Let’s talk about the pelvic floor. BY MARIE-PHILIPPE JEAN

It’s time to address issues that many women face every day.

Over the past few years, there have been a lot more open and honest conversations about women’s health. We’re (finally) interested in talking about menopause, we’re challenging the taboos surrounding menstruation and now it’s time we address why millions of women still suffer silently from incontinence, urinary leaks and pain that affects their activity levels and sex lives.

Douanka Gendreau, a physiotherapist specializing in perineal and pelvic rehabilitation, has never considered issues related to the pelvic floor trivial. “Organ descent, leaks, incontinence— they’re common, but they’re not normal,” she says. “We have to stop saying that this is our new reality and there’s nothing we can do to change it.” Pop culture might be one culprit for this resigned acceptance. In comedies, we make fun of the aunt who pees her pants a little when she laughs or the mother who can’t hold it while waiting in line at the grocery store. The fitness industry might also play a part by constantly focusing on the aesthetic results of workouts, which means the muscles we can’t see are forgotten—and the pelvic floor is made up of 20 of them. Their role is essential—they hold back urine, stool and gas by supporting the bladder, uterus and rectum—but it’s usually only when they’re not doing their job that we start paying attention.

Vaginal childbirth is a traumatic event for this muscle group, causing wounds that need to heal. Unless the muscles are strengthened before and after pregnancy, the road to full recovery can be long—very long. Gendreau explains that while every birth has its share of surprises and unknowns, understanding the musculature in the pelvic region and how to control

it through breathing, strengthening and flexibility exercises can speed up the postpartum repair process. She debunks the myth that pelvic strengthening during pregnancy can increase the risk of tears during childbirth. On the contrary, by improving our proprioception (awareness of the positions of the different parts of our body), we’re better able to contract and relax those muscles, which is helpful when you’re giving birth.

A weakened pelvic floor can also affect our sexual health (it can reduce the feeling of pleasure and make it harder to orgasm) and our mental health (incontinence can lead to giving up sports and cause symptoms of depression). So what’s the solution? Re-education. The Pelvic Health Solutions website (pelvichealthsolutions.ca) helps patients find specialized practitioners in Ontario (it hopes to expand across Canada soon) and offers pelvic-health-specific workshops for women. Other resources, including Pelvic Guru (pelvicguru.com), offer information and a variety of exercise programs that can be done at home.

Pelvi-Santé (pelvisante.com), a clinic just outside Montreal that specializes in pelvic health, helped Sarah*, a young mother of two toddlers, find relief through physiotherapeutic massage, but it also helped her find the courage to deal with how pelvic problems were affecting her. “I’ve been involved in high-performance sports my whole life,” she says. “I was doing 30-kilometre hikes and scuba diving—now I can’t even do jumping jacks.” She has often felt the injustice of her situation around other women and even her spouse, who’s been able to keep doing all his activities. She misses team sports and would like to be able to lift her children without the fear that it will cause her pain. Accustomed to sports injuries, Sarah knows that the road to recovery will take a few years and she needs to be patient with and kind to herself.

Because there’s a lack of resources for women, particularly in rural areas, Gendreau co-created Pelvi-Life (pelvilife.com), an online platform that offers information and various homebased exercise programs. Other technologies for strengthening the pelvic floor are also emerging on the market; Emsella, for example, is a treatment offered in medical spas across the country that stimulates the pelvic muscles using electromagnetic beams that cause more than 11,800 muscle contractions over the course of a 28-minute session.

The more we talk about pelvic health, the more democratized the discourse will become and the more we’ll collectively realize that solutions do exist—for everyone.