Having a baby is a magnificent experience. Seeing the combination of you and your partner’s genetic pool, nurturing them, watching them stumble and grow into beautiful big people is a wonderful life experience. It’s just a shame about the collateral damage for women’s pelvic floors following a vaginal delivery. Nerve compression, levator avulsion, prolapse, urinary incontinence, faecal incontinence, difficulty with bowel evacuation, and finally our topic for today, loss of sensation. It is actually a wonder so many of us have a go at it! You’d think women don’t talk.
Every week I see a number of patients who present complaining of poor sensation in their pelvic floor. Poor sensation manifests itself in a number of ways – decreased sexual awareness, including loss of the ability to orgasm; no messages of impending faecal emptying including solid and gas; no feeling of lift or squeeze in the pelvic floor muscles despite some muscle activation, which means no feedback to the brain. One of my patients who had quite a reasonable muscle contraction and yet could not feel anything moving described it beautifully – that it was like a blind spot when driving a car. Many women have quite a disconnect between the pelvic region and the brain – disconcerting to say the least.
Some of the strategies to improve sensory awareness include ways to deliver feedback to the brain such as via a mirror – try positioning yourself so you can see the pelvic floor in a mirror and then firstly draw in at your low tummy and look for co-contraction of the anus and slight in-drawing around the vagina. Then do a pure pelvic floor contraction and look for more significant lift. And then put the two together and see the enhanced activation. And then it’s a “OH YEAH!!” moment for the brain.
Self examination (such as in bed or in the shower) also enhances the messages to the brain of lift and squeeze. But rather than popping your finger in the vagina and just squeezing, try directly palpating the muscles on the left and right sides at about 4 o’clock and 8 o’clock. Awkward to reach it but gives a more direct message to the brain.
Another method of getting feedback about your pelvic floor muscle strength is using a biofeedback device. There are a number of them on the market but while it can be a useful device which gives you a visual report on how your muscles are contracting should your sensation be poor and you can’t feel lift and squeeze, it can also encourage women to adopt a poor technique of over-squeezing to try and get a reading. So biofeedback devices are better supervised by Continence and Women’s Health physiotherapists.
So what can you do to help you if you are suffering with faecal urgency, or stool or gas incontinence:
- Improve the stool consistency with bulking agent such as Normafibe *, which is a type of soluble fibre with minimal gas production. The granules swell and bind the stool better.
- Use Imodium *or Gastrostop *(level 1 evidence for managing faecal incontinence) to slow the bowel motility and improve compliance at the internal anal sphincter (IAS).
- Any pain relieving medication with codeine * in it if you have concurrent joint pain will also have a slowing effect on your bowel.
- Do regular pelvic floor exercises concentrating on the External Anal Sphincter (EAS) to improve sensory awareness at the anus and hopefully get earlier warning of an impending stool.
- Dietary modifications to decrease foods that produce gas and bloating and cause a relaxation of the IAS. Seeing a dietician to get help with more sophisticated eating plans such as FODMAPS or gluten free diets if that’s needed.
And what can you do if decreased sensory awareness is affecting sexual function?
- Regular pelvic floor exercises to maximise potential of the muscles. If the muscles are weak, work on visualising the muscles working!
- Use different positions such as a pillow under the buttocks to help when the vagina is capacious following a large baby or levator avulsion.
- Contract and relax the muscles during intercourse to heighten awareness for both partners.
- Using a vibrator to capitalise on the vibration reflex that every muscle has.
- Use it or lose it…..
So you can see why sensory awareness is just as important as the movement of a contracting muscle. Let’s all work on our sensory awareness and our visualising and lots of things will be improved in time for Christmas (all that fruit cake) and the holidays (all that fun…).
*Disclaimer: When considering taking any medication to help control faecal incontinence it is important to ask the advice of your GP or specialist.