PELVIC FLOOR HEALTH

Hello, wonderful people,

It's been a while since I last put my blogging hat on, but alas, I am back with more personal experiences that I think will help other women by talking about them. The aim of this post and those that follow is to remove the stigma surrounding stress incontinence, prolapses, and anything related to the pelvic floor muscles and the vagina. Yes, I'm going to talk about the vagina without any shame. I am not a doctor, and I have no qualifications in this area, but what I do have is my personal experience and knowledge I have picked up along the way, which I am sharing. So if this is something that interestes you, or you sense that your pelvic floor muscles are not 'thriving' then read on..

So let's get straight to it... "The Pelvic Floor" - what is it?

Well, I honestly don't think I even knew what this was until I had my daughter 14 years ago (don't get me started on this - honestly, time seriously flies way too quickly!), when I was told to do my 'pelvic floor exercises' to restore tone and strength to my pelvic floor muscles. I did a few pelvic floor clenches after I had my child, but honestly, as a 23-year-old, I really didn't take it seriously. Like many other 20-somethings, I hadn't given much thought to my body and just expected it to be invincible forever. Oh, how wrong I was! Fast forward 10 years, and burnout got the better of me, and my goodness, it truly put me in my place. My burnout delivered a very clear and blunt message, with what can only be described as a screaming, harsh slap to the entire body: "YOUR BODY IS NOT INVINCIBLE."

So, what is the pelvic floor, and why do people go on about it when you have a baby?

The pelvic floor 'muscle' isn't actually a single muscle but layers of several muscles that work as a hammock to support the bladder, uterus, and bowel, playing a crucial role in overall bladder, vaginal, and bowel health. Often, problems that arise in this area can be linked to your pelvic health. Ultimately, these layers of muscles work tirelessly every day to keep not only the bladder, uterus, and bowels in place, they are key in our urethral health (where we pee from), our vaginal opening and walls, and also our anus - as well as supporting the weight of all the above organs. It is what keeps our important bits and pieces in place - a very important set of supportive muscle tissues.

The reason a lot of women may not hear much about this until pregnancy is understandable: if these muscles are holding everything in place, the weight of a baby is only going to increase the pressure on the pelvic floor muscles. This alone can tire the pelvic floor muscles, and that's before we even get into the actual process of pushing said baby down that teeny tiny birth canal and out of the vagina! So whether you give birth naturally through the birth canal or have a c-section, pregnancy alone asks a lot from these muscles.

The Decline of My Pelvic Floor

I noticed during my CrossFit training days around 4-5 years ago that the urgency to pee increased when I lifted weights - and honestly, I never really got to heavy weights. I also noticed that when I was running, the urgency was there, and I managed this by not drinking anything for at least an hour or two before exercising. It worked for a while, but I knew this wasn't sustainable because, let’s be honest - drinking fluids and working out go hand-in-hand, especially if you're one of those people who profusely sweat and go bright red during exercise. Lucky me - I have never been one of those women who look even remotely sexy when exercising lol! This then progressed into peeing while coughing, sneezing, and whenever I was sick, I lost all control of peeing. As if vomiting wasn't bad enough, wetting yourself simultaneously really was a humbling experience!

Anyway, it wasn't until one year into my burnout in 2021 that I started reading more about health and well-being, hormones, and, generally for the first time in my life, actually took an interest in taking care of this body of mine. Let's just say I was receptive to the harsh message my body gave me and found myself on a journey to better my overall well-being, physically and mentally. At this point, I had stopped CrossFit and running due to the urgency to pee - and was always adamant that I wasn't going to normalize wearing Tena Lady products. After all, I was only 33! Through self-study, I had learned that during burnout, our sex hormones (estrogen, progesterone, and testosterone) take a huge hit and are put on the back burner while the body focuses on our stress hormones, cortisol and adrenaline. In chronic stress, our body starts shutting down parts that are not deemed important when in fight or flight, one of which is the reproductive system and the hormones that come with it. These hormones are essential for sexual health and overall muscle elasticity and strength, which directly impacts these very important sets of pelvic floor muscles. This, along with the fact that our pelvic muscles are very much linked to our fight or flight response, means they are directly impacted by our emotional state and stress levels as the pelvic floor muscles hold onto tension. When stressed, our muscles, particularly our pelvic muscles, remain tight through fear of a threat, which does not necessarily mean a physical attack in many chronic stress cases, but more emotional or situational circumstances - breakdowns in family, work, friendships, etc.

During burnout, I also started noticing differences in my sex life - loss of sensation entirely. It was quite literally as if my vagina had died and my days of enjoying pleasure were behind me. Again, as a 33-year-old, this was not acceptable to me. However, after seriously focusing on looking after my physical and mental health, leaving behind anything toxic, and healing from the grief of these 'losses' that were my normal, lo and behold, sex became pleasurable again. Another reminder to all of how energy impacts your body: your body and soul will communicate this to you, you just have to listen and take action. That being said, the urge to pee didn't improve, which then put me on a pelvic health mission.

