Pelvic Floor Clinic (Module 1): Introduction to Pelvic Floor

Pelvic Floor Clinic (Module 1): Introduction to Pelvic Floor


Hello and welcome to the
pelvic floor introductory education module. My name is Grace and I am a clinical nurse
specialist, part of a multidisciplinary team at a clinic that sees women with pelvic floor issues. Here in our clinic, we receive many
referrals for women, like you, that are having some type of pelvic floor issue. The pelvic floor is part of a woman’s anatomy
that we tend to take for granted and don’t really discuss or think about – until we
start having issues with our bladder or bowels. When we have babies, we may think about
it more because we wonder how having a baby might affect it…and it certainly does. There are other things that affect it as well
that we will discuss as well as a variety of options to help improve your symptoms – some
which only you can initiate yourself. This video is the first of a series of educational
programs designed for women. There are five basic modules that will provide
you with an overall understanding of pelvic floor issues, and some extra ones that you may also find helpful that go into more detail about some topics. The objectives for this session are: 1. To help you understand how a normal pelvic
floor should work, 2. To help you identify what might be happening
to cause bothersome symptoms, 3. To give you information and suggestions that
might help manage your symptoms, and 4. To help you think about treatment options
that may help. In this module I will introduce you to the
pelvic floor – where it is located, a quick look at the normal anatomy and functioning,
and will talk a bit about the common symptoms and disorders that women deal with and often
referred to specialists or clinics for. Many times, women may have a combination of
issues going on, even though they are only aware of one. That is why we recommend that you view ALL
of the basic modules. You may realize that other issues are affecting
you or as well or you may learn how to PREVENT these issues from becoming a problem in the
future. So – lets take a look at where the pelvic
floor is located. The pelvic floor is found at the base of the
abdomen, between your legs. You may think of it as the bottom of a canister. Your muscles and bones in your abdomen, back
and sides are the sides of the canister and the top is your diaphragm muscle that moves
your lungs up and down, helping you breath. Your abdominal contents sit on the base of
this canister, or, the pelvic floor. There are no bones at the bottom, only circling
around it. So the pelvic floor muscles located here bear
the impact of the abdominal contents like a sling or trampoline. This group of muscles is intersected by 3
openings in women – the urethra (from the bladder), the vagina in the middle and the
anus at the back. You can see the muscles that encircle these
openings and affect their functioning. There are different levels and layers of muscle
here. From the side view, on the left is the urethra
which drains urine from the bladder above, the vagina in the center – where you have
intercourse and where you push your babies through, and the anus and rectum at the right, where stool collects and is emptied with a bowel movement. At the top of the vagina is the cervix, the
opening to the uterus where your babies grow in pregnancy. The red line indicates where the muscles lie,
like a hammock, extending from the pubic bone in the front to the tail bone in the back,
and how they are intersected by the 3 openings. You can think of the pelvic floor like a trampoline
which supports the weight of your abdomen. Trampolines stretch and give and usually bounce
back. Trampolines can be damaged with too much weight
or strain on them. Our pelvic floors can also be damaged which
affects how they function. Our pelvic floor muscles need to be protected
from potential problems so they continue to support effectively and to work in the way
we need them to for the duration of our lives. They are affected by various ways we do things
and factors of life as you will discover. Problems women tend to have with their pelvic
floors usually fall into 3 categories – prolapse problems – referring to the position of
the organs, problems with bladder function or problems with bowel movements. Prolapse means “falling downwards” and
refers to our bladder, uterus, vagina or rectum shifting from their normal positions and pushing
towards our vagina. About half of all women have prolapse to some
degree – mild to severe. If it is a problem, you usually have symptoms
that accompany it – for example, pressure or heaviness in the vagina, bulging tissues,
difficulty with peeing or having bowel movements. If there are no symptoms – great! – but
you don’t want it to get worse and you can make changes that will do that. We will go into more detail about prolapse
in Module #2. The most common bladder problem is incontinence
– leaking urine when we don’t want to. There are other bladder issues as well, but
incontinence is the most common one and the one we will cover in module #3. About a third of women have bladder issues
