It’s been a decade since Kate Winslet broke the incontinence taboo. One in four women has a pelvic floor disorder, and it’s now a booming wellness category.
“I can’t jump on trampolines anymore; I wet myself,” Kate Winslet told Graham Norton during an appearance on The Graham Norton Show in 2016. “It’s bloody awful, especially if you’re wearing a skirt. When you’ve had a few children, you know, it’s just what happens.” She put a number on it. “It’s amazing, two sneezes, I’m fine. Three, it’s game over.”
The muscle Winslet was describing is the pelvic floor, a hammock slung beneath the bladder, bowel, and uterus. It is also a big buzz in the wellness world: Elvie, Perifit, and Minna Life now sell biofeedback pods that sit inside it, grading a woman’s contractions on her phone. The Elvie Trainer runs five-minute guided workouts through an app; Perifit turns the same squeezes into a game. Boutique physical therapy practices have opened around the same muscle, and the pods sell beside sleep trackers and the gut health supplements.
About one in four American women lives with moderate to severe symptoms of at least one pelvic floor disorder, according to the National Institutes of Health. The share rises with every decade, from roughly 10 percent of women in their twenties and thirties to 27 percent of women in their forties and fifties, 37 percent of those in their sixties and seventies, and nearly half of women past 80.
“As a society, it is vitally important that we start speaking about our pelvic health. Symptoms related to our bladder, bowel, sexual and pelvic floor function should no longer be something we are ashamed about treating,” Maya Nisani, a pelvic health physical therapist at Riverwalk Physical Therapy, told Flow Space. “It should be part of our normal conversations with each other and with our health care providers.”
“Pelvic floor health is important at all ages, particularly during hormonal changes like pregnancy, postpartum and menopause,” Dr. Meleen Chuang, chief of service for obstetrics and gynecology at NYU Langone, said. At midlife, estrogen drops in the vulvar and vaginal tissue, and “a lack of estrogen in the tissue can lead to decreased moisture, dryness, thinning of tissue and less pliability,” Nisani said. The muscles pay off earlier, too. “Women preparing for pregnancy will benefit from strong abdominal core and muscle strength to help with labor and achieve vaginal delivery,” Chuang said. “Postpartum recovery may be quicker as strong pelvic muscles may prevent injuries after physical activities and childbirth.”
What pelvic floor trainers actually do
A biofeedback trainer can locate a contraction a woman has never consciously felt and rebuild it after childbirth or surgery. It cannot diagnose why she leaks (and weakness is frequently not the reason).
“There is an assumption that the pelvic floor is weak, but most of the time it is actually very tense and needs to be able to relax fully to actually get the true benefit from performing a contraction,” Terra Gegg, a pelvic-health physical therapist and the owner of Enhance Physical Therapy, told Parade. Kegels help, she said, “for someone who has true pelvic floor weakness and can fully relax their pelvic floor.” Done too often, Gegg told the outlet, they produce the symptoms women bought the device to fix, among them painful sex, frequent urination, bladder pain, and leaks. Specialists generally recommend to see a pelvic floor therapist before starting.
The most common error among women over 40 is pushing down instead of lifting up, Dr. Amanda Neri, a physical therapist and the founder of The Pelvic Institute, told Parade. “[When kegels are done this way], there’s a greater risk of leaking long-term and having coordination issues, which can lead to a prolapse,” she said. Neri typically prescribes two sets of 10 kegels, three to five times a week, though she and her colleagues said the dose depends on the woman.
An assessment covers more than the pelvis. “During an examination, you should expect your therapist to look at your posture from head to toe,” Nisani said. “We may not realize it, but things like our feet, back and even jaw can influence your bladder, bowel, sexual and pelvic floor function.”
“There isn’t an exercise to avoid, but in general avoid straining,” Dr. Lopa Pandya, a urogynecologist and medical advisor at Aeroflow Urology, told Flow Space. “If and when you lift, avoid bearing down to carry a heavy object, and in general a strong and engaged core is going to help relieve tension off of your pelvic floor muscles.”
“Pads are not treatment for pelvic floor disorders,” Dr. Samantha Pulliam, a board-certified urogynecologist and the chief executive of Axena Health, told Flow Space. Women live with a pelvic floor disorder for about six and a half years on average before they seek treatment, the outlet reported, citing published data, and use pads, liners, and diapers in the meantime. Pulliam said the delay compounds the problem. “There’s a sort of snowball effect with those things,” she said.
Treatment usually starts with training the muscles, even for severe symptoms, and a number of the options that follow require neither medicine nor surgery. “The truth is there’s always something to do and there’s usually a range of treatment options for pelvic floor disorders,” Pulliam said. “You’re not stuck.”
“Because it’s such a taboo, it’s so important that as women, we do talk about it because you don’t have to accept it,” Winslet said. “There are so many things you can do.”
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