Tackling Pelvic Floor Taboo
by Julia Hlaing
Physiotherapist in Pelvic Health, Personal Trainer, Strength Sports Athlete
You look around your exercise class. The instructor is yelling for you and everyone around to continue working hard. Together, you’re overcoming the endless burpees and squats. You can see the sweat dripping as everyone gasps for air but you are barely breaking a sweat. You can’t exert the effort you’d like because… you’re worried about that wet sensation down your leg. You’re afraid of leaking or feeling the deep vaginal heaviness after exercise. You feel defeated because your GP has advised that you limit your lifting and jumping.
‘It’s the safer thing to do,’ they say.
Can you imagine that for a moment? Imagine feeling broken and embarrassed about your own body. Imagine not being allowed to do what you love. How would you feel if I was to say, ‘you should never lift weights or jump again?’
Many athletes are told to stop lifting weights. This could be due to multiple pelvic health concerns such as post-pregnancy, pelvic organ prolapse or incontinence. As you can surmise, the pelvic floor is a vital component of our body, and yet topics on the pelvic floor have been considered taboo to this day. Management strategies have shown a divide between health and fitness professionals but until we can tackle it together many will continue to suffer in silence. Pelvic health conversation will continue to be taboo.
There is research to suggest that fatigue and poor load management can result in bearing down, thereby increasing risk of damage on the pelvic floor. However, these studies were based on female paratroopers and women who worked laborious jobs. As an opposing argument, there is lack of research that suggests ‘lifting’ sports directly cause pelvic floor issues. The nuance in my argument is this – abstaining from lifting weights may potentially minimise pelvic floor risks, but at the expense of many other benefits.
We know that resistance training provides countless benefits:
-Prevent osteoporosis by augmenting bone mineral density
-Slow down loss of lean muscle mass with age (sarcopenia)
-Decrease risk of heat disease, lower blood pressure, diabetes management and improves cholesterol
-Mental and emotionally outlet to provide clarity, purpose, identity & community
Furthermore, the World Health Organisation and ACSM guidelines recommend:
-Adults aged 18-64 to partake in muscle strengthening activities at moderate or greater intensity 2 or more days per week
-65 years or older should partake in strength training for 3 or more days per week
-Pregnant and postpartum women are also encouraged to do a variety of muscle strengthening exercise
Having treated elite strength athletes and the general population, I’ve seen how symptoms can vary. Over the years I have come to notice that symptoms are prevalent amongst athletes whilst under heavy training loads. However, symptoms from performing daily functional activities seem to be of higher prevalence for those who do not meet exercise guidelines.
So here is my unique dilemma as a pelvic floor physiotherapist and someone who engages in regular strength training. I see and feel the benefits of strength training both physically and mentally. I also understand the concerns of surgeons, pelvic floor physiotherapists and doctors. Most importantly, I see the missing link between health professionals and the fitness community. This missing link, better understood as a lack of collaboration, is the reason many clients are lost, forgotten and eventually abandon exercise.
So where do we draw the line when symptoms of underlying pelvic floor issues can be so debilitating for some patients? Imagine the sensation of a bowling ball in your vagina as you move through the day-to-day. Or even a deep dragging bulge. Imagine being afraid to laugh, cough or carry your own child because incontinence and prolapse are always at the back of your mind. How much would your life change?
As severe an impact pelvic floor health can have, conversation in this field continues to be taboo. It is not clear to me why such is the case – but a few reasons come to mind. It could be because there carries a sense of shame due to the private nature of the pelvic region. Or perhaps there just hasn’t been enough advocacy for this field. Either way, this needs to change. We need to change it.
Let’s tackle this taboo by:
-Educating ourselves on common pelvic floor issues and how it can impact you or your clients
-Understand how to modify exercise variables if you, or your client are feeling discomfort with exercise
-Provide an open environment to discuss the pelvic floor
-Refer and collaborate with allied health if symptoms of prolapse or incontinence persist
Let’s keep tackling the taboo surrounding pelvic floor health from all angles. The benefits of exercise and strength training are clear but understanding risks are also important. As health professionals and coaches, it is integral to collaborate with pelvic floor physios and specialists to encourage safe long term exercise.