Pelvic health is rarely talked about, beyond a few vague references to “leaky laughs” among mums as if they were one of the inevitabilities of childbirth.

Yet the problem is real, as the recent report into the shocking misuse of pelvic mesh surgery revealed. Most people are unaware that 50 per cent of women over the age of 51 and 31 per cent of men over 64 are incontinent to some degree.

Then there are prolapses, stress incontinence, emptying issues, “latchkey incontinence” (where you suddenly get desperate as you are entering your house), constipation and anal pain for both women and men – all these are among the issues afflicting the unreported world of the pelvis. Until I met pelvic health physiotherapist Clare Pacey, I had not known such a profession existed.

My friend Sally* suffered from incontinence issues and was referred to Pacey by her gynaecologist.

British medical guidelines state pelvic physiotherapy is the gold standard and first-line treatment for prolapses and urinary incontinence. Yet Pacey says this rarely happens: “The hierarchical, biomedical model our healthcare system currently operates in means referral pathways tend to direct patients straight to a surgeon.”

“Many women are led to believe that doing self-taught kegels at home is the same as pelvic health physiotherapy,” says Pacey. 

“In other areas of medicine it is standard procedure to undergo rehabilitation with a physio after surgery or injury, but this is not so after giving birth – which can be just as, or more, traumatic.”

The figures are startling: 85 per cent of women in UK experience perineal tearing during vaginal birth and 50 per cent of women who have had children will have prolapse to some degree, with incontinence and elasticity issues arising out of these unseen injuries.

“Skipping the rehabilitation and just putting up with a body that does not allow us to run or jump on a trampoline for fear of leaking – simply because only we know we cannot still do these things – is not a good idea.”

Ignorance is widespread. “People don’t think about their pelvic floor,” says Pacey. “And we receive very little education about this part of our body. Many women are not aware they even have a pelvic floor until they have a baby or reach menopause when this area fails them and they start to consider it for the first time.”

But pelvic health does not just concern post-partum women. “Because women have reduced oestrogen in the post-menopause period, tissues become thinner and there is a loss of elasticity, which makes the area more fragile, often revealing underlying issues that had gone unnoticed.

“Young men and women also suffer from pelvic and anal pain. Serving in the Army and even elite young athletes, especially gymnasts and trampolinists, are especially susceptible to leaking because of jumps and impact landings. Wind control is another issue for both sexes.

“Pelvic floor exercises have been simplified so much they now rarely work on their own because women are exercising a muscle in isolation and this is not how muscles work. We need to train the pelvic floor muscles in unison with the breath to ensure that the deep ‘core’ system is coordinated and absorbing impact.”

At the moment Pacey’s clients tend to be women who are educated and aware enough to want to optimise their pelvic health or those whose symptoms can no longer be ignored.

She would like to encourage those women who are OK – but at risk – for example, they are post menopausal, they do or did lots of high-impact sport, lift heavy weights, have chronic constipation or chronic coughing, to consider a pelvic health consultation in the same way as you would visit a dentist or a hairdresser.

*Names have been changed

Clare Pacey’s top tips for a healthy pelvis

1. Avoid constipation and straining on the loo. We are designed to squat to empty our bowel. Invest in a stool to place your feet on when on the loo so your knees are higher than your hips and lean forward placing your elbows on your knees. Instead of bearing down, breathe and relax your tummy.

2. Let your abdominals go! Have you ever been told to suck your tummy in before lifting to protect the spine or felt you need to hold in throughout the day because you think you should? Letting go helps with relaxation, reduces anxiety and aids digestion.

3. Do daily pelvic floor exercises: inhale and relax and on exhale gently squeeze the pelvic floor as if picking up a kidney bean or stopping wind. Inhale and relax fully. Repeat. Aim to do some quick squeezes and some holds. Do the exercises in different positions – lying, sitting, standing. 

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The Daily Telegraph

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