More than half of women between the ages of 30 and 75 have experienced urine leakage while laughing or sneezing. Urinary incontinence, also known as bladder weakness, is a widespread condition in society. Approximately 50 percent of women suffer from it, many of them between the ages of 30 and 39.
A strong pelvic floor is the best way for women to prevent urinary incontinence. However, the prevalence of bladder weakness in society is not discussed enough, and the importance of pelvic floor exercises for health is still underestimated.
The pelvic floor is a complex network of various muscles that closes off the abdominal cavity at the bottom. It supports the organs in the abdomen and pelvis and stabilizes the lower back. Furthermore, the pelvic floor muscles are involved in the sphincter mechanism of the bowel and urethra.
A weak pelvic floor manifests as urinary incontinence or a prolapse of the bladder, uterus, or bowel. Because the pelvic floor is no longer strong enough, the urethra can no longer be kept effectively closed, or the organs are no longer adequately supported and descend.
To learn more about the pelvic floor, I visited the St. Joseph-Stift Pelvic Floor Center . There we spoke with Dr. Sabine Gaiser and Dr. Kerstin Volkmer, the medical directors of the Pelvic Floor Center, as well as with Annika Krüger-Tiefenbach, who works there as a physiotherapist specializing in pelvic floor therapy.
What kinds of complaints bring women to the pelvic floor center?
Dr. Sabine Gaiser:
"Here at the Pelvic Floor Center, we advise women with pelvic organ prolapse and bladder weakness. The women must be referred here by their gynecologists or urologists, and we then conduct further specialized diagnostics, refer them to specific treatments, or recommend surgeries that we perform here at St. Joseph-Stift Hospital.".
And since pelvic floor weakness and urinary incontinence are issues that affect women from a young age, usually after childbirth, into old age, we see women of all ages here. Physiotherapy, or in short, pelvic floor training, is always part of the treatment for pelvic floor problems
Why is it good to train the pelvic floor?
Annika Krüger-Tiefenbach:
"The pelvic floor needs to be trained regularly – for everything we need in everyday life. There needs to be balance in the movement of the muscles in relation to the abdomen, back, and pelvic floor. This is the best protection. The pelvic floor should be optimally prepared for all possible stresses, whether from aging or childbirth.".
This includes training in an upright standing position and while moving – not just while sitting. Because the function of the pelvic floor is simply so multifaceted that otherwise we cannot train it sufficiently well, and certainly not functionally.”
Pelvic floor exercises while brushing your teeth?
Annika Krüger-Tiefenbach:
"The classic exercise, which many people are familiar with, is standing on one leg while brushing your teeth, two minutes in the morning and two minutes in the evening. You're going to be brushing your teeth for those two minutes anyway, so you can use that time for balance exercises. Standing on one leg and anything that challenges your balance and provokes core stability also strengthens the pelvic floor."
When surgery is the last resort
Dr. Sabine Gaiser:
"To women who come to us after menopause with severe pelvic organ prolapse or pronounced urinary incontinence, I have to say that pelvic floor exercises alone will no longer bring about any improvement. A hormone deficiency, such as occurs during menopause, can improve mild symptoms with local treatment using hormone creams or vaginal suppositories. However, in severe cases, surgery is often necessary.".
Our general principle is that surgery is only appropriate if symptoms are present, and all conservative treatment methods should generally be exhausted beforehand. We also know that surgery doesn't provide a permanent solution.
These are generally supportive and stabilizing operations. For bladder weakness, minor procedures can be successful, such as supporting the urethra with a small sling. However, in cases of prolapse, the entire pelvic floor needs to be supported, usually requiring a more complex operation
Is the pelvic floor only an issue for women?
Dr. Kerstin Volkmer:
"In women, there are three openings in the pelvic floor – the urethra, the vagina, and the anus. In men, there are only two. Because of the vagina and therefore also the birth canal as a third opening, women are more at risk of developing pelvic floor weakness."
Is pelvic floor training also important for men?
Dr. Kerstin Volkmer:
"A man's pelvic floor is not under as much strain as a woman's. The largest opening in the pelvic floor, the vagina, is not present, and men do not experience childbirth, which weakens the pelvic floor. Men do not develop urinary incontinence due to a weak pelvic floor, but usually as a result of prostate removal. This surgery puts stress on the pelvic floor, which is why pelvic floor exercises are also important for men."
What attitude should women develop towards pelvic floor training?
Annika Krüger-Tiefenbach:
"When it comes to dental care, we never think about why we brush our teeth and go to the dentist twice a year. We do it because we know it's necessary and that dental care is essential for keeping teeth healthy.".
And it must be just as natural to engage with our pelvic floor until the very end. You have it with you; you can work with it anytime, anywhere. We ourselves must have this understanding of it and actively engage it
Sabrina Muscharski completed her practical semester at the Bremen Family Network and, as part of her Public Health studies at the University of Bremen, created a poster series on the topic of "Bladder Weakness and Pelvic Floor Training with Ben Wa Balls" together with her fellow student Sarah Bauder. She conducted extensive research for this project and carried out this interview in March 2022.
Part 1/2: How pelvic floor exercises give us the chance to find our stable core. (Week 31)
Part 2/2: Out of postpartum confinement, into movement! (Week 32)