Almost everything in your day-to-day work revolves around the pelvic floor. What stories do your patients bring with them?
Petra Spalding: Their topics are varied: urinary and faecal incontinence, pelvic pain, pain during sex or chronic bladder infections. Many have waited a long time before seeking help, perhaps because they thought «It's just part of life after giving birth» or «It's normal in old age». They rarely talk openly about their complaints - neither with friends nor with specialists. Yet many of these problems affect a large proportion of the population!
Why do you think the topic of the pelvic floor is taboo?The taboo is slowly beginning to crumble. But many people still feel ashamed when something «doesn't work in this intimate area». Talking about incontinence or sexual reluctance with family or friends takes courage. At the same time, many people don't even know what the pelvic floor is, what it can do and how important it is for our overall well-being.Can you briefly explain what functions the pelvic floor fulfils?The pelvic floor is a supporting network of muscles and connective tissue that closes off the abdominal cavity at the bottom. It supports our internal organs, controls the bladder and bowel - and plays an important role in our sexuality and posture. A healthy pelvic floor is elastic and strong. When it comes to the topic of the pelvic floor, many people first think of mothers after giving birth. What other groups are affected?It's a big misconception that the topic only affects mothers. Women who have not given birth, men and children can also suffer from pelvic floor weakness. Causes include chronic coughing, severe obesity, hormonal changes or intense exercise. Competitive athletes also belong to the risk group, especially those involved in high-impact sports such as triathlon or crossfit. Men can develop incontinence or pelvic pain after prostate surgery, for example, but also through intensive weightlifting in the gym. [[image:76998840 "Pelvic floor training: still uncharted territory for many men, but well worth it." "Shutterstock - mapo_japan"]]A gastroenterologist told me that women often struggle with faecal incontinence as they get older. Can you confirm this? Yes, especially women who have had several children are often affected. Pregnancy and childbirth leave their mark on the pelvic floor, especially if there has been a perineal tear or an instrumental birth. And during the menopause, tissue tension decreases - this also affects women without children. How can women prevent this? Regeneration in the postnatal period is the be-all and end-all: Mums should rest after giving birth so that the body can recover. Intensive postnatal exercise is then crucial. In addition, a conscious approach to weight-bearing is worthwhile: no heavy lifting, good posture and ongoing targeted pelvic floor training. What do you recommend for women who want to be fit again as quickly as possible after giving birth?I understand the desire, but the pelvic floor needs time. After pregnancy and childbirth, the tissue is under enormous strain. It's completely normal for it to take time to recover. Women should never allow themselves to be pressurised by celebrity images. I would like all new mothers to be accompanied by a specialised pelvic floor physiotherapist as standard. She can assess whether the muscles already have enough tension and control - and then recommend suitable exercises or forms of movement. How do you recognise for yourself that you can get active again? It's important to feel yourself well. The body often lets you know when it's not ready with feelings of pressure, pain or urine loss.Why does a strong pelvic floor contribute to more pleasure in bed?The pelvic floor is not solely responsible, but it does provide support. A strong pelvic floor improves blood flow - including to the clitoris and penis - and this can increase the sensation of pleasure. So if men «can't get it up», they should also think about their pelvic floor! And if women feel less after giving birth, this may be due to weakened muscles. The feeling can be restored - with patience and targeted training.How can you prevent a weak pelvic floor - even if you don't have children? Lifelong pelvic floor training is important. Just like other muscle groups, it needs regular stimulation. It is best to incorporate exercises into your everyday life so that they become a matter of course: for example, tensing and relaxing the pelvic floor ten times when brushing your teeth.[[infobox: title=How to strengthen and protect your pelvic floor in everyday life; content=Close the urethra, vagina or anus, pull it up inwards and then release it again. You can imagine holding back urine or bowel movements or internally pulling a lift upwards or pulling a ball upwards. The exercise can be done invisibly on the side. For example, ten repetitions three times a week. The small but effective strategy of turning your head over your shoulder when coughing or sneezing helps to relieve the pelvic floor. This relieves the downward pressure.;]]And if the pelvic floor is already very weakened - what else can help? In practice, we first clarify what is causing the weakness. Then we work with targeted exercises, biofeedback devices or electrostimulation. The good news is that even a weak pelvic floor can almost always be trained - it just takes a little patience.How does pelvic floor therapy actually work? We start by asking about various aspects: Urine loss, urination, defecation, sexuality and posture. This is followed by a physical assessment: we palpate the pelvic floor and check how the muscles are working. We then put together an individual programme, including exercises to do at home. The aim of therapy is always to achieve freedom from symptoms.[[image:77001805 "The good news is that you can train your pelvic floor not only at home, but also on the go - without anyone noticing." "Pelvisuisse"]]What do you think of aids such as vaginal balls or smart Kegel trainers? Some devices and apps can have a motivating effect. However, it is important to use them correctly. The devices react positively to any pressure, even if users push instead of tense. This is counterproductive. If you push, you exert downward pressure, which strains the pelvic floor. Instead, the force should be developed gently inwards and upwards. That's why I recommend getting to know and recognise your pelvic floor first.What contact points can you recommend for questions or uncertainties?A good first point of contact is your gynaecologist or GP. If necessary, they can also issue a referral for pelvic floor physiotherapy. There are specialised physiotherapists in Switzerland - you can find a therapist near you via the Pelvisuisse network.What do you wish for the future? More awareness, less shame. Pelvic floor health belongs in the education of young women and men, in pregnancy counselling and in prevention. I would like professionals, especially gynaecologists, to think about the pelvic floor much more quickly in the event of complaints! And I think it's important that those affected don't wait too long. Because most complaints can be remedied.
