Do bladder and pelvic floor problems run in families?
This is a question that I am often asked by my patients. The answer is yes, they can run in families but that isn’t the end of the story.
What is the pelvic floor?
Your pelvic floor is a sling of muscles, ligaments and tissues that supports your bowel, bladder and womb. Anything that weakens your pelvic floor can put you at risk of stress incontinence and prolapse.
Stress incontinence is when you leak urine if you cough, sneeze or laugh. This type of urine leakage can definitely run in families and if your mother or sister leak or have had an operation to treat bladder weakness then there is a greater chance that, without treatment, you will develop the same problem. It is also likely that you will develop these problems at a younger age than women whose close relatives do not have any bladder problems.
A prolapse is where the bowel, bladder or womb sag down into the vagina. Prolapse is divided into three main categories. A cystocele is a prolapsed bladder where the bladder pushes on the front wall of the vagina. This can lead to stress incontinence or frequent urination. A rectocele is a prolapsed bowel where the bowel pushes against the back wall of the vagina. This can lead to difficulties in moving your bowels (doing a poo). Finally, a uterine prolapse is where the womb moves down into the vagina. In all three cases you may feel a heaviness or dragging sensation as well as experiencing a weak bladder or faecal incontinence. If the prolapse is more than mild, you may also see a ball at the entrance to your vagina which gets worse as the day goes on.
Certain hereditary tissue conditions (called connective tissue disorders) can also lead to an increased chance of developing a prolapse. The two main conditions are Marfan’s Syndrome and Ehlers-Danlos Syndrome. Certain nationalities are less likely to develop pelvic floor weakness. African American women have the lowest risk, followed by Caucasian women and then Asian and Hispanic women.
Is there anything I can do to lower my risk if my mum has problems?
There is a huge amount that you can do. Genetics is only one part of the story. There are lots of other risk factors that can make it more likely you will develop incontinence or a prolapse. Being over-weight and smoking are big risk factors that you can change. Doing a lot of heavy lifting or lots of aerobic type exercise can also be a problem. However the most important thing you can do is to regularly exercise your pelvic floor muscles (perform kegel exercises). Although the tissues and ligaments that support your bladder, womb and bowel can stretch over time, your pelvic floor muscles can provide a support to these tissues and will help to cure, control or prevent the symptoms of pelvic floor weakness.
To perform a pelvic floor contraction, you should breathe in and then as you breathe out, pull up and in down below as though you are trying to stop yourself passing wind or going for a wee. Hold onto this contraction for 10 seconds whilst you breathe normally and then let go for a count of 10. Repeat this 10 times, 3 times a day. Our article on pelvic floor weakness tells you more about how to do these exercises.
Many women find that they can’t feel what they are doing or are unsure if they are performing their pelvic floor exercises correctly. Fortunately there are lots of things you can do to help this. Using an Educator can help to show you that the muscles are tightening and relaxing properly. You simply insert a small probe into your vagina and a stick moves up or down depending on whether you are tightening properly or relaxing. If your muscles are very weak then ask to see a Women’s Health Physiotherapist so she can assess your muscles. If your muscles are struggling to contract, a Pericalm is often recommended to give them a boost. This is a machine a little bit like a TENS machine (a pain relieving machine that gives a mild pins and needles sensation) that you use at home for a few weeks or months, depending on how weak your muscles are. Once it’s done its job, you can then exercise your muscles in the normal way, confident that they are helping to support your bladder and womb.
So if your mum or sister has already shown signs of bladder weakness or a prolapse, don’t despair. Get your own pelvic floor up to scratch and you don’t have to go the same way…
By Alison Bourne MA (Cantab) BSc MCSP ACPWH