Let’s Talk Pelvic Floor Health!
I recently had the opportunity to attend the final session in a women’s health series by Allison Imel, PA-C, FNTP, MMS, focused on pelvic floor health and it was amazing. As someone who regularly devours information on women’s health, neurodivergence, and neuroscience, I still walked away having learned so much.
The room was filled with midlife women openly discussing what’s often considered taboo; pooping, peeing, sex, STDs, trauma, stress and doing so in a safe, supportive space. It was powerful.
As a coach for midlife women, I’m passionate about sharing evidence-based, practical health information that helps us live more whole, empowered lives. The more we talk about these issues, the more we normalize them and the more people feel safe sharing their own stories.
Here is just a fraction of some of the information shared during her talk.
Signs and symptoms that MAY indicate you have a pelvic floor disorder:
· Frequent bathroom visits
· Have to frequently start and stop when you’re trying to pee
· Straining or pushing to pass a bowel movement
· Having to change positions on the toilet or use your hand to eliminate stool
· Constipation
· Experts estimate that up to half of the people with long-term constipation also have pelvic floor dysfunction
· Leaking stool (fecal incontinence)
· Leaking urine (urinary incontinence)
· Painful urination
· Unexplained low back pain
· Ongoing pain in your pelvic region, gentials or rectum – with or without bowel movement
· Painful sex
Some treatment approaches for PFD (of course consult a medical professional trained in pelvic medicine (gynecology, urogynecology, pelvic floor PTs, etc.):
Urge Incontinence and Urgency Frequency Syndrome
o Avoid bladder irritating such as artificial sweeteners
o Vaginal estrodial therapy (many issues are secondary to low estrogen in the vagina)
o Bladder training
o Pelvic floor physical therapy
o Medications if necessary
o Percutaneous tibial nerve stimulation
o Botox
o Sacral nerve stimulators
Stress Incontinence
o Pelvic floor physical therapy
o Vaginal estrodial therapy
o Weight loss
o Disposable pessaries (flexible, often silicone device that fits into the vagina and provides support to vaginal tissues displaced by pelvic organ prolapse)
o Incontinence dish pessaries (re-usable)
o Urethral bulking agents
o Mid-urethral slings
o Emsella chair (a non-surgical, non-invasive treatment for urinary incontinence caused by weakened pelvic floor muscles that uses electromagnetic waves to stimulate the pelvic floor muscles, inducing intense contractions.)
Constipation
o Intake of minimum dairy, gluten, sugar
o Adequate hydration
o Oral magnesium glycinate (others magnesiums such as magnesium oxide work but it is less gentle)
o Increase fiber intake (but make sure also hydrating or else can cause more blockage)
o Pelvic floor physical therapy
o Functional GI assessment and treatment. I had to have a defecography done which was fun but it led to a referral for pelvic floor physical therapy which was very helpful.
Pelvic organ prolapse
o Vaginal estrodial therapy
o Pelvic floor physical therapy
o Pessaries
o Surgery
Dyspareunia (pain with intercourse):
o Vaginal estrodial therapy
o Pelvic floor physical therapy
o Relaxation techniques
o Rule out organ dysfunction
o Pelvic wand release
o Vaginal dilators
o Vaginal baclofen suppositories
Pelvic floor weakness
o Pelvic floor physical therapy
o Emsella chair
o Vaginal weights
Vulvodynia
o Pelvic floor physical therapy
o Treat constipation
o Compounded amitriptyline-gabapentin vaginal creams
o Treat chronic viral infections [such as Herpes Simplex Virus (HSV), Epstein-Barr Virus (EBV)]
o Treat lichen sclerosus or lichen planus
Fecal incontinence
o Optimize fiber (but no Miralax)
o Functional GI workup/stool test to rule out pathogens
o Pelvic floor physical therapy
o Colorectal evaluation
o Possible sacral nerve modulation with Percutaneous Tibial Nerve Stimulation (PTNS) or an implantable device (Axonics or Medtronics Interstim)
Painful Bladder Syndrome/Interstitial Cystitis
o Functional medicine approach
§ 5 R Gut healing protocol
§ Bladder instillation
§ Hydrodistention
Severe constipation
o Dairy avoidance
o Anti-inflammatory diet
o Increased dietary fiber
o Oral magnesium glycinate
o Pelvic floor physical therapy
o Functional GI evaluation/functional stool test to work on optimized microbiome to improve motility
Here are just a handful of interesting takeaways I had:
· Make sure you are regular (as in pooping) because backed up fecal matter can press against the vagina and bladder causing the urge to pee so check that first.
· Associated with the pooping aspect, fecal incontinence is often associated with dairy so removing or start with just cutting back on dairy from your diet is very beneficial. (this one is going to kill me but I remember how good I felt when I was removed it from my diet for a low-carb diet). Sugar too.
· STDs can impact pelvic floor health in a variety of ways (e.g. herpes virus occasionally comes off the spine during stress and can cause inflammation of pelvic floor muscles so sometimes anti-viral meds can really help in those cases). Who knew?!
· Survivors of sexual assault have a higher rate of pelvic floor disorders. The mind/body connection is strong and the body stores that trauma.
· There are more than just physical causes but psychological/emotional causes such as stress, anxiety, and sexual trauma.
· Episiotomies are not always stitched up thoroughly at deeper layers causing issues.
· We tend to focus on estrogen but progesterone and testosterone are also key players in pelvic floor and overall health for women.
· Vaginal estrodial cream is effective, safe and NOT hormone replacement therapy (HRT) as it is not systemic. Treats Genitourinary Syndrome of Menopause (GSM), recurring Urinary Tract Infections (UTI), vaginal dryness, painful intercourse, urge incontinence, and even stress incontinence.
· “MIND OVER BLADDER”- many of us can unknowingly train our bladders to be weaker. I, personally, struggle with this one. “Let me go pee one more time (literally just went a few minutes ago) before we hit the road”. I went to pelvic floor physical therapy and had exercises to strengthen my pelvic floor as well as worked on increasing my times between urinating.
My takeaway? We need to prioritize our pelvic health without shame or silence. There’s help, there’s hope, and there’s nothing embarrassing about wanting to feel good in your body.
If this resonates, I encourage you to follow Allison Imel on Facebook or Instagram. Her expertise is grounded in data and compassion.
To all the women navigating midlife, healing from trauma, or simply curious about what’s going on down there: You’re not alone. Stay curious. Stay compassionate. You deserve care that sees all of you - body, mind, and soul.
