There are many recommendations for the pelvic floor. Some things have turned out to be unsustainable, some are even harmful. That is why Astrid Scheuermann clears up false information about the pelvic floor in her book “Powerzentrum pelvic floor”.
by Astrid Scheuermann
1. Myth: You have to stop the urine stream several times when using the toilet, this is natural pelvic floor training.
The emptying of the bladder should always be complete and uninterrupted. In the past, women were often told to exercise the pelvic floor muscles in everyday life by stopping the urine stream. However, studies have shown that this behavior can even make you sick in the longer term. After all, the urinary bladder, urethra, internal and external occlusive muscles, bladder and brain work together when using the toilet. The level of the bladder is constantly measured via receptors and the “current state of affairs” is reported to the autonomic nervous system (involuntary control). If the bladder is filled to a certain degree, the feeling of having to go to the toilet arises. In cooperation with arbitrary and involuntary processes, continence is secured until we actively decide to pass urine. It is only during the emptying of the bladder, the so-called micturition, that the closure is opened deliberately, the pelvic floor muscles relax and the bladder contracts and, so to speak, drives out the urine. By deliberately interrupting the urine stream by means of our urethral sphincter muscle, the sensitive urination program is severely disturbed. A nervous bladder, urge incontinence and, as a result, residual urine can develop. The urinary bladder is then no longer completely emptied even when it is relaxed. In addition, the residual urine can lead to infections. The interruption also reduces the maximum flow of urine, which can trigger bladder dysfunction.
2nd myth: pelvic floor problems only arise after giving birth and in old age
Both women and men can develop pelvic floor problems at any age. Women who have given birth can suffer from it, but also those who have not given birth. The causes include physical conditions such as obesity, heavy and incorrect lifting, chronic illnesses such as chronic cough and constant sneezing attacks. In many cases, incorrectly learned behavior patterns play a major role. Various symptoms are not assigned to a pelvic floor problem. However, problems with emptying the bowel and dribbling urine can indicate that the closure system in the pelvic outlet level is disturbed.
In her book, the experienced physiotherapist Astrid Scheuermann clearly explains how one of the most important muscle groups in our body works and reveals the easy-to-use exercises that can be used to strengthen the pelvic floor and prevent complaints.
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Myth 3: Trained women have harder births.
First, not every sporting activity affects the pelvic floor equally, so a distinction should at least be made between different types of sport. Secondly, it cannot be proven in studies that a firm, i.e. exercised, pelvic floor leads to more difficult births, more perineal tears or cuts, or birth complications. Quite the opposite: Even during pregnancy, a strong core prevents back pain and hip pain and supports women in coping with everyday life. And the advantages in regression are also obvious.
4. Myth: It is better to go to the toilet before a drive – whether you have to or not.
A normal urge to urinate with a correspondingly well-filled bladder should not be suppressed. But visits to the toilet without a signal that the bladder has reached full capacity ultimately has the same effect as interrupting the urine stream, namely messing up the reporting system. In a complex process, the brain is constantly presented with messages about the filling status of the bladder. Even if the urge to urinate is already consciously felt, there is still more or less time to go to the toilet. Going “to be on the safe side” before activities that do not allow you to go to the toilet quickly is therefore counterproductive in the long run. So please no preventive toilet visits. Don’t go to the bathroom until you have to. Incidentally, this also applies to your children. A child who has complete control of their bladder system should also not be sent to the bathroom as a precaution. There is no objection to the question of whether she has to urinate again, but she shouldn’t be forced to go to the toilet.
5th myth: After a few pregnancies, the pelvic floor is worn out.
Pregnancies and births stress the pelvic floor. During this time it is particularly challenged, strained and possibly not only stretched, but overstretched. However, all these changes are limited in time and are also set up by nature in this way. And they can be alleviated prophylactically by strengthening the pelvic floor or, in most cases, practiced afterwards so that they do not acquire any disease value. What many women perceive as being worn out are physiologically clever developments. Ligaments have to give way to hold the fast growing uterus securely, the abdominal muscles have to give way to make room for the baby, the pelvic floor muscles have to be flexible despite their strength to let the child’s head through. All of these structures are highly elastic and thus able to guarantee both expansion and contraction. Evolution has made appropriate adaptation mechanisms possible. The term “worn out” alone does not correspond to the regenerative capacity of our body and therefore gives a completely wrong picture of the female anatomy.
6. Myth: You don’t need pelvic floor exercises after a caesarean section.
The special stress on the pelvic floor during a natural birth, triggered by the passage of the child, does not exist with a caesarean section. But there are two reasons for taking intensive care of the pelvic floor after a caesarean section. First, all loads on the pelvic floor took place throughout the course of pregnancy. This means that the physiological adaptation mechanisms of ligaments, muscles and organs in the middle of the body have taken place in the same way as with a spontaneous delivery. Second, the stretching or severing of the abdominal muscles during a caesarean section destabilizes the abdominal capsular system. Here the connection to the small pelvis becomes more unstable and should be strengthened again.
7. Myth: The pelvic floor is a problem for women.
Pelvic floor problems are more common in women than in men. However, this does not mean that the male pelvic floor would not benefit from special training or that it may not even exist. There are specific clinical pictures of the pelvic floor in men, for example after prostate surgery, which can represent a pelvic floor problem in the form of incontinence. Even more than female pelvic floor problems, these are taboo and can usually be treated satisfactorily with specially trained therapists.
8. Myth: There is nothing you can do about incontinence and you have to rely on appropriate hygiene products for a lifetime.
Correct: pelvic floor therapy can help. The chance of recovery is up to 80 percent, depending on the cause of the incontinence. Therefore, it is worth doing everything possible to achieve the state of continence. Hope dies last – and: There is nothing to lose, but everything to gain.
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Every tenth woman sustains massive pelvic floor damage when giving birth to her children, sometimes with terrible consequences such as bladder and uterus subsidence, incontinence and impairment of the intimate and sexual life of those affected. But not only mothers are affected by pelvic floor problems, every woman bears the risk of developing pelvic floor weakness. There is still far too little talk and education about it.
Astrid Scheuermann is a physiotherapist with her own practice in Cologne. With her effective training program for the pelvic floor, she was able to help many of those affected regain a better quality of life.
Her book Power center pelvic floor was published by Piper Verlag and costs € 12.