Oscar winner Kate Winslet reports on a talk show that she suffers from urinary incontinence after three deliveries. Television star Amira Pocher advertises pelvic floor exercises, and bestselling author Sheila de Liz has YouTube videos about “sexual muscles”.
The training device with app-controlled belly games is flooding your social media channels. The pelvic floor – which is also confirmed by gynecologists – becomes an IT topic after decades of shameful silence.
The pelvic floor is made up of several muscles and connective tissue. It closes the belly at the bottom and is bent up at the edges like a hammock. It is attached to the pubic bone in front, to the coccyx on the back and to the sciatic tumors on the sides. There is an opening in the center of the woman that can widen in time to give birth. The pelvic floor holds the bladder, uterus and rectum from above and surrounds the urethra, vagina and intestines from below.
When the strength of the pelvic floor muscles decreases, medical problems can arise. The most common are pelvic floor weakness and pelvic floor drop. One consequence is that women can no longer hold their urine well. There are also negative effects on sexuality.
Urinary incontinence a problem in old age
According to the German Society of Gynecology and Obstetrics (DGGG), urinary incontinence is “a serious health problem for women of all ages,” as stated in the guidelines for the treatment of urinary incontinence in women, which were only adopted in 2022. It is not clear how many people are affected. The expert society assumes that there are a large number of unreported cases on this sensitive issue.
According to DGGG, the number of affected women increases with age. In a 2005 survey, 7.8 percent of those under the age of 40, but 27.1 percent of those over the age of 60, said they could not always hold urine. A 2017 German-Danish study estimates that 48.3 percent of all women are affected by the disease.
Thomas Fink, head of the pelvic floor center at the Sana Klinikum Berlin Lichtenberg, explains the most common forms: “Stress incontinence” causes you to involuntarily urinate when you cough, sneeze or exercise. With “urinary incontinence” you have to suddenly. If both happen it is called “mixed urinary incontinence.”
birth as a risk
A frequent cause is the birth of a child – explains the urogynecologist – the interface between gynecology and urology. “How labor progresses is critical to how great the risk is later to develop pelvic floor disorders.” This is problematic, for example, if the child is very large and heavy or if forceps are used. Other risk factors include weight lifting, obesity, smoking, and age at first childbirth.
For a long time, obstetrics didn’t focus that much on this topic, says Fink, who trains midwives in their research into “pelvic floor friendly births”. After birth, the pelvic floor is only more carefully examined when serious damage is suspected, for example, that it has been torn off. Every labor is a burden: “During labor, the parts of the pelvic floor stretch three times. It can take years or even decades for symptoms to appear, ”explains Fink.
Wiesbaden gynecologist Sheila de Liz also emphasizes the importance of re-fitting the pelvic floor after giving birth, which has brought a taboo zone. In one of his YouTube videos he explains: “It is very important to strengthen the pelvic floor muscles as they also play a role in sex.” Women who had a good pelvic floor could narrow the vagina better. As a result, both partners felt more: “Orgasms are much more intense with healthy and strong pelvic floor muscles.”
Male pelvic floor more stable
Men also have a pelvic floor, but it has a different structure and is therefore more stable. Pelvic floor weakness in men is rare, Fink reports. Sometimes it occurs after prostate surgery. Many men would not even know they have a pelvic floor if they could not consciously tighten it. “Men would also benefit from pelvic floor training, such as potency,” says Fink.
According to the guidelines, the standard for pelvic floor damage is “non-surgical therapies are tried first”. Typically, physical therapy is prescribed, where women learn specific pelvic floor exercises. Electrostimulation is also one possible measure. If the damage is so severe that surgery is needed, there are now several methods to choose from, according to Fink. Either an attempt is made to repair the damage with the patient’s own tissue. Or, if that is too weak, stripes or mesh can be applied.
“Science is paying more attention to it now,” says Fink. In his opinion, contributing to this is the fact that ultrasound devices are getting better as an important diagnostic tool, and damage can be diagnosed more often. A few years ago, a separate working group for urogynecology and plastic pelvic floor reconstruction (AGUB) was established under the patronage of the German Society of Gynecology and Obstetrics (DGGG).
New fashionable gadgets
The fact that the topic is slowly leaving the private corner is also evidenced by how aggressively fashionable gadgets are advertised on social media. For example, “Perifit”, a product from France, looks like a dildo, but is actually a medical device that connects to a mobile phone via Bluetooth. The user can use the pelvic floor training app by playing with the abdominal muscles in the truest sense of the word: tensing and relaxing, guides the cursor around the field of play and scores points.
The manufacturer can’t provide research on what this brings: they’re working on it, but haven’t got any results yet. Sheila de Liz considers such devices “really good”. The idea behind this – learn to evaluate and develop your own pelvic floor strength – is “great”. However, it is more appropriate for women “who are already well versed in the pelvic floor.” Anyone with serious pelvic floor problems needs professional support.