Jessica McKinney, PT, DScPT, MS
Career-long women’s health provider (PT), educator & advocate with current roles as VP at a digital women’s health company, adjunct university faculty, & consultant in global/community women’s health.
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While the wisdom, resilience and confidence that come from decades of valuable life experience are welcome hallmarks of aging, the physical changes often are not! For many women, they can present real and complex challenges. Though every body is unique, women tend to lose strength and muscle mass as they age: this includes the group of muscles that form the pelvic floor. Decreased function of these muscles can present physical and emotional challenges. However, greater awareness of the importance of a woman’s pelvic floor, understanding the causes of pelvic floor weakening and learning about effective interventions can help women enjoy all the benefits of age without the consequences associated with a weak pelvic floor.
Various physiological factors over the course of a woman’s life can lead to pelvic floor weakening. Women who have experienced pregnancy know it can challenge this group of muscles and tissues in a few substantial ways. First, weight gain is a normal part of pregnancy. The increased size and weight of the uterus alone places new strain on the pelvic floor. During pregnancy, the pelvic floor and pelvic organs descend lower than their usual pre-pregnancy position, creating an increased burden for these muscles.
Constipation is also common during pregnancy. If a pregnant person is regularly straining to have bowel movements, this can negatively affect the pelvic floor. Some occupational activities like repetitive lifting and carrying tasks have been linked to pelvic floor problems in non-pregnant women. However, when a pregnant woman is also caring for one or more small children, including repeatedly lifting and carrying those children, those activities also present a challenge to the pelvic floor.
Like pregnancy, childbirth places stress on the muscles, nerves and connective tissues of the pelvic floor. Vaginal childbirth demands remarkable strength and elasticity from the pelvic floor. To deliver a baby, the deep pelvic floor muscles experience tremendous strain as they stretch up to five times or more their original length to allow the baby to pass through the birth canal. This normal physiological process of childbirth often leads to pelvic floor problems, sometimes related to bladder or bowel control. In rare instances, there can be enough injury to deep or superficial muscles that symptoms require focused rehabilitation. Whether injury occurs or not, pelvic floor muscle exercises are recommended during pregnancy and in the postpartum timeframe to help the pelvic floor prepare for and recover from the physical work and challenge of childbirth.
Women who never experience pregnancy or childbirth are still at risk for pelvic floor weakening. Aging alone involves a general loss of muscle mass and strength throughout the whole body. Menopause can also contribute to a weakening of all muscles due to hormonal shifts; the drop in estrogen level that occurs with menopause can cause pelvic tissues to become thinner, dryer and less resilient, making the pelvic muscles more prone to becoming weak. This is also a time when general physical activity declines and this can contribute to weakness throughout the entire body, including the pelvic floor.
So why is pelvic floor weakening problematic? Weak muscles cannot adequately support the uterus and bladder, and this can contribute to a host of issues with a woman’s urinary and reproductive systems as well as her sexual function. In some cases, the pelvic organs are not adequately supported, leading to a bulge, or prolapse, which can be quite painful and may require surgery. Incontinence, however, is a much more common experience associated with pelvic floor muscle weakness. Urinary incontinence (UI) is the technical name for the involuntary loss of urine. Urinary incontinence can be mild—just a few drops, or severe—a large volume of urine leakage or the complete loss of a full bladder. If left untreated, UI can progress and worsen. The severity and the number of women who report incontinence increases with age—from 37% of women in their 30s up to 64% of women in their 80s reporting symptoms.
While UI is common—affecting over 20 million women in the U.S. and 250 million women worldwide—it is NOT normal, and it can have significant negative impacts on women’s lives. The uncertainty and unpredictability that come with UI can affect women’s mental health, quality of life and relationships. Women may limit their physical activity or social engagements, experience feelings of isolation and distress and/or experience problems with intimacy. My colleague, Laura Keyser, DPT, MPH, recently wrote an article titled, “Read this if you dismiss urinary incontinence is no big deal.” In it, she explains that while women have a greater life expectancy than men, women report more disability and illness. Untreated UI is among the conditions women experience with more frequency later in life, and numerous studies show the consequences.
- Among older women, UI is a major risk factor for falls, hospitalization, nursing home admission, and dependance on a caregiver.
- Women with UI experience faster and greater degrees of physical decline when compared to women who are continent.
- They score lower on physical performance tests and show significant declines in muscle mass.
- Research shows that women with UI reduce physical activity or stop exercising to manage symptoms, which can lead to functional decline and even worsen UI symptoms over time.
- In addition, 20% of women with UI also experience fecal incontinence, the involuntary loss of stool.
As you can see, ignoring a decline in pelvic floor muscle function can have real and substantial impacts on a woman’s health and quality of life as she ages. But take heart! There are numerous interventions and lifestyle changes that enable women to take charge of their pelvic health. Stay tuned for a follow up to this article, a piece abouthow to support pelvic floor health as we age, by the colleague mentioned earlier, Laura Keyser. I’ll be sure to share it as soon as it is live!