I decided to seek help through an NHS gynecological consultant who basically told me, 'It's just what happens to women,' and to live with it. I was outraged - it was a big step for me to pluck up the courage to seek professional advice, so let's just say I left feeling very let down and emotional. Adamant that there were answers and SOLUTIONS out there, I decided to go private and booked an appointment with a Harley Street gynecological consultant in London. This was a time when I was having severe psychological symptoms during my premenstrual cycle, so I went to see Mr. Morris to help me. Not only did Mr. Morris put me in touch with Professor Michael Craig, who diagnosed me with PMDD and quickly resolved that problem through medication, but Mr. Morris also informed me that I had a bladder prolapse, which essentially is where your bladder starts to protrude into your vaginal wall. I was informed surgery was the last resort and set on a path of ways to address this...

What Can Help with Pelvic Floor Health?

Diet - Like all muscles, the pelvic floor needs protein. So if you don't eat protein or don't like meat, then check your diet and see if you can supplement through protein shakes and/or plant-based proteins. These muscles work hard and need nutritional fuel for support. So that's exactly what I did - protein added to the priority list - CHECK. Also, diet and intolerances can play a role in pelvic fatigue. If you find yourself regularly bloated or have consistently struggled with constipation, remember that bloating adds additional pressure to the pelvic area, and straining from constipation does the same. It all makes perfect sense when you think about it - our pelvic floor muscles can only take so much before they tap out and start giving way. I have started eating through Green Chef with a good mixture of protein and fiber to help with overall digestive health, energy, and muscle strengthening. This just helps me prioritize my physical health and diet, as I often found myself skipping meals or grabbing food on the go, which never results in me getting the necessary fuel my body needs.

Yoga - Yoga is a great way to activate your pelvic floor and overall strengthen it. As a yoga teacher, this is something I have been doing, and I have no doubt it has helped, but given the severity of my condition and how advanced it now is, sadly, it's not the solution. I really do think that my symptoms would be worse if I hadn't been practicing yoga for the last 4 years. Yoga is a great preventative way to look after your pelvic muscles!

Physiotherapy - Physio that focuses on the pelvic floor muscles is also very useful. I went to a female pelvic health specialist named Lincoln who inserts a kegel probe into the vagina and walks you through a series of instructions and exercises while checking on screen that you are engaging the pelvic muscles correctly. You can even play a game that's all about engaging the pelvic floor to pass each level. This was great, but when I asked if it would fix my current issues, the physio replied, "it won't get worse," which for me, wasn't good enough. I didn't just want to live with this level of pelvic floor health, I wanted to get back to running, weight lifting, and generally put this fear of my weakening pelvic floor behind me. This was a rather intrusive treatment, and while Tracey was lovely, I can't say it was an enjoyable experience. Let's be honest - anything that goes wrong down there isn't exactly welcomed, so physio absolutely has its place, and I would recommend trying it. We are all different.

Emsella Chair - In my determination to find solutions, and appreciating that surgery was the last resort, I came across this magnetic device called the Emsella chair at Body Lipo Lincoln. This is a non-intrusive option where you are fully clothed and simply sit on a chair that works by sending magnetic shocks into the pelvic floor to strengthen it. Marcus is a wonderful man, and the team there was lovely - stressing that diet, and particularly protein intake during these treatments, is non-negotiable. The chair makes the pelvic muscles work hard, and therefore, protein to fuel the muscles is a must. While this did improve my pelvic floor strength, with some improvements to the urgency to pee at the gym, and while gently jogging, it didn't get me to where I needed to be. So the search continued.

Before I talk about the last resort for me - surgery - I'll explain how and why I got here. After trying all of the above over the course of several years, and despite efforts to improve my pelvic health to no avail, I went to the Manchester Private Hospital to seek professional help again. A good friend of mine had been to see Dr. Mofid Ibraheim, who had worked wonders with her pelvic floor, so I thought, "sod it - I'm going to him." During this consultation, he informed me that I not only have a bladder prolapse (cystocele) but also a rectal prolapse (rectocele). Having had a fairly traumatic birth with my child 14 years ago, which ended with ventouse (a vacuum cup that is attached to the baby's head by suction) and an episiotomy (a cut made by a healthcare professional into the perineum and vaginal wall to make more space for your baby to be born), the doctor advised that this is the likely primary reason for my pelvic floor issues now. This actually made me feel good - my prolapses are a small price to pay for the best thing that has ever happened to me. I am proud of what my body has done to bring the light of my life into this world. This helped me to radically accept my situation and wash away any embarrassment - my body is amazing for what it did, and I am eternally grateful for the fact that my body enabled me to birth my daughter - the ultimate gift and blessing.

