By now we all know that COVID- 19 isn’t great for our health, our families, our community or our hip pockets … but on the other hand it is great for mother earth, family time and slowing down.
Not wanting to be a negative Nancy... but has anyone sat down and thought about the impact COVID-19 and the symptoms associated with the virus could have on our pelvic floor?
What is the pelvic floor?
I’m glad you asked. The pelvic floor is a beautiful collection of muscles and fascia at the base of our pelvis that controls urinary, bowel and sexual function, as well as helping with the stabilisation of our spine.
I can tell you right now that the pelvic floor will loathe COVID-19.
Why? What does the pelvic floor muscle have to do with COVID-19?
By now most of us are aware of the symptoms associated with COVID-19
Dry cough
Fever
Tiredness
Sore throat
Runny nose
Shortness of breath
Did you know that coughing and sneezing place great stress on the pelvic floor? Have you ever tried to keep your eyes open while sneezing? The pressure created during a sneeze, means that it is impossible to keep your eyelids open. I dare you to give this a try. That same force and pressure also heads south, forcing our pelvic organs downwards. We rely on our pelvic floor muscles appropriately engaging to oppose this pressure, and by doing so, keep us dry. Pretty impressive, right?
As for those elegant ladies out there who pinch their noses when they sense a sneeze coming. Know this, lovely ladies... the force we rely on to clear our nasal passage is consequently being contained within, and you guessed it... that contained force has to go somewhere. And it does, it heads south, putting further stress on our pelvic floor muscles. So, I say NO to the pinch! Let that sneeze out! Be loud and proud!
In a perfect world, just prior to coughing or sneezing, we rely on an automatic, well timed, perfectly coordinated, strong contraction of our pelvic floor. If achieved this keeps us safe from leakage by resisting the pressure of our organs being forced down and keeping our sphincters closed. Nice work muscles!
However, when the timing is off, or our pelvic floor muscles are weak, urine is going to flow, as our pelvic floor muscles will be unable to keep the urinary sphincter closed. It is embarrassing, common and NEVER EVER normal. We call this - Stress Urinary Incontinence (SUI).
A recent study has shown that coughing, one of the most common symptoms of COVID-19, puts more pressure on our pelvic floor muscles than lifting 18.2kg, running or even jumping. Imagine that you have COVID-19 and a persistent cough. You are going to hope your pelvic floor is functioning well. I know that there are people who are already cringing at the very thought of a persistent cough… they already know the consequences.
If your pelvic floor is not strong and healthy or if its timing is off, urine may leak out when you cough. A persistent cough places extreme pressure on the pelvic floor, even those who suffer with mild pelvic floor dysfunction can suffer from urinary leakage with a persistent cough. Every Winter at Eastern Osteopathy, we have an influx of patients who complain of SUI when coughing. hear you asking. But what can I do about it?
Now is the time to start with a well timed KNACK. What is this KNACK I speak of? It is an intentional, strong contraction of your pelvic floor muscles just prior to coughing, sneezing, laughing or lifting. If you are one of the many women/men who suffer with SUI, a KNACK can be an essential part of your pelvic floor retraining by learning about appropriate timing of contractions.
ARRRGH but it only works for the first cough/sneeze then I’m like a leaking tap. This is also common, to work on increasing the strength of the pelvic floor and by doing so improving the effectiveness of the KNACK, you can do short sharp contractions of the pelvic floor holding for 1-2 seconds then relaxing before you contract again. Doing three sets of 10 repetitions should get the best results.
To make the contraction even more effective add a short, high pitched sound like quip or tip when lifting and contracting your pelvic floor muscles. STOP reading now!! Give this a try; start with short sharp contractions of your pelvic floor and then add the high pitched sound (quip/tip). Feel and sense the difference..You can thank me later!
One last thing about training your pelvic floor using a KNACK, it is important that you don’t lift and engage your pelvic floor too early. We want and need your diaphragm to descend fully with a breath in. Contracting too early will prevent your diaphragm from doing its job of fully descending and therefore creating enough force to clear your airway.
If you still experience leakage after strengthening and actively engaging your pelvic floor using a KNACK, check out your posture. When it is time to cough, stand up straight, correct posture and alignment results in any increases in intra abdominal pressure being distributed to the pelvis rather than adding stress to the pelvic floor. Still not working!!! It's time to see a pelvic floor trained osteopath (or physio) - as you may need a specific training program and to work out the ‘Why?’. Why is my pelvic floor not functioning correctly? What structures are preventing my pelvic floor from functioning correctly?
The impact of COVID-19 and it’s array of symptoms on our pelvic floor do not stop there. The breathing restrictions associated with respiratory distress can also have a negative impact on your pelvic floor. Breathing restrictions do not allow your pelvic floor muscles to fully lengthen and contract as would normally occur with relaxed breathing. This kind of breathing can cause our pelvic floor muscles to stay in a constant state of tension, which is definitely not ideal.
If your pelvic floor muscles are in a constant state of tension and you cough, this group of muscles tend to have nothing more to give. A KNACK just won't cut it. The impact of a tight pelvic floor is huge; it's not just urinary leakage on the cards, it can also result in a variety of symptoms ranging from painful intercourse, urgency to urinate, as well as lower back and pelvic pain.
What you may need to do is some relaxed diaphragmatic breathing exercises. By doing this you are allowing your pelvic floor muscles to go through their entire range of motion, optimising their ability to contract and lengthen. This action is essential and allows for maximal strength of contraction, which is uber important when you are suffering from coughs and sniffles.
Not sure how to do a relaxed diaphragmatic breath? Check out our video.
As we enter the season of coughs, colds and sniffles (and COVID-19), we are washing our hands, practicing social distancing and staying home. It's also time to add a KNACK prior to coughing, sneezing and lifting and 5 minutes of daily relaxed breathing to our daily routine, and by doing so we can strengthen, lengthen and teach our pelvic floor muscles about appropriate timing of contraction. These suggestions can help minimise the impact a cough or sniffle has on this essential group of muscles during this tricky time.