Tight or weak? A gynaecologist's guide to healthy pelvic floor health
As women, we know that our sexual health is incredibly important, not just for our intimate relationships but for our overall well-being. One aspect of sexual health that is often discussed but not always fully understood is pelvic floor health credited to Kegel exercises.
In an insightful conversation with Independent Media Lifestyle, Dr Marie Subrayan, a seasoned obstetrician, gynaecologist and aesthetic gynaecologist, shared her expertise on the often-overlooked topic of pelvic floor health care.
With a wealth of experience in managing everything from menopausal issues to sexual health dysfunction, Subrayan offers a comprehensive perspective on the many factors that influence women’s health, wellness and overall sexual well-being.
“A Kegel exercise is just one type of exercise that can be done to strengthen the pelvic floor muscles. It’s by no means the only exercise and its often done incorrectly, which is why it’s not as effective as it could be.”
Subrayan said pelvic floor exercises could be divided into two categories: exercises for a “hypotonic” (weak) pelvic floor and exercises for a “hypertonic” (too tight) pelvic floor.
When it came to pelvic floor health, it was not a one-size-fits-all situation. Different people could be prone to different types of issues, and understanding the differences was key to finding the right solution, she said.
Hypertonic pelvic floor: when the muscles are too tight
That was when the muscles were too tight, almost like they were always on high alert. Women who experienced that often had a few things in common – they tended to be a bit more anxious and the anxiety could show up in various ways.
Maybe they ground their teeth at night, got frequent headaches or struggled with digestive issues like irritable bowel syndrome.
They might also experience lower back pain or hip discomfort and often feel more comfortable sitting in a curled-up, foetal position, Subrayan said.
When it came to their periods, they might find them more painful than most, and the same went for sex – it could be uncomfortable or even painful and something as simple as inserting a tampon or menstrual cup could be a challenge.
The symptoms could be connected to their experiences or personality traits, said Subrayan. For instance, someone who had experienced trauma, like sexual assault, or someone who was naturally more anxious might be more prone to the condition.
Even athletes, especially those doing ballet or horseback riding, could be affected. The key wasn’t just about doing exercises to relax the muscles (though that was part of it), but also addressing the underlying causes, whether they were physical, emotional or psychological, Subrayan said.
Hypotonic pelvic floor: when muscles need a boost
On the other hand, in women who had a hypotonic pelvic floor, the muscles were too weak. It was often seen in women who had some sort of trauma during childbirth, like a difficult delivery with forceps or a vacuum or significant tearing, she said.
Being overweight or having gone through a major weight change could also put extra strain on the muscles, making them less able to support the pelvic organs properly.
Interestingly, there was also a genetic component at play. For instance, Caucasian women tend to have pelvic floor prolapse more often than women of other racial backgrounds.
How do you know you have a weak pelvic floor?
“It can show up as incontinence – whether that’s leaking a little when you laugh, sneeze or jump, or not being able to control your bowel movements. You might even find that tampons don’t stay in place or that sex feels less pleasurable because there’s not enough muscle strength to create friction.”
Some women with a weak pelvic floor might feel a heaviness in their vagina, which could be due to the bladder or uterus starting to slip down because the muscles couldn’t hold them up anymore, Subruyan said.
Finding the right solution for you
Whether you have a hypertonic or hypotonic pelvic floor, the approach to treatment needed to be tailored to your needs. For those with a weak pelvic floor, strengthening exercises like Kegels could be incredibly helpful.
But if your pelvic floor was too tense, doing Kegels could make things worse. That was why it was important to get a proper assessment before starting an exercise routine, she said.
“If Kegels are the right choice for you, the first step is to learn how to do them correctly. The goal is to isolate the pelvic floor muscles without involving other muscles like your abs, glutes or legs.
“Imagine you’re trying to suck up a tiny blueberry through a straw with your vagina – yes, it sounds strange,but it’s a helpful visual. The movement should be upward, not just a tight squeeze.
“If you have a weak pelvic floor, you'll want to focus on exercises that build up the muscle, like lunges, bridges, and unilateral leg raises. These exercises engage the deep core muscles, which, in turn, work the pelvic floor.”
On the other hand, if your pelvic floor was too tight, the focus should be on stretching and mobility exercises, such as child’s pose and clam shells.
“We also want to look at any areas of injury or tightness and address those specifically, just like you would with any other part of the body.”
The key was finding the right balance and not just relying on Kegels alone.
“Kegels are only one piece of the puzzle, and they’re often done incorrectly,” Subrayan said. “If you can do them properly, you could see a 30 to 50% improvement, but there are so many other exercises that can be just as effective, if not more so.
“Once you’ve got the hang of it, you can start building up your strength. Aim for 10 Kegels per set, to do 30 Kegels in total each day.
“Most people think they can fix the vagina by only focusing on the vagina but, in reality, your vaginal health is deeply connected to your overall well-being. This includes your mental health, your diet and how active you are.”