at some point in their lives. Bowel control issues may include leakage from
the rectum– when women find it hard to hold their bowel movements or gas. Anal incontinence is not as common an issue
as urinary incontinence, but has a tremendous effect on quality of life. Another common bowel problem is constipation. We may think this is not worth mentioning,
but is very important, as constipation can worsen prolapse and affect bladder functioning
significantly! All these issues affect women to a huge degree. We don’t clearly understand how prevalent
bowel issues are, but we know that half of all people use laxatives routinely. Anal leakage issues worsen with age, but we don’t know how many
people deal with it privately. Module #4 provides more information on bowel
control problems. Like this whistling fish, we try to keep these
often embarrassing issues hidden but may eventually have public accidents that we can no longer
hide. That may become the factor that prompts women
to look for help with these issues – when they become a bother and a challenge that
limits or impacts their lives in a negative way. Not often are these problems “life-and-death”
issues, but they do have a tremendous impact on quality of life, self-esteem and sexuality
and a ripple effect that impacts many parts of our life. We recognize how personal and how difficult
these issues can be for women and hope that by viewing these modules, you can be equipped
to understand them better and to deal with them in a positive way. Now we will briefly look at possible reasons
why these problems happen – potential factors that can alter how well the muscles continue
to support the organs, and how the bladder and lower bowel function. You must carefully consider which of these
factors apply to you – some will and others not. Very rarely is one factor the only cause,
rather, it is usually a combination of factors which lead to these problems. You may also note that some can be modified,
and others you can’t change. Identifying what is relevant to you will help
you select your treatment direction. Aging is a factor we can’t change! Not all older people develop pelvic floor
issues, but they are more common as we age. We may have developed habits which negatively
impact the pelvic floor and in general, our body parts may not work as well as they used
to. Unknowingly, we may have some lifestyle habits
that are negatively affecting our pelvic floors. Our pelvic floor muscles may become weaker
and don’t provide the support we require – especially if we are not actively exercising
them! As well, with aging, we may not move as easily
and get to the bathroom quickly enough. Then, as we age, our kidneys actually make
more urine during the night time hours. Women are affected by estrogen levels declining
in their bodies, as they approach and go through menopause. This affects the many estrogen receptors in
the vagina, urethra and bladder base, as without estrogen, there are changes which negatively
impact how the bladder and vagina function. The tissues become dry – and like dry skin
– becomes more easily irritated. The bladder on the left, with normal estrogen
levels, has a urethra that is plump and thick and stays closed better. (Imagine it like a sponge full of water –plumper,
moister) On the right, with decreased estrogen levels, the urethra no longer is as moist
– more like a dry sponge. We all know that smoking is not a great habit,
but did you know that it irritates both the bladder and the rectum and affects their functioning? It is also associated with bladder cancer. Most smokers develop a chronic cough, and
coughing – be it from smoking or other reasons – puts pressure on the pelvic floor and can
worsen issues like incontinence and prolapse. Being pregnant and giving birth changes a
woman’s pelvic floor – probably the most common associated factor. Women often look back at the childbearing
years as the starting point of pelvic floor issues – both leakage and prolapse. We can’t change what happened. The extra weight and pressure of the baby
on our bottoms during pregnancy, and then pushing them through the birth canal creates
a huge amount of strain and cause stretching of muscle, nerve damage, tearing and so on. Big babies, many babies, a long pushing stage,
the use of forceps or other instruments may have made it worse. Because the pelvic floor is the supporting
structure for the weight in the abdomen, every extra pound pushing down makes a difference. This “trampoline” must bear this extra
weight and can stretch or be affected by the extra pressure. Losing weight may not completely solve all
the issues, but many times women note an improvement in their symptoms. If weight is an issue for you, we strongly
recommend a healthy weight loss program that includes exercise and lasts for your lifetime. There are many resources available to assist
you with weight control – we recommend those that have a good balance of exercise and healthy
food choices. In Alberta, here are some links that may assist
you. Genetics we cannot change! We may have inherited some issues. If your mother/grandmother/sisters have these
