Oscar winner Kate Winslet reports on a talk show that she suffers from incontinence after three births. TV celebrity Amira Pocher advertises pelvic floor exercises, non-fiction bestselling author Sheila de Liz posts videos about the “sex muscle” on YouTube.

A training device with app-controlled games for the abdomen is flooding the social media channels. The pelvic floor – which is also confirmed by gynecologists – is on the way to becoming an IT topic after decades of shameful silence.

The pelvic floor consists of several muscles and connective tissue. It closes off the abdomen at the bottom and is bent upwards at the edges like a hammock. It is attached to the pubic bone at the front, to the coccyx at the back and to the ischial tuberosities at the sides. In the middle of women is an opening that can widen for childbirth. The pelvic floor holds the bladder, uterus and rectum at the top and encloses the urethra, vagina and intestines at the bottom.

When the strength of the pelvic floor muscle decreases, medical problems can arise. The most common are pelvic floor weakness and pelvic floor descent. One consequence of this is that women can no longer hold their urine well. There are also negative effects on sexuality.

Urinary incontinence a problem in old age

According to the German Society for Gynecology and Obstetrics (DGGG), urinary incontinence is “a serious health problem in women of all ages”, as stated in the guideline for the treatment of female incontinence, which was only adopted in 2022. It is unclear how large the number of those affected is. The specialist society assumes that there is a high number of unreported cases on the sensitive issue.

According to the DGGG, the number of women affected increases with age. In a 2005 survey, 7.8 percent of those under the age of 40 but 27.1 percent of those over the age of 60 said they can’t always hold their urine. A German-Danish study from 2017 assumes that 48.3 percent of all women are affected.

Thomas Fink, head of the pelvic floor center at the Sana Klinikum Berlin Lichtenberg, explains the most common forms: With “stress incontinence” you involuntarily lose urine when coughing, sneezing or exercising. With “urge incontinence” you have to suddenly. If both happen, this is called “mixed urinary incontinence”.

birth as a risk

A common cause is the birth of a child, explains the urogynaecologist – an interface area between gynecology and urology. “How the birth goes is crucial to how great the risk is of later developing a pelvic floor disorder.” It is problematic, for example, if the child is very large and heavy or if forceps were used. Other risk factors include heavy lifting, obesity, smoking and age at first birth.

For a long time, obstetrics did not focus on the subject so much, says Fink, who trains midwives to study “pelvic floor-friendly births”. After birth, the pelvic floor is only examined more closely if serious damage is suspected, for example that it has been torn off. Every birth is a burden: “During a birth, parts of the pelvic floor are stretched threefold. It can take years or even decades for symptoms to appear,” explains Fink.

The Wiesbaden gynecologist Sheila de Liz also emphasizes how important it is to get the pelvic floor fit again after childbirth brought taboo zone. In one of her YouTube videos, she explains: “It is very important to strengthen the pelvic floor muscles because they also play a role in sex.” Women who had a good pelvic floor could narrow the vagina better. As a result, both partners felt each other more: “The orgasms are much more intense with healthy and strong pelvic floor muscles.”

Male pelvic floor more stable

Men also have a pelvic floor, but it has a different structure and is therefore more stable. Pelvic floor weakness in men is rare, as Fink reports. Sometimes it occurs after prostate surgery. Many men would not even know that they have a pelvic floor if they could not consciously contract it. “Men would also benefit from pelvic floor training, for example for potency,” says Fink.

According to the guideline, it is standard for pelvic floor damage “that non-surgical therapies are tried first”. Physiotherapy is usually prescribed for this, during which women learn specific exercises to strengthen the pelvic floor. Electrostimulation is also one of the possible measures. If the damage is so severe that surgery is required, according to Fink, there are now several methods to choose from. Either an attempt is made to repair the damage with the patient’s own tissue. Or, if that is too weak, straps or netting could be employed.

“Science is now paying more attention to the topic,” says Fink. In his opinion, a contributing factor to this is that ultrasound devices are becoming better and better as an important diagnostic tool and damage can be diagnosed more frequently. A few years ago, a separate working group for urogynecology and plastic pelvic floor reconstruction (AGUB) was founded under the umbrella of the German Society for Gynecology and Obstetrics (DGGG).

New trending gadgets

The fact that the topic is slowly coming out of the private corner is also shown by how aggressively hip new gadgets are advertised on social media. “Perifit”, for example, a product from France, looks like a dildo but is actually a medical device that connects to a cell phone via Bluetooth. The user can use the app to train her pelvic floor by playing with her abdominal muscles in the truest sense of the word: by contracting and relaxing she steers the cursor through the playing field and collects points.

The manufacturer cannot provide studies on what this brings: They are working on it, but have not yet had any results. Sheila de Liz finds such devices “really good”. The idea behind it – to learn to assess and develop your own pelvic floor strength – is “great”. However, this is more suitable for women “who are already well acquainted with their pelvic floor”. Anyone with serious pelvic floor problems needs professional support.

Guideline on urinary incontinence Guideline on lowering of the pelvic floor Perfit Dr. Fink, Sana Klinikum Lichtenberg Prof. Gabriel, St. Josefs-Hospital Wiesbaden Working group on urogynaecology Book and blog “Outrageous” Video Pelvic floor Sheila de Liz Article in the German Medical Journal