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Challenging myths about . . . the pelvic floor

We don’t talk about bladder issues, but we should, says chartered physiotherapist Sylvia Farrell

The mysterious pelvic floor and the hushed conversations about loss of bladder control have encouraged many myths to perpetuate around one of the last great conversational taboos.

We don’t talk about bladder issues, but we should.

Incontinence is nothing to be embarrassed about and if you find yourself with pelvic floor issues, you can guarantee you are not the only one. And yet, the pelvic floor is awash with falsehoods spreading rumours that incontinence will ruin your sex drive, that you can’t fix a weak pelvic floor, that leakage is normal and something to be endured, and that the pelvic floor is a female issue.

“Improved awareness about pelvic health and understanding of the issues affecting both women and men is needed,” says Sylvia Farrell, chartered physiotherapist in women’s and men’s pelvic health at the Evidence-Based Therapy Centre in Galway. Farrell helps to debunk some of these misinformed myths and set the record straight. She most notably validates that there is help available for pelvic health conditions and people should not suffer in silence. It’s never too late to work on your pelvic health.


1) Myth - Pelvic floor problems only affect women

The belief that the pelvic floor is a female issue is most certainly a myth, but this misinformation goes one step further with some believing that men don’t have a pelvic floor. They do and they should take care of their pelvic health too.

“Although pelvic floor issues affect more women than men, men do have a pelvic floor and it can cause problems,” says Farrell. “Surgeries on the prostate, age, injuries, trauma or certain diseases can contribute to pelvic floor dysfunctions like incontinence, overactive bladder, bowel issues, erectile dysfunction and pelvic pain.”

With one in three women suffering incontinence due to the weakening of the pelvic floor muscles, it is estimated that one in nine men are also affected by the same issue. Farrell says that pelvic floor muscle training can improve bladder or bowel control and enhance sexual performance for men.

2) Myth - I only need to think about my pelvic floor after childbirth

Conversations around the pelvic floor often begin after pregnancy and childbirth when the muscles may be weakened and need support to strengthen. By association, the pelvic floor has been misrepresented as being a female issue after childbirth.

“There is no doubt that pregnancy and childbirth challenge the pelvic floor,” says Farrell, “and for most of us it’s the first time we hear of or start thinking about the pelvic floor. However, you don’t have to have had a baby or even be female to experience pelvic floor dysfunction. Many pelvic health issues we have as adults actually start when we are younger and may be the result of poor bladder and bowel habits. If you experience bladder or bowel leakage, pelvic pain, prolapse symptoms, sexual dysfunction, an overactive bladder or other pelvic floor issues at any stage in life please get support. It’s never too early or too late.”

3) Myth - Pelvic floor is only about incontinence

“Oh no, your pelvic floor is about so much more than continence!” says Farrell.

The narratives around pelvic floor are more often than not focused on a weak pelvic floor, a lack of control of the bladder, and not a lot of understanding about what our pelvic floor routinely does.

“Let me tell you some more about these amazing muscles,” she says. “They form the base of your core, running from the coccyx at the back to the pubic bone at the front of the pelvis and fan out the sides. As well as maintaining control of the bladder and bowel, the pelvic floor provides support for the pelvic organs, helps with stability of the spine, aids circulation of blood and lymph around the pelvis and is also involved in sexual function. Did you know pelvic floor training can enhance orgasms? A pretty vital and impressive group of muscles.”

4) Myth - Kegels are all a person needs to do

A good pelvic floor equals lots of Kegels, or at least that’s the idea the cliches and myths surrounding this muscle tells us. “If only it were that simple,” says Farrell, “but no, Kegels are not everything. In fact, you could have the strongest muscles in the world and still have pelvic floor issues.”

“Co-ordination, tissue integrity, endurance or tone could be the problem,” suggests Farrell who explains that our pelvic floor does not work in isolation and is part of our core so other muscle groups, pressure management, posture and breathing strategies may need to be addressed.

“For some pelvic health conditions, pelvic floor strengthening exercises/Kegels can be counterproductive and even exacerbate symptoms,” she advises. “A thorough assessment is key to effective treatment and management of any pelvic-floor issue.”

5) Myth - Painful or uncomfortable sex is normal

“No, sex should never be uncomfortable or painful unless intentionally,” says Farrell. Sex is meant to be enjoyable and if there is pain or discomfort during sex, there may be a reason for it which needs investigating.

“Dyspareunia is the medical term for difficult, uncomfortable or painful sex,” advises Farrell. “There are many structural or psychological reasons for dyspareunia. It can be experienced if there is scarring from a vaginal tear, episiotomy or C-section; after any pelvic/abdominal surgery/pelvic cancer treatment; if there’s a history of sexual trauma, pelvic floor tightness or the hormonal changes associated with breastfeeding or the menopause can also contribute to pain with sex.”

“Don’t suffer in silence, there is help available,” says Farrell. “Sex is an important part of relationships and should be pleasurable. Pelvic health physiotherapy alongside psychological support where needed can resolve dyspareunia.”

6) Myth - It is normal to leak

“Leakage is common, but not normal,” says Farrell. This myth perpetuates that women will leak post-childbirth, during menopause, exercise, laughing or sneezing. It’s a damaging belief that it is normal and should be tolerated. Women, and men for that matter, can fight against this falsehood and care for and take control of their pelvic floor by recognising that loss of bladder control is treatable and preventable.

“Leaking, be that urine, faeces or gas, is simply a message from the body that things are not working quite as well as they should and possibly that the activity you are doing is too much for your system to cope with at that time,” says Farrell. “Unfortunately leaking is often accepted as normal after childbirth and around the menopause, however it doesn’t have to be your new normal. There are effective treatments for both bladder and bowel leakage, and it’s important to know that it’s never too late to improve or resolve symptoms.”

Myths Series

  1. Ageing
  2. ADHD
  3. Grief
  4. Sexual health
  5. Loneliness
  6. Introverts
  7. Imposter syndrome
  8. Mental health
  9. Rage in motherhood
  10. Therapy
  11. PTSD
  12. Food safety
  13. Endometriosis
  14. Pregnancy
  15. Frozen shoulder
  16. Thyroid gland
  17. Eating disorders
  18. Chronic pain
  19. Pelvic floor
  20. OCD
  21. Happiness
  22. Physiotherapy
Geraldine Walsh

Geraldine Walsh

Geraldine Walsh, a contributor to The Irish Times, writes about health and family