Urogynecological and sexual diseases caused by muscular alterations of the perineum have gained visibility in recent years. In part, thanks to the testimony transmitted by popular and successful women in their profession such as actresses Kate Winslet and Whoopi Goldberg, or singer Katy Perry.
Until recently – and even now in some sectors of the population – female symptoms related to urinary and / or gas incontinence, discomfort during sexual intercourse or bodily alterations such as prolapses were ignored and silenced.
However, in recent times, sensitivity to these problems has increased and many women are aware that they are pathologies or symptoms. treatable and curable.
This does not prevent the need to inform and sensitize the population about the importance of prevention from youth.
This will ensure that women detect minor alterations early, reduce the incidence and prevalence of these pathologies and, ultimately, increase their quality of life.
In addition to reducing expenses to the health system.
Control of the perineum
First of all, women need to be aware that their perineum, like any other muscle group, should be contracted and relaxed on demand.
That this possibility is present is indicative that the representation in the body diagram of the perineal musculature is preserved.
For practical purposes, a simple verification of this phenomenon is that, by voluntarily contracting the perineum, we should not feel changes in tension in the buttocks, the adductors (inner thighs) and / or the abdomen.
It is important to be aware of the perineum. (Photo: .)
The three major muscle groups that usually act as “parasites” of perineal contraction are located in these areas.
Parasites because should not activate, since they do not really increase continence but they deceive the person by making them feel that they are contracting their muscles properly.
In the day to day, it is highly recommended to raise awareness about the importance of proper urination hygiene habits.
The first and simplest is to respect the “voiding call.” Namely, go to evacuate when the need is felt without relegating it until it can no longer be held.
And once that call is respected, urination must be passive and complete: there is no active force to evacuate and it is necessary to wait for the emptying of the bladder to be completed.
It is not advisable to relegate the “voiding call”. (Photo: .)
Furthermore, the “stop-pee” or stop-test is not advisable.
This technique consists of the voluntary interruption of the voiding jet to resume it again after a few seconds.
This procedure, designed to train perineal strength, alters the sequence of reflexes defined by Mahony based on automatism.
That is, the continuous repetition of this technique alters the sequence of muscle actions, nervous and automatisms that occur naturally during urination.
Therefore, it could cause and aggravate urinary incontinence and bladder hyperactivity processes.
The correct defecation posture
Other relevant daily habits have to do with defecation.
For a correct defecation it is necessary that there is a hip flexion greater than 90º. Or what is the same, the knees must be higher than the hips.
In this position, the muscles in charge of fecal continence relax and it is not necessary to exert as much force to defecate.
If a woman defecates in a biomechanically incorrect position or is chronically constipated, she will be forced to exert herself.
This additional force causes harmful increases in intra-abdominal pressure.
The knees must be higher than the hips for a correct bowel movement. (Photo: .)
It occurs because, by increasing the pressure inside the abdomen, this force compresses the pelvic viscera (intestines, uterus, vagina and bladder, mainly) downwards.
The movement towards the feet pushes the pelvic floor which, progressively, becomes increasingly deformed and weakened.
To avoid the negative effects of living with constipation, it is necessary to internalize that healthy nutritional guidelines are also part of the prevention of urogynecological and sexual pathologies.
Specifically, minimize the consumption of ultra-processed foods, consume foods rich in fiber in abundance, and maintain an adequate supply of water.
Something similar happens, albeit on a smaller scale, during the coughing spells.
In this case, the increases in intra-abdominal pressure are smaller and shorter.
But, in cases of chronic respiratory disease, the repetition is much more frequent throughout the day and can have sequelae.
Obesity and smoking, enemies of the pelvic floor
Abdominal obesity is a risk factor. (Photo: .)
Another modifiable risk factor is the presence of abdominal obesity that increases the pressure (by the own weight of the fat mass) on the pelvic diaphragm.
Smoking is also related to a higher incidence of alterations in the pelvic floor because the toxic substances it contains facilitate the degeneration of the connective or fascial tissue.
This type of tissue represents more than 70% of the cells that make up the perineum.. If, while maintaining a good level of muscle strength, the fascia and ligaments in the area do not perform their function properly, pathologies may develop.
Pelvic floor and pregnancy
Finally, the prevention of alterations during pregnancy and postpartum is of special importance.
Pregnancy, by itself, whether or not it ends in vaginal delivery, represents a risk factor for the development of pathologies related to the pelvic floor.
The weight overload (the weight) of the belly on the perineum progressively weakens it throughout pregnancy.
In addition, this process usually ends with the enormous structural overload of the area that implies dilation for the birth of the baby.
To which is added the risk of injury implicit at delivery in lithotomy position (face up), to the use of medical instruments such as forceps and suction cups, interventions such as episiotomy or the spontaneous development of complications such as muscle tears.
In order to minimize the incidence of these problems and reduce their severity, support and physical preparation programs for pregnancy and childbirth should be implemented in a generalized way.
Exercises during pregnancy and after delivery minimize the incidence of pelvic floor problems. (Photo: .)
The active participation of physiotherapists specialized in obstetrics offers pregnant women:
Guidance regarding sports activity and physical exercise during pregnancy and postpartum. Pre and postpartum perineal prevention and evaluation. Useful information and physical tools during childbirth: dilation and delivery positions, pushing technique and respiratory modalities. Treatment of the painful obstetric pathology of nonspecific syndromes such as lumbago, lumbociatalgia, back pain and leg cramps, so frequent during pregnancy and quarantine. Manual therapy and pelvic normalization pre and postpartum.
As has been observed, daily habits and prevention methods are numerous and have a great long-term impact on the development of pathologies related to the pelvic floor.
Therefore, it is necessary to disseminate this information and that health institutions make a great outreach and awareness effort to increase the quality of life of women.
* Raquel Leirós Rodríguez is an assistant professor of Physiotherapy at the University of León. His original article was published in The Conversation, the original of which you can read here.
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