Prolapses are extremely common, particularly bladder prolapses in middle-aged women - it is estimated that approximately 50% of women have some level of a cystocele. Women who have had children can later in life find their muscle elasticity loosening as their estrogen levels decline. It's important to note, however, that having a prolapse doesn't mean you need to 'fix it.' It is so common that many women don't even know they have it, as it isn't causing them any issues. Prolapses are only problematic if they are hindering you from living and impacting day-to-day activities. I have been chasing solutions because of my yoga career, the worsening symptoms, and the increasing activities that are impacted by it.

What is a Prolapse?

Pelvic organ prolapse (POP) is when your pelvic organs (vagina, uterus, bladder, rectum) drop from their typical positions. It happens when your pelvic floor (the muscles, ligaments, and tissues that support your pelvic organs) becomes too weak to hold your organs in place. This can be caused by a series of reasons as detailed above - if you think you have one and you think it is impacting your confidence or day-to-day activities, then go to your GP. As mentioned above, your pelvic floor supports the organs in your pelvis from underneath — almost like a hammock. If these supports become too loose, the organs they support shift out of place or sag into the vagina. Your pelvic floor can weaken due to things like childbirth or aging.

With mild cases of POP, your organs may drop slightly. In severe cases, they may extend outside your vagina and cause a bulge. Sadly, prolapses do tend to worsen with age, which is another key reason for me pushing for a solution. People with a prolapse typically describe it as fullness or pressure in their vagina, as if something were falling out... even if it hasn't quite got to that point. Your exact symptoms will depend on what type of prolapse you have and how severe it is, so if it’s bothering you, seek attention from your GP. While the NHS wasn't helpful to me, I would still suggest this as your first port of call.

What are the Different Types of Pelvic Organ Prolapse?

The type of prolapse you have depends on where the weaknesses are in your pelvic floor and what organs the weakness affects.

Anterior Vaginal Wall Prolapse (Dropped Bladder): Weakened pelvic floor muscles above your vagina can cause your bladder to slip out of place and bulge into your vagina. This type of prolapse is also called a cystocele. Anterior vaginal wall prolapse is the most common type of POP.

Urethrocele: Weakened pelvic floor muscles can cause your urethra to drop. A dropped urethra often accompanies a dropped bladder.

Posterior Vaginal Wall Prolapse (Rectocele): Weakened pelvic floor muscles between your vagina and rectum can cause your rectum to bulge onto the back wall of your vagina.

Enterocele: Weakened muscles in your pelvis can cause your small intestine to bulge onto the back wall or the top of your vagina.

Uterine Prolapse (Dropped Uterus): A weakened pelvic floor can cause your uterus to drop down into your vaginal canal.

Vaginal Vault Prolapse: Weakened pelvic floor muscles can cause the top part of your vagina (vaginal vault) to drop into your vaginal canal.

Each prolapse type is graded 1-4, with 1 being a very mild prolapse where the organ begins to move position, and 4 being the prolapse protruding out of the body. Again, I want to stress that prolapses are very common, and therefore you may have one, but that doesn't mean you need to act on it if it isn't impacting you every day. This is nothing to be embarrassed about. I have been through the embarrassment, and although I was a little upset to hear about the second prolapse, I am taking action and feel really positive about it.

Surgery!

So after going through all of the above attempts to fix my pelvic floor, I am scheduled for surgery on April 9th with Dr. Ibraheim at Manchester Private Hospital. I am a little nervous about it, as let's be honest, IT IS MY VAGINA we are talking about, lol. But I know I am in the best hands for it. I feel empowered and generally really good about finally getting to the end of this journey with a solution. If you feel something is not right, despite being told to just accept it - you DO NOT HAVE TO.

I will blog after my surgery to let you know how it went and keep you updated on my recovery for any of you that are interested in this surgery. I truly hope this blog has helped inform you about pelvic health, given you some ideas of what can be done to help it, and helped you understand what the pelvic floor does and why it can become weak.

Writing this blog has been liberating for me - having gone through all the emotions over the last few years of embarrassment, sadness, shame - to now writing a blog sharing it with the world (well, not quite, lol) but you get my point - I feel relieved and excited about the future.

I am not embarrassed, and I hope this has helped some of you feel like you don't have to be either! Your body is a beautiful, insanely complex machine that works tirelessly to keep you living here and able to experience life. We should all be in awe of our bodies and grateful for the ones we have!

If any of you have any questions or would like to know more, I am more than happy for you to reach out one-to-one - obviously, full confidentiality will be in place. While I am happy to share this with you all, I fully appreciate that you may not. Having held onto embarrassment and shame for years with one thing or another, I just swore to myself that those days are behind me, and speaking about it really does help. I just want to use my challenges as a way of helping others.

Big love,

See you on the other side...

Jade

xxx