COVID-19 and your Pelvic Floor

With the Omicron wave still impacting Australia, we've had an increasing number of calls and emails from our clients who have tested positive to COVID-19 and are telling us their bladder control has gotten worse. In today's blog we will explore why this may happen, things you can do to look after your pelvic floor while you are unwell, and how you can rehabilitate after you recover from the virus.

(Please note this is information only and not specific medical advice. Please discuss your own recovery with your Doctor and your Physiotherapist)

How is COVID-19 related to my Pelvic Floor?

The most common symptoms of COVID-19 are sore throat, dry cough, fever and shortness of breath. Other symptoms you may have heard of include a runny nose, headache, fatigue, body aches, loss of sense of taste/smell and loss of appetite. Some people suffer vomiting and/or diarrhea and there is a small number who have bladder symptoms of urgency and waking frequently at night to urinate. Considering this with the effects of chronic coughing or vomiting, COVID-19 can have a big impact on the pelvic floor.

But the biggest link between COVID-19 and your pelvic floor is through coughing. Our pelvic floor and our respiratory system (that’s everything involved in breathing) are functionally linked by the muscles we use to help us breathe. When we take a breath in, our diaphragm muscle contracts and pulls downwards to expand our lung, which then increases pressure on the tummy and pelvic floor muscles. Because of this downward pressure, in a healthy person the pelvic floor relaxes and lowers slightly and the tummy expands. When there is a relaxed breath out, the diaphragm relaxes and lifts, while the tummy muscles and pelvic floor return to their resting positions. This coordinated pattern of muscle activity is easy to do when you are not sick and breathing is easy. If exercising and breathing more vigorously, or if the breath out is forced (such as with coughing or COVID-19 that is impacting the lungs) the pelvic floor and tummy muscles contract to push the diaphragm and lungs upwards to force the air out faster.

During a cough, the tummy muscles contract quickly and forcefully which put a high load on both the diaphragm above and the pelvic floor below. While a cough is usually something that a healthy person rarely needs to do, the pelvic floor can fatigue very quickly if you are unwell and coughing repeatedly and frequently.

As well as this, if you are short of breath and must work harder to breath in and out due to COVID-19, your tummy muscles and pelvic floor further become overworked and tired. A tired pelvic floor will be less effective when you most need it, such as with coughing, sneezing and lifting. With a tired pelvic floor, you may have more trouble controlling your continence when you cough and may have an increase in pelvic symptoms you had previously (such as leaking, or feeling heaviness related to pelvic organ prolapse). Taking this into consideration, you might find the following advice helpful for managing this.

Tips for coping with COVID-19 and pelvic floor symptoms

· Don’t try and hold back your cough- let the air blow out through your mouth rather than trying to contain it and hold it in. Holding it in can increase the load on your pelvic floor.

· Although your pelvic floor may be very tired, it’s still important to turn your pelvic floor muscle on before you cough each time, so that it can support you in your cough. Whilst many people will automatically switch on their pelvic floor before they cough, some people need to consciously do this especially if they are recovering from surgery or have had pelvic floor weakness previously.

· Although not always practical or feasible, you will have less load on your pelvic floor either sitting or lying down than you will standing up. If you do need to cough, or are having a coughing fit, opt for the more rested positions of sitting or lying if you can.

· If you have recently had surgery, or have prolapse, are pregnant or have recently given birth, you may find it helpful to physically support your pelvic floor with your hand when you cough. You can do this by pressing your hand on your perineum (between your legs) and gently drawing everything in towards the body prior to coughing.

· If at all possible, try to slow down and spread out your coughs if you can. Quick, rapid coughs are harder for the pelvic floor to deal with than slower, spread out coughs.

What about afterwards?

After you’ve recovered from COVID-19, you may find your pelvic floor symptoms continue, and this is a good time to seek treatment from a Pelvic Health Physiotherapist to start rehabilitation. In addition, some people continue to have issues with shortness of breath, fatigue and muscle weakness. This is known as “Long COVID.” If you are affected then we will work to ensure that your exercise and home program is gentle and builds very gradually to ensure that your Long COVID symptoms aren't made worse.

Written by Danielle Ware and Chantelle Morrissey