Pelvic health, the inside story. There’s more to it than the pelvic floor.
Written by Lowenna Holt and Janelle Gullan
We don’t always know a whole lot about pelvic health before we have children. And afterwards it’s either a heap of horror stories or deathly silence as we try to reconnect to our body and work out what might have happened ‘down there’. The focus can also be on the pelvic floor muscles, which – while they do have a role – are only a part of the picture when we are trying to recover pelvic health and vitality. The pelvis is such an important part of the body. It can impact our ease of movement and how we play with our children; our comfort and intimacy with a partner; or our ability to do everyday activities and contribute to our community in the way that we would like. Having pelvic symptoms does not mean that our body is broken, and in fact there is so much we can do to support our body in this area.
Left: the pelvis showing how the organs fit within it.
Right: the bones of the pelvis attached to the sacrum.
What is the pelvis?
The pelvis is a bowl-shaped structure that is part of the skeleton. The bones of the pelvis include what we all know as the pubic bone and hip bones at the front and the ‘”sit bones” at the rear. Inside the bowl shape are three important organs that impact on pelvic health – the bladder, the uterus and the bowel. The bladder holds urine and feels squishy like a plastic bag full of water. The urethra is the tube through which your urine flows from the bladder to the outside of your body. After birth the urethra can be pushed off to one side. Internal work can help bring it back into the midline. The uterus should be a mobile organ but most women have a position where the uterus tends to sit. Its optimal position is tilting forwards over the bladder, but sometimes it can tend to lean even further forwards, backwards or to either side. The way we use our body, our posture, any scars, adhesions, tension or congestion in our abdomen can pull it toward a less optimal alignment. After birth things such as c-section or perineum scars, or the movement of other organs to accommodate the size of the baby, can influence the position and its mobility after birth. Abdominal massage and internal work can be used to bring the uterus to a more optimal position, especially when challenges with menstruation, abdominal discomfort or digestion are being experienced.
Diagram showing the position of organs within the pelvis
Prolapse – what is that anyway?
Many women suffer from pelvic organ prolapse, with it being estimated around 50% of women (or even more) may have prolapse. A prolapsed bladder or bowel is one that has moved from its optimal position and as a result is pushing into the vagina. It is also possible for the uterus itself to slip down into the vagina. Prolapse can occur on a wide spectrum, and it is rated from grade 1 to grade 4. However the grade of prolapse has no correlation to what symptoms a women may experience (women with a grade 3 prolapse may not feel any discomfort while someone with grade 1 may feel heaviness and dragging in the pelvis). The most common symptoms reported relate to urinary or bowel continence, sensations of heaviness or pain with sex.
Stages of prolapse of the uterus as it slips down into the vagina.
Pelvic floor exercises
Doing pelvic floor exercises (kegels) can help to strengthen the pelvic floor, and the pelvic floor does play a role in supporting the pelvic organs. However prolapse is really an issue of pressure and posture. For this reason, we should be thinking about our posture when we do pelvic floor exercises. Hips back over the heels with the pubic bone and hip bone in alignment usually places the pelvic floor muscles in their best position. We also need to make sure we fully relax the pelvic floor muscles along with the tighten to use them in their full range of movement. The goal should also be for the pelvic floor muscles to activate automatically when you move your body or go to pick something up. This tightening should also be proportionate to what you are trying to do.
Here is a great video by Janelle Gullan that demonstrates
the correct way to do pelvic floor exercises.
Exercise and daily movements
If you have pelvic organ prolapse, it is common to feel nervous about movement and exercise. Sometimes we can be told that some activities could make our pelvic health worse and they may cause us to leak or feel heaviness. While in the short time it might be the right decision to change your exercise activities, we also need to work toward strengthening our body and challenging our pelvis. No other part of our body gets stronger or more functional without us working it. The same is true for our pelvis. We also need to remember how physical general mothering can be, and a focus on training for everyday life can support our mental and physical health.
Left: the normal position of the organs within the pelvis
Right: a case of prolapsed bladder, where the bladder is pushing on to the vaginal wall
Where to go for help
Pelvic health contributes significantly to our overall health and wellbeing and it can impact on many parts of our lives. If you experience urine leaking or pain/discomfort in your pelvis during your normal daily life, it is a good time to check-in with your GP as a first step. There are health professionals who do specialise in women’s pelvic health. Have a look in your area for a physiotherapist or occupational therapist who does this type of work. Medicare and health insurance rebates can be available to help with the cost.
Janelle Gullan from The Wild Orange Tree is an occupational therapist who specialises in pelvic health. She is based in Melbourne but offers phone and internet consultations within the whole of Australia. Contact Janelle to book a free 20 minute consultation about your pelvic health, prolapse enquiries or menstrual concerns. Find more details about Janelle in our directory here.
Disclaimer: The information provided in this blog is intended as a general educational aid. It should not replace advice given by a qualified healthcare provider in relation to your own unique circumstances and those of your family. Always consult your doctor regarding medical or mental health concerns that you or your family may have.