Dthe usual, we discover what the pelvic floor is, where it is and why it is important for well-being, when it stops working well and begins to cause embarrassing discomfort, such as the involuntary loss of a few drops of “pee”, pain during sexual intercourse and difficulty reaching orgasm.
Why training the pelvic floor is essential
Structured in the shape of a funnel, composed of muscles, ligaments and tissues, this muscular district extends from the pubis to the anus. But the vast majority of women, and men, have a very poor perception of it. And, unlike what happens with other parts of the body, he doesn’t know how to train him. Nevertheless, keeping this musculature strong and toned is essential for both female and male health. In fact, it performs crucial functions: it contains and supports the weight of organs, such as the bladder, urethra, internal genitalia (uterus, ovaries and vagina, in women, prostate in men) and rectum, which would otherwise collapse due to gravity; allows both to retain urine and feces and to release them on command; contributes to sexual pleasure.
«The key to prevention, starting from adolescence, is the adoption of an active and healthy lifestyle. The efficiency of the pelvic floor, in fact, helps to preserve a good quality of life and relationships, avoiding disorders that could occur at any age” he warns Stefano Salvatoreprofessor of gynecology at the San Raffaele University of Milan and past president of the European Association of Urogynecology. «It’s the physiological weakening of the pelvic muscles, which worsens with aging in both sexes, causing incontinence» the doctor points out. But, Before the age of 60, women are at double the risk of developing it. In this case, the most exposed are women during and after childbirth and athletes who practice sports that involve a strong impact on the ground, such as running, basketball, volleyball, athletics, dance, artistic gymnastics”.
Gaining mastery of the pelvic floor means learning to feel these deep muscles and getting used to strengthening them with simple exercises within everyone’s reach. The professor indicates yoga, tai chi, pilates and Kegel exercises (see box on the next page) among the ideal activities “to prevent, but also to counteract incontinence once it has manifested itself and improve sexual satisfaction”.
Prejudices to dispel
There are two prejudices to dispel. The first, that pelvic floor disorders only affect females. The second, that they exclusively affect women who decide to have children. «Recurrent cystitis and vulvovaginal infections, in addition to vulvodynia, can cause hypercontraction of the pelvic muscles – explains Salvatore -. The pudendal nerve, which branches from the external genitalia to the pelvis, when inflamed causes a contraction in the muscles to defend against pain. This tightening – he adds – it can also result from prolonged situations of stress and anxiety or from repeated trauma to the sacrum and coccyx following falls during activities such as skating».
«Symptoms vary, based on severity, from difficulty urinating, to constipation and dyspareunia (pain during sexual intercourse)” clarifies the gynecologist. «To resolve them, one is indicated muscle rehabilitation, conducted by expert physiotherapists or obstetricians. It is expressed through diaphragmatic breathing, relaxation techniques and/or biofeedback (sensors that return the signal to the patient on the recorded activity, to learn to control the response, ed )”.
The role of extra pounds
Weakening of the pelvic floor that prevents it from contracting adequately causes “stress incontinence”explains the professor, «with the loss of small quantities of urine when lifting weights, running, climbing stairs, you sneeze or have a cough. In more serious cases, when walking.” Muscles that are too relaxed are therefore unable to adequately support the organs within them. «A sensation of fullness in the belly and a decrease in vaginal sensitivity is felt which, in the most serious cases, leads to prolapse of the uterus and vagina». Reducing the elasticity and strength of this muscular structure can contribute sedentary lifestyle, overweight and obesity, because greater abdominal weight stresses the muscles of the lower abdomen. «For the same reason, pregnancy represents a risk factor, especially if the maternal age exceeds 38 years, but complex vaginal birth, which requires obstetric maneuvers or medical interventions, is even more so».
Gymnastics also facilitates childbirth
«Kegel exercises are based on the voluntary contraction and relaxation of the pelvic floor and are named after the American gynecologist Arnold Kegel, who made them popular in the 1950s», explains Elisa Cappelli, obstetrician at the Santagostino Center in Milan, specialized in the treatment of pelvic floor pathologies. (Getty Images)
For this reason today yes to future mothers She strongly recommends pelvic gymnastics before giving birth. And then to resume it starting from the child’s 3 months. A practice that is divided into specific breathing exercises, contraction and release of these internal muscles. «The movements help to reduce birth times and avoid lacerations of the perineum during construction. And to subsequently recover muscle tone” recalls Salvatore. Even the aathletes engaged in sports that increase pelvic pressure (running, jumping) have a greater propensity for stress incontinence. As well as smokers, because smoking – explains the professor – can trigger chronic cough, which wears out the pelvic muscles. The weight factor becomes effective again with menopauseimpacting in particular on less active women. This happens because the decline in estrogen and the aging process make the pelvic floor tissues thinner and less elastic.
The solution is there
Up to this point we have talked about prevention. But what if you already feel some of the symptoms that have been described? «The first thing to do is overcome the shame. And talk about it, immediately, with your doctor, with the certainty that there is always a solution – reassures Salvatore -, except in cases of bedridden and serious motor disabilities». If the problem is mild or moderate, kinesitherapy is prescribedbased on active and passive movements, which can be accompanied by electrostimulation or electromagnetic wave treatments to induce muscle contraction.
«In the most severe forms, bulking agents are injected into the urethral wall to increase its closure, or surgical intervention is performed, with positive outcomes in 85-90 percent of patients.” From menopause onwards, however, he suggests, «It’s best to take 10 minutes a day to train your pelvic muscles with Kegel exercises» and, during the annual gynecological examination, «ask the visitor to check the tone and contractile speed of the pelvic floor».
The men’s side
As it was written, the male pelvic muscles can also be damaged. «But men, let’s be honest, don’t do prevention. Between the ages of 40 and 50, however, they should schedule a first visit to the urologist to check the prostate and pelvic floor health» recommends Enrico Finazzi Agròprofessor of urology at the Tor Vergata University of Rome and director of the functional urology section of the European Association of Urology. The problems affecting the muscular region are the same. «Hypercontractility of the pelvic floor also concerns them – explains Finazzi Agrò -, when there is underlying inflammation of the prostate, which must be treated with drugs».
The symptoms of this disorder are burning and difficulty urinating, sexual pain, erection failure and ejaculatory delay. Be careful, though: «The symptoms resemble those generated by an enlarged prostate: in the case of pelvic hypercontractility, physiotherapy is sufficient, with specific relaxation exercises. In the second case, drugs or minimally invasive surgery are required” underlines the urologist.
Equally shared between the sexes is the loss of tone and strength of the pelvic muscles, as a consequence of excess weight, metabolic syndrome (i.e. the presence of at least three of these conditions: obesity, hyperglycemia, hypertension, high triglycerides and cholesterol, ed), chronic smoker’s cough, but also having an exaggerated abdominal muscle mass. «All factors – underlines the urologist – which put pressure on the pelvic floor and can predispose to having an overactive bladder, that is, an urgent need to pee, and sexual dysfunction. Ailments that man finds it difficult, alas, to confide in his doctor».
Remedies exist. «In the mildest cases – explains Finazzi Agrò – it is enough to practice one strengthening exercises and learning to drink regularly and not hold back the urge. These behaviors can be assisted by drugs to increase the containment capacity of the bladder or electrostimulation sessions. In patients who have incontinence after prostate cancer surgery, surgery is performed, as in women”.