Pelvic Floor Health: Causes of Weakness & Expert Tips to Keep It Strong. We spoke to Dr Rihannon Bray
We asked Dr Rihannon Bray, Lead for Urogynaecology at Kingston Hospital , about pelvic floor health, prolapse and the link to the microbiome. We're so excited she was able to share her knowledge with us and answer some of the most common questions we see.
Tell us a little about yourself and what you do?
I am a consultant in Obstetrics and Gynaecology and I specialise in urogynaecology, which is the care of women with bladder and pelvic floor problems. I counsel women in clinic and also perform operations to treat these conditions.
What are the common issues/concerns you see women about with regards to pelvic floor health in your clinic?
The main issues I treat are recurrent or chronic urinary tract infections, urinary leakage and prolapse, which is where the organs of the pelvis, such as the uterus, the bladder and bowel descent into the vagina.
What can cause changes to pelvic floor health and what are the typical symptoms to look out for?
Aging, pregnancy and childbirth and anything that causes increased pressure on the pelvic floor can disrupt the anatomy and cause prolapse and incontinence. A woman might notice a heavy feeing in her lower abdomen or back, or the feeling of a lump or bulge in her vagina. The muscle that surrounds the bladder can also become ‘overactive’. In this way the bladder does not fill normally, and when only partially full women can feel desperate to pass urine and can even leak. A recurrent, or chronic urinary infection can present itself in a variety of ways. Sometimes it may be the typical symptoms of burning and pain passing urine, or it can present with the same symptoms as an ‘overactive’ bladder. We are still trying to understand the causes of these kind of infections but the urinary microbiome and the balance of ‘good’ and ‘bad’ bacteria does seem to be implicated.
What is the impact of menopause on pelvic health?
Menopause and Peri-menopause (the time leading up to menopause) results in a decrease in the hormone oestrogen. Oestrogen has many roles in the body, and is particularly important for the pelvis. It helps to keep the tissues of the vulva and vagina healthy and resistant to infection. As oestrogen levels drop the vagina and vulva can start to feel dry, sore and uncomfortable. Low oestrogen can also result in lower levels of the ‘good’ lactobacillus bacteria in the bladder, and this can result in a higher number of ‘bad’ bacteria and an increase in urinary infections. Childbirth and pregnancy can strain or damage the muscles of the pelvic floor. Oestrogen levels can also be low during pregnancy and breastfeeding and women might suffer with some of the same symptoms as perimenopause.
What is the link between painful sex and pelvic floor health?
It is important to try to diagnose and treat any underlying conditions which can cause pain. Pain coming from the skin of the vagina and vulva can be helped with adequate lubrication. Prolapse, even severe prolapse does not usually cause pain or issues with intercourse. It can however, affect a woman's body image and this can effect sexual satisfaction. Pain coming from the skin of the vagina and vulva can be helped with adequate lubrication. Incontinence during intercourse can also be embarrassing and off putting for women. Some find that emptying the bladder before can help and can also prevent issues with recurrent urine infections.
How can women generally help support their pelvic floor health to prevent any future issues?
It is a good idea to keep to a programme of lifelong pelvic floor exercises. There is good evidence that they can treat and prevent prolapse and incontinence. It is also sensible to try to minimise risk factors for pelvic floor dysfunction. This would include maintaining a healthy weight, this decreases any excess pressure on the pelvic floor and systemic inflammation, avoiding constipation and straining with bowel movements , and treating a chronic cough.
So many women are told to do pelvic floor exercises across many stages of life. Are they worth it? Will it actually help?
Yes, there is good evidence that they can prevent and treat both prolapse and incontinence. It is also possible to re-train the muscle surrounding the bladder when it becomes overactive. This involves leaving it a little longer each time you need to pass urine in order for the bladder to stretch a little more and gradually increase the time you can wait before passing urine, and making you less likely to leak. There is a good NHS app called Squeezy, which can support this.
Can you tell us a little about prolapse? How common is it and what treatments are available?
Prolapse is most common after childbirth. If we were to examine all women, some degree of prolapse would be very common. Prolapse is not usually an issue unless the woman has symptoms of prolapse, such as the sensation of something coming down in the vagina, or a lump or bulge or a heavy feeling. If the prolapse is severe it can also cause difficulties emptying the bladder and bowel. There are many treatments available. The first thing we would usually advise is a 4 month programme of supervised pelvic floor exercises with a women's health physiotherapist. If this is not successful then a woman may wish to consider a vaginal support pessary, or surgery. A pessary is usually a plastic or silicone ring which sits at the top of the vagina and supports the prolapsing organs. When correctly fitted it remains in place for 6 months and relieves the symptoms of prolapse. The alternative would be surgery. The majority of operations are performed through the vagina and involve a 3-6 week recovery where we advise women to limit any excess weight through the pelvic floor as it heals.
Dr Rihannon Bray
MBBS, Bsc (hons), MRCOG, MD, Consultant Obstetrician and Gynaecologist, Lead for Urogynaecology at Kingston Hospital.
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