Editor’s Note: Dr. Jamin Brahmbhatt is a urologist and robotic surgeon at Orlando Health and past president of the Florida Urological Society.
CNN
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The heart keeps our blood flowing, the gut processes our fuel, and the mind keeps it all in place. But what about the pelvis?
This unsung hero, or heroine, is essential to many bodily functions. The muscles and organs of the pelvis are essential to fertility, urinary and bowel control, sexual function, and even the most provocative of dance moves, the “twerk.” Some studies even suggest that moves like twerking or belly dancing may be a non-surgical treatment for pelvic floor problems.
We often don’t realize the importance of pelvic health until something goes wrong, like pain instead of pleasure during intercourse or that first unexpected leak when coughing (in women and men) and the inability to get or maintain an erection (in men). Understanding how the pelvic floor works and recognizing the signs of dysfunction is essential to maintaining overall health and well-being.
Although both men and women have a pelvic floor, the anatomy and function differ greatly. Think of the pelvic floor as a hammock of support. In women, the pelvic floor supports the bladder, uterus, and rectum, and it also plays a vital role during childbirth. In men, the pelvic floor supports the bladder and rectum and contributes to erectile function and bladder and urinary tract control.
According to the National Institutes of Health, nearly a quarter of women in the United States have pelvic floor problems. Women ages 20 to 39 are less likely to have symptoms. About a quarter of women in their 40s and 50s have pelvic floor problems. The percentage increases with age, with more than half of women in their 80s having pelvic floor problems.
And what about men? Although most of the attention is focused on women, 16% of men also suffer from pelvic floor disorders. This problem is not just for men; anyone can be affected.
Aging, surgery, obesity, chronic coughing, heavy lifting, and even high-impact exercise can impact the pelvic floor in both men and women. Over time, increased pressure inside the abdomen can cause the pelvic floor muscles to weaken, strain, or even tear. Preventative measures include performing pelvic floor exercises (Kegel exercises), maintaining a healthy weight, and using proper lifting techniques. While vaginal birth can directly damage the pelvic floor, a cesarean section or excessive high-impact activities like jumping can also contribute to pelvic floor problems over time.
However, this should not be an excuse to avoid exercise altogether. Regular physical activity is essential for overall health and can be safely maintained with appropriate modifications and careful attention to pelvic floor health. These issues can cause similar symptoms in both sexes, highlighting the importance of pelvic health for everyone. However, childbirth adds a unique set of challenges for women, making it a critical goal in their pelvic health journey.
During pregnancy and childbirth, the pelvic floor muscles are stretched and stressed, some naturally, some forced. According to a 2023 study, approximately 56% of women experience some form of pelvic floor dysfunction after childbirth. This can lead to a host of issues such as urinary incontinence, pelvic organ prolapse, and pain during intercourse. Many women assume this is all natural, but as healthcare providers, we know that this is not the case if this issue persists after childbirth.
Urinary incontinence: Imagine you’re watching your favorite TV show. Suddenly, you laugh a little too loudly and suddenly you have that infamous urinary leak. Oops. Sure, it’s common after childbirth, but that doesn’t mean it’s okay. Urinary incontinence is a sign that your pelvic floor muscles, which support your bladder and urethra, need medical attention.
Pain during intercourse: Pain during sex after childbirth is often considered normal, but it shouldn’t be. This discomfort is your body’s way of telling you, “Hey, something’s wrong here.” Similarly, menopause can cause changes to the pelvic floor, with decreased estrogen levels causing vaginal dryness and thinning of the vaginal walls. These anatomical changes can contribute to discomfort and pain during sex.
Pelvic pressure and organ prolapse: Have you ever felt like there was an invisible bowling ball in your pelvis? This strong pressure or bulge could be due to organ prolapse, where organs like the bladder or uterus slip out of their normal position. While this is common, it is not normal.
Given the prevalence and impact of these issues, maintaining pelvic floor health is essential to a good quality of life. Pregnancy, childbirth, surgery, or aging can weaken these muscles, leading to the symptoms listed above. But here’s the good news: Pelvic floor health can be improved with the right care at the right time—early in life.
There are many treatment options, both surgical and nonsurgical, for pelvic floor disorders. One of the most common treatments is pelvic floor therapy, which goes beyond the famous Kegel exercises. It includes specialized exercises, physical therapy, biofeedback, and learning about breathing and body mechanics. And Kegel exercises, which strengthen the pelvic floor muscles, aren’t the only essential pelvic floor exercises. In fact, many people may have tight pelvic floor muscles that can benefit from stretching and lengthening. Others should avoid vigorous core exercises. Pelvic floor therapy isn’t a one-size-fits-all solution; it’s a dynamic intervention that’s personalized to the patient, their symptoms, and their future goals.
Although most discussions about pelvic floor disorders focus on women, men are not immune to these problems. Prostate surgery, especially for conditions like prostate cancer, can disrupt the pelvic floor muscles. This can lead to urinary incontinence and erectile dysfunction, much like childbirth affects women. Pelvic floor therapy can help men regain control and improve their quality of life. Just like women, men need to understand that while these symptoms are common after surgery, they are not normal and can be treated.
The first step in addressing the problem is knowing what is abnormal and talking to your doctors about it. In my practice, even if a patient comes in with another urological issue, I always ask general questions to screen for pelvic floor issues. I am often surprised to hear patients answer “yes” to my questions and then add, “Well, that’s normal for my age.” This is a unique situation because I am a urologist and this is something we actively look for to help treat. This may not come up as openly in a general primary care visit because it is a broader topic—that’s why you need to talk about it!
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