5 Signs It May Be Time to See a Pelvic Health Professional: A Guide for Women
Many women live with pelvic health symptoms for months – sometimes years – before asking for help.
A little urine leakage gets blamed on having children. Needing the bathroom more often gets blamed on getting older. Pain during sex is brushed off as hormones or menopause. And that uncomfortable feeling of pressure or heaviness? We often simply learn to live around it.
But although pelvic health problems are common in women, that doesn’t mean you simply have to accept them.
Your pelvic floor is a group of muscles that plays an important role in bladder and bowel control, sexual function and supporting the organs within your pelvis. Pregnancy, childbirth, ageing, hormonal changes, surgery and other health factors can all influence pelvic health.
Importantly, though, not every bladder, pelvic or sexual symptom is caused by the pelvic floor. Similar symptoms can have several different causes, which is why proper assessment matters.
Here are five signs that it may be time to speak to a pelvic health professional.
- You Leak Urine When You Cough, Sneeze, Laugh or Exercise
If you’ve ever crossed your legs before a sneeze because you know what’s coming, you’re certainly not alone.
Leaking urine when you cough, sneeze, laugh, jump, run, exercise or lift something heavy is commonly associated with stress urinary incontinence.
You may only leak a few drops. Perhaps you wear a liner “just in case”, empty your bladder before exercise, or you’ve quietly stopped doing certain activities because you know you’ll leak. The amount isn’t really the important part.
If you’re changing what you do because you’re worried about leaking, it’s worth talking to someone about it.
Pelvic floor muscle training can be an effective first-line treatment for many women with stress urinary incontinence, but the right approach starts with understanding your individual symptoms and pelvic floor function.
- You’re Going to the Bathroom All the Time – or Suddenly Have to Rush
Do you always know where the nearest bathroom is?
Perhaps your bladder seems to go from perfectly comfortable to “I need a toilet now” very quickly. You may be urinating more frequently, waking during the night to go, or getting into the habit of using the bathroom “just in case” before leaving home.
Urinary urgency and frequency can occur with conditions such as an overactive bladder, but other causes are possible too.
This is important because treatment isn’t necessarily just about strengthening your pelvic floor. For women experiencing urgency or frequency, bladder retraining and other approaches may form part of treatment depending on the cause.
If your bladder is starting to dictate where you go, what you do or how comfortable you feel leaving home, it deserves attention.
- You Feel Pressure, Heaviness or a Bulging Sensation
A feeling of heaviness, pressure or bulging in the vagina or pelvis can sometimes be associated with pelvic organ prolapse.
Women describe this in different ways. You may feel as though something is “dropping”, experience a dragging sensation, notice a bulge, or find that the pressure becomes more noticeable after standing for a long time or being physically active.
Pregnancy and childbirth are among the factors that can increase the risk of pelvic floor dysfunction, but they aren’t the only ones.
If you notice a new or persistent feeling of pressure, heaviness or bulging, it is worth having it assessed.
And a diagnosis of pelvic organ prolapse does not automatically mean surgery. Depending on the type and severity of the prolapse and your individual circumstances, non-surgical treatment options may also be appropriate.
- Sex Has Become Painful or Uncomfortable
Pain during sex is something many women struggle to talk about.
Some assume it’s simply part of getting older, menopause or life after childbirth. Others continue having painful sex because they feel embarrassed discussing it or believe nothing can be done.
There are many possible reasons why sex may become painful or uncomfortable. Hormonal changes, vaginal dryness, endometriosis, scar tissue, pelvic pain conditions and other medical factors may all contribute.
Pelvic floor dysfunction can also sometimes play a role.
And here’s something that’s particularly important to understand:
A pelvic floor problem doesn’t always mean that your muscles are too weak.
Pelvic floor muscle training isn’t simply about building strength. Depending on the problem, treatment may involve improving strength, endurance, coordination or the ability of the muscles to relax.
That’s why repeatedly doing Kegel exercises without knowing what is causing your symptoms isn’t necessarily the right answer.
If sex has become persistently painful or uncomfortable, or you’ve started avoiding intimacy because you expect it to hurt, it’s worth talking to an appropriate healthcare professional.
- You’ve Started Changing Your Life Because of Your Symptoms
Sometimes the biggest sign isn’t the symptom itself.
It’s everything you’ve started doing because of it.
You’ve stopped running because you leak.
You don’t jump on the trampoline with your children.
You use the bathroom before leaving home even when you don’t really need to.
You avoid long journeys.
You wear a pad every day “just in case”.
You avoid intimacy because it hurts or because you’re worried about your bladder.
These little adjustments can gradually become so normal that we stop seeing them as adjustments.
Pelvic health symptoms can affect confidence, exercise, relationships, intimacy, work and social life. If that is happening to you, you don’t need to wait until your symptoms become severe before asking for help.
What Can You Do About Pelvic Health Problems?
The first step isn’t necessarily doing more pelvic floor exercises.
The first step is understanding what is causing your symptoms.
No single treatment is right for every woman. Depending on your symptoms and their cause, management may include pelvic floor physiotherapy, supervised pelvic floor muscle training, bladder retraining, lifestyle changes, medical treatment, pessaries for some women with pelvic organ prolapse, or other appropriate therapies.
Sometimes further medical assessment is necessary because bladder, bowel, pelvic and sexual symptoms can also be associated with conditions that aren’t primarily caused by the pelvic floor.
That’s why an individual assessment matters.
At my practice, pelvic health concerns can be discussed openly and without embarrassment. Bladder leakage, changes after childbirth, menopause, sexual discomfort and other pelvic health concerns are health issues – and you deserve to be able to talk about them as such.
You don’t have to wait until the problem becomes severe.
Sometimes the first step is simply saying:
“Something has changed, and I’d like to find out why.”
Pelvic health problems may be common. Living around them doesn’t have to be.
References
National Institute for Health and Care Excellence (NICE). Lower urinary tract symptoms in men: management (CG97).
Guidance on the assessment and management of urinary symptoms in men, including frequency, urgency, nocturia, urinary incontinence and voiding symptoms.
European Association of Urology (EAU). Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms.
Clinical guidance covering male urinary symptoms and the management of urinary incontinence following prostate surgery.
European Association of Urology (EAU). Guidelines on Sexual and Reproductive Health: Management of Erectile Dysfunction.
Clinical guidance on erectile dysfunction, its possible causes, assessment and treatment.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Kegel Exercises/Pelvic Floor Muscle Training.
Patient information on pelvic floor muscle function in men and women and its role in bladder and bowel control.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Treatment for Faecal Incontinence.
Information on the assessment and treatment of bowel-control problems, including the role of pelvic floor muscle exercises in appropriate cases.
Leanne Steyn
Need support? The Society of Sexual Health offers confidential online sexology and relationship therapy. Useful next steps: confidential therapy support.
