with them about increasing their fibre and fluid intake and making sure they don't put off the urge to empty their bowels.
Looking after your pelvic floor
All women should be able to take their time going to the toilet, never leak, never strain with their bowels, or experience painful sex or periods.
Pelvic floor exercises can prevent many issues (not just leakage)
Many of us have heard of pelvic floor exercises to prevent urinary incontinence. But you might not have heard these exercises can also prevent prolapse and faecal incontinence, too.
Pelvic floor exercises have additional benefits for pregnancy people: " Research has showed they can reduce the pushing stage during labour, and it can reduce the risk of tearing during birth," says Ms Morrison.
So important are these exercises that she wants everyone be doing them as part of their regular exercise regimen.
"Pelvic health should sit alongside cardiovascular health and resistance training.
"[Our exercise regimen] should be like: cardiovascular exercises, resistance exercises, pelvic floor exercises. As women we need to be doing them all."
Just be sure you're doing them correctly: Ms Morrison has seen many women think they're doing a pelvic floor exercise, when they're actually clenching the muscles around the pelvic floor - such as their glute, tummy or inner thigh muscles - or bearing down instead.
A pelvic floor physio can help teach you the correct method, she adds.
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You can get a Medicare rebate to see a physio in many cases
Worried about cost?
If you need specialist treatment from a physiotherapist, you may be able to get a Medicare rebate if you have an ongoing condition, such as incontinence or prolapse or sexual dysfunction, says Ms James.
Just speak to your doctor about getting an Enhanced Primary Chronic Disease Management plan, formerly called an Enhanced Primary Care plan.
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