When Brittany Mahomes recently advised moms to take care of their pelvic floors, she raised awareness of a condition that is more common than many young women realize.
“Women don’t get educated about this, especially when they are younger, when they are of childbearing age,” said Dr. Deepanjana Das, a urogynecology and reconstructive pelvic surgery specialist at the Cleveland Clinic.
Earlier this week, Mahomes, who has two young children with her husband, Kansas City Chiefs quarterback Patrick Mahomes, gave a reminder to women on her Instagram story: “Once you have kids take care of your pelvic floor. Seriously,” signing it “from a girl with a fractured back.”
NBC News has reached out to representatives for Mahomes for comment. Meanwhile, doctors say back and pelvic floor problems can be connected.
“Women can be at risk of both due to low-back issues and factors such as pregnancy and childbirth,” said Dr. Roger Dmochowski, a professor of obstetrics and gynecology, urology and surgery, and associate surgeon in chief at the Vanderbilt University Medical Center.
The gynecologic organs, the bladder and the rectum are all held in place by a group of muscles and ligaments known as the pelvic floor, Dmochowski explained. When these tissues are stretched and weakened, urinary and fecal incontinence can result. More severe issues with those muscles can lead to organ prolapse, during which one or more of the pelvic organs can drop down into the vaginal canal and even protrude through the vagina.
Other risk factors include repeated lifting of heavy weights and standing for many hours.
“Gravity is not your best friend,” Dmochowski said.
Overall, nearly a quarter of women in the U.S. develop pelvic floor issues, according to the National Institutes of Health. Younger women ages 20 to 39 are less likely to experience symptoms — less than 10%. About a quarter of women in their 40s and 50s have symptoms, although that percentage increases with age. More than a third of women ages 60 to 79, and half of those 80 or older, have pelvic floor problems.
What are symptoms of pelvic floor injury?
Early signs of pelvic floor weakening can start with urinary symptoms.
“A sudden loss of urine that can be activity-related or an overactive bladder can be signs that the pelvic floor is acting up,” Dmochowski said. “Other women might develop new bowel symptoms, such as loss of control or new constipation.”
As the problem progresses, women might feel pressure as “either the rectum, the bladder or the uterus, or all three, bulge into the vagina,” Dmochowski said. “Women will sometimes describe this as feeling like a beach ball coming out of their vagina.”
Some women don’t notice any symptoms and the prolapse is discovered during their annual exam, Dmochowski said. Sometimes, women might not notice they are experiencing back problems until they come in with pelvic floor symptoms, he said.
How is pelvic floor injury treated?
Kegel exercises, when women tighten and relax the pelvic floor muscles, can help, especially among younger women.
“You can do this at a stoplight when driving,” Dmochowski said. “Imagine you’re urinating and then try to stop. You contract for a few seconds, and then relax for a few seconds. You want to repeatedly activate the muscles.”
Pelvic floor exercises are like lifting weights.
“By flexing and then relaxing them, you build volume and hopefully regain function,” Dmochowski said.
Dmochowski tells patients that once or twice a week isn’t enough.
“I draw the analogy to training for a road race or a marathon,” he explained. “There has to be some stick-to-itiveness.”
How well do Kegels work?
“The response rates are all over the place in the literature,” Dmochowski said, adding that the number might be as low as 20% recovery.
Another option is guided physical therapy to rehab the pelvic floor muscles, said Das.
“It’s been established that monitored physical therapy can help rehab those muscles after delivery,” she said. “We know it can play a huge role in helping women recover.”
Das recommends women get physical therapy soon after vaginal childbirth.
“In other countries, it’s a regular part of delivery to get physical therapy,” she said. “That’s not something we have in the U.S.,” except in cases where there was a difficult delivery.
Among the other options for women with pelvic floor issues is a pessary, a vaginal insert that works “like an internal crutch that holds everything in place,” Dmochowski said. “It’s something a woman is fitted for and then she determines whether she likes it or not. About 1 in 4 women in our practice uses them.”
Another option is surgery in which the pelvic floor is put back in place and is anchored there by attaching it to a knob of spinal bone, Dmochowski said.
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