Weir: Peeing when you laugh and painful sex is not normal

If you can't sneeze without peeing, your pelvic floor is telling you it needs some attention.

Shirley Weir 5 minute read September 16, 2020
shirley weir menopause advocate

Shirley Weir is the founder of Menopause Chicks

Dear Shirley,

I’m 48 and the mother of three teenagers. I used to be an avid runner, but now I leak when I run and I have to wear pads. And my back hurts all the time. Plus, I’m constipated for the first time in my life. A friend told me she sees a pelvic floor physiotherapist to help with all of these things, while my doctor said surgery is an option down the road. Help! I’ve never even heard of the pelvic floor.

Dear Connie,

Light bladder leakage is definitely one of the top signs that your pelvic floor is in need of some attention. Twenty-five to 50 per cent of all women will develop an issue related to her pelvic floor and approximately 19 per cent will undergo surgery.

I was in my forties before I ever heard the terms pelvic floor, pelvic health or pelvic floor physiotherapy. I’ve had some great teachers since then — including my own pelvic floor physiotherapist and Kim Vopni, the “Vagina Coach.”

What is the pelvic floor?

Both men and women have pelvic floors — an essential group of muscles that form the base of the pelvis, along with ligaments, tendons, a huge blood supply and many different nerves. They attach to the pubic joint, the tailbone and the sit bones (those two boney parts in our butt cheeks).

Pelvic floor muscles play a key role in maintaining continence by keeping our internal organs — uterus, bladder and rectum — in place, and they play a key role in sexual satisfaction. They also influence the sphincter muscles, help us decide if we need to pee, poo or fart, and if it is okay to do so.

It is common for women to experience incontinence, either with urine or stool, feel a frequent need to go to the bathroom, be constipated — or have to push hard to pass a bowel movement, feel pain during sex, or have lower back pain. In men, pelvic floor challenges tend to present as erectile dysfunction, incontinence and prostate issues.

Pelvic organ prolapse, is when an organ—such as your bladder—drops from its normal place in your lower belly and pushes against the walls of your vagina. This is sometimes caused by pelvic muscles holding the uterus, rectum and bladder loosen and get stretched — often by childbirth (but it is a myth that only women who have given birth will experience pelvic health challenges).

Some women will feel the sensation that something is pressing against the vagina or rectum. Sometimes, there is a visible bulge, or the organs may stick out of the vagina or rectum and require you to push them back inside.

But the majority of women with a prolapse feel no symptoms at all. I went for my first pelvic floor physiotherapy appointment earlier this year — with no symptoms — and learned that I have a stage two to three bladder prolapse and rectocele (a bulging of the front wall of the rectum into the back wall of the vagina).

Peeing when you sneeze is not normal

One of the biggest myths is that peeing a little when you run, jump, cough, laugh or sneeze is “just part of being a woman.” It’s not. Leaking urine also means leaking confidence, and it can wreak havoc on many other areas of life by restricting movement, limiting social outings, and significantly impacting sexual relationships.

One of the biggest myths is that peeing a little when you run, jump, cough, laugh or sneeze is ‘just part of being a woman’

Another myth is that women can expect to be constipated.

Constipation is a signal from your body that something requires attention. It could be digestion-related, or it could be a symptom of prolapse where the rectum has bulged into the vagina. The connection between constipation and pelvic floor health is not well known, and learning more about how diet, hydration and digestion affect your pelvic floor is just one way that working with a pelvic health professional can be beneficial.

What is a pelvic floor physiotherapist?

Pelvic floor physiotherapists are physiotherapists trained in treating conditions involving the pelvic floor. Ideally, we would all see a pelvic floor physiotherapist preventatively to maintain our pelvic floor and help identify issues early — similar to the reason we see a dentist regularly.

Pelvic floor physiotherapists can assess, educate and treat incontinence (bladder and bowel), organ prolapse (bladder, uterus or rectum), and pain (pain with sex, joint pain, back pain). They can also help you avoid surgery, and provide support post-surgery.

Can I afford a pelvic floor specialist?

If you have extended health coverage that includes the services of a physiotherapist, pelvic floor physiotherapy is usually included. Typically, pelvic floor physiotherapy fees are in the $150 to $200 range per visit. If you think about this compared to the cost of incontinence pads for the next 50 years — that’s about $1500 per month for 600 months — it’s a steal.

Pelvic floor physiotherapy should be regarded as an investment and accessible for all women. Ninety per cent of cases of incontinence in aging women can be improved with exercise, and 70 per cent can be treated with physiotherapy, so how can we not further explore this very important part of our overall health and emotional well-being?

I envision a future where pelvic floor physiotherapy is offered as the first line of defense to prevent, assess and treat organ prolapse, pain with sex, back pain and incontinence.

Think of it like this: Not seeing a dentist decreases the quality of your oral health and puts you at risk for cavities, gum disease, and cancer — all things that can impact your quality of life and sense of well-being and health. Not seeing a pelvic floor physiotherapist is just as important — for your body, your health and emotional wellness.

Looking for more? Join me & Kim Vopni, The Vagina Coach, for “The Ultimate Guide to Pelvic Health” on September 16.

Do you have a question about perimenopause, menopause or beyond? Post it in our private online community or write to me

Shirley Weir is the founder of Menopause Chicks, an online facebook community that advocates for women in perimenopause, menopause & beyond! She is also the author of Mokita: How to Navigate Perimenopause with Confidence & Ease@MenopauseChicks