WHAT A STATE
Here’s the 411 on the conditions that can arise when your pelvic floor isn’t playing ball
INCONTINENCE
There are many things that might cross your mind during a particularly intense circuits class. Do these new leggings pass the squat test? Why isn’t there a clock in here? How many more burpees until I actually cry? Whether the next set of lunges might cause you to wet yourself, however, isn’t a welcome thought. Yet, for Katy, 34, from Hertfordshire, it’s an all-too-real anxiety. ‘It was after starting a fitness kick with friends that I realised I had a problem,’ she recalls. ‘During the warm-up, we were asked to do this deep sideways lunge and I leaked. I was so embarrassed. I carried on with the class, but there was this constant fear of “what if?” It got worse over time, too. I’d leak if I sneezed or coughed. It felt shameful – this was something that toddlers did, or that happened to 90-year-olds.’ While feeling a dampness in your knickers (now, now) during a workout might be a topic you’d feel too embarrassed to bring up over brunch, incontinence is shockingly common. An estimated seven million women in the UK suffer from unbidden peeing, and a 2017 study found that more than a fifth of physically active women between the ages of 18 and 40 can hold their hands up (should they feel confident enough to do so). This is stress incontinence, where leaks occur because of a sudden impact – think high-impact exercise, laughing and coughing – due to the sphincter role of your pelvic floor not delivering.
PELVIC ORGAN PROLAPSE
Less common than incontinence but more debilitating, prolapse is a condition where one of the pelvic organs slips from its normal position and begins to bulge into the vagina because the muscles that are meant to hold everything in place weaken. ‘The risk of incontinence in women of all ages is around 25%, while one in 10 women will need surgery for prolapse at some point in their life,’ says Dr Robinson.
HYPERTONIA
Issues aren’t just caused by weak pelvic floors. Mann says around 10% of the patients she sees have the opposite problem. It’s called hypertonic pelvic floor, where the muscles are too tight or incapable of relaxing, and causes issues like pain during sex, problems using tampons and chronic constipation, as well as pelvic and lower back pain. Exact causes are unknown, but stress is thought to play a role. ‘For hypertonic pelvic floor, you need help from a specialist physio,’ says Mann. ‘They will assess your pelvic floor with an internal examination, then do what we call “down training” – teaching you relaxation exercises.’