issues, you may be more prone to them. Constipation is an issue women may be referred
for assistance with, but constipation also greatly affects the other issues, like bladder
issues and vaginal prolapse. Chronic years of bearing down, hard straining
and heavy stool in the system pushes down on the organs as we see in this slide. What happens in one area affects its neighbours
close beside. Some medications that you may take for other
reasons may also affect or worsen bladder and bowel issues. Common ones are diuretics or water pills as
they cause you to produce more urine right after taking them, medications to help you
sleep as they also make your bladder slow down, medications for depression also slow
down your bladder and cause some constipation – they may all play a role in worsening
your symptoms. Some medications for pain may cause constipation. Never discontinue any prescribed medications
without your physician’s approval, but it is helpful to understand the role they play. There are specific medications that may improve
some incontinence symptoms, and we will talk about them in module 3. Sporting activities with running and jumping
or ongoing impact with the ground may potentially worsen symptoms of prolapse or leakage. Although the cardiac and circulatory benefit
of vigorous exercise is very important, you may need to carefully consider the symptoms
you are having. Perhaps modifying activities may reduce these
symptoms. We include a link to an Australian website
that provides information about recommended exercises for those at risk for pelvic floor
issues and those that should be carefully considered. You may have noticed that in a similar way,
coughing and sneezing may give you some incontinence or worsen your prolapse symptoms. Many women notice their symptoms of prolapse
or leakage worsen after a day of heavy lifting – whether it be lifting as part of your
daily activities (such as laundry, gardening and so on), your occupation or weight lifting
to stay in shape. The extra weight tends to transfer down to
the vulnerable pelvic floor and is another associated factor that may contribute to your
symptoms. It is important to be lifting properly to
protect your pelvic floor and not damage it. We may have other health problems or diseases
that may impact or affect our pelvic floors, especially those that might be affecting the
nerves that help control this area. An example might be diabetes and the nerve
damage that occurs over time. It may affect normal bladder and/or bowel
function. Sometimes, accidents or injuries may also
affect the pelvic floor and the organs. The last associated factor to consider is
that some foods and beverages may affect bladder and bowel function. Everything you drink will be stored in the
bladder. If you drink a lot, you will pee a lot, and
if you do not drink much, urine will be concentrated and strong and can worsen symptoms. The same can happen in the bowels. For some people, consuming certain foods or
beverages that irritate the bladder or bowel might be a factor. Others may find some foods are constipating
or cause loose stools. It is helpful to become aware of what these
might be and to avoid them. We will discuss these in the other modules. We suggest that you view all of the 5 basic
modules – more than once if you like. This information is helpful to all women and
especially those with bothersome symptoms. You will have a better understanding of things
that you can do that make a difference to your symptoms and will also understand types
of treatment options that are available. It will make any clinic visit more helpful
as you already have a good basic knowledge and can build on that. There are also additional videos you may choose
to view that go into greater depth on certain topics and answer further questions you may
have. There are also written materials that will
reinforce what the videos teach you. Depending on your location, you then can move
forwards with treatment options available for you. We hope that you now have a better understanding
of what pelvic floor issues are all about and how common they are. Our goal is that you will better understand
some of the associated factors in your own situation, and can clearly see some specific
areas where you may make changes. The remaining modules will assist you understanding
what your options are and what you specifically can work on. So now, please take the time to view modules
2, 3, 4 and 5. You will meet some other team members – nurses,
physiotherapist and physicians – in some of the other modules. They will help you gain a much better understanding
of your pelvic floor issues – what normal is, what abnormal looks like and things that
only you can do to improve your symptoms along with your other options for treatment. The Pelvic Floor Clinic is found on the basement
level of the Womens Health Center, located beside the Foothills Hospital in northwest
Calgary. Our hours are Monday to Friday, from 0800
to 4:00 pm. The main phone number is 403 944-4000. This information will be provided again later.

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