The Menstrual Cup and the Pelvic Floor, Tips and Answers

Many times I have mentioned the vaginal muscles but I have not mentioned the pelvic floor and its function in our body. They are one of the most important muscle groups in a woman’s body… but one that is not exercised as often as other more ‘visible’ muscle groups. In this article we will explain which pelvic floor injuries can make it difficult to use a menstrual cup.

What is the pelvic floor?

The pelvic floor is a set of muscles located in the lower pelvis that support the pelvic organs: bladder, bowel, and uterus (in women).

The pelvic floor muscles allow you to control the release of urine (pee), faeces (poo) and flatus (gas) and delay emptying until it is convenient.

When the pelvic floor muscles contract, they lift the internal organs of the pelvis and squeeze the openings of the vagina, anus and urethra. Relaxation of the pelvic floor allows the passage of urine and faeces.

This function is especially important if the urethral or anal sphincters (muscles) do not function normally, as may occur after childbirth or prostate surgery.

Pelvic floor muscles are also important for sexual function in both men and women. In men, it is important for erectile function and ejaculation. In women, voluntary contractions (clenching) of the pelvic floor contribute to sexual sensation and arousal.

In women, the pelvic floor muscles also support the baby during pregnancy and must be relaxed during the birth process.

What are pelvic floor injuries?

There are certain stages in a woman’s life that cause changes that can lead to injuries to the pelvic floor muscles and deep abdominal muscles. Mainly during pregnancy, postpartum, if there are drastic hormonal changes (e.g. hypothyroidism or endometriosis), during menopause or in cases of gynaecological surgery.

How can pelvic floor injuries be prevented?

It is essential to keep these muscles strong and to exercise frequently, regardless of age or stage of life, especially to prevent pelvic floor injuries and dysfunctions such as urinary incontinence.

Relationship between the menstrual cup and pelvic floor injuries

During pregnancy, due to the growth of the baby, the dimensions of the pelvis and abdomen increase. Apart from these adaptations of the body, which are completely normal, a hormone is produced that relaxes the tissues, especially in the pelvic region. This hormone, relaxin, causes further stretching and weakening of the pelvic floor.

Without a doubt, the pelvic floor area is the most damaged by vaginal childbirth. But the better prepared and strengthened this muscle is, the more the risk of suffering the typical injuries is reduced:

Episiotomy: this is a vaginal cut made by the gynaecologist to widen the birth canal. If our pelvic floor and vagina are not sufficiently flexible, it may be necessary to make the cut to prevent it from tearing badly during childbirth.

Perineal tearing: spontaneous rupture of the skin (in less severe cases), of the mucous membrane of the vagina or of the pelvic muscles (in more severe cases).

Instrumental childbirth: the use of certain instruments such as kiwi, vacuum cups, forceps, spatulas, etc. automatically increases the risk of episiotomy or tearing.

After perineal trauma, the doctor stitches the wound. After two or three weeks, the wound closes and a scar is visible in the perineal area.

Can I use a menstrual cup if I have a perineal scar?

Any scar can cause adhesions. Symptoms of a scar adhering to the pelvic floor muscles are pain when sitting, discomfort that prevents penetration, pain when touching the vagina, difficulty urinating or defecating.

We recommend that if you have suffered a cut or a vaginal tear, you go to a physiotherapist specialised in pelvic floor to assess the state of the scar. The professional will perform a vaginal examination and assess the depth of the scar, its flexibility and the degree of dysfunction of the muscles.

If we want to use the menstrual cup and we have had a vaginal birth with episiotomy and/or tearing, it is essential to assess the pelvic floor before the first use of the cup and determine the degree of injury to the pelvic floor.

The pelvic floor physiotherapist will assess the genital area, pelvic floor strength, the presence of genital prolapse and the condition of the scar. Any dysfunction in this area could cause the cup to fall out or damage the scar.

We should still NOT start using the menstrual cup if we suffer from

– Pain and adhesions in the perineal scar.

– Genital prolapse: bladder, uterus or rectum.

– pudendal nerve neuralgia.

– Pain in the walls of the vagina.

– Urinary and/or faecal incontinence.

If in the pelvic floor evaluation the professional ruled out these injuries, then it is recommended to start using the menstrual cup by choosing a larger size than usual. If before giving birth we used the small size, after delivery we start with the large size. The muscles need time and training to return to their normal state. And to prevent the cup from sagging, it is better to start with the larger size.

By exercising the pelvic floor and deep abdominal muscles, after three or four months we should be able to return to our previous size. If this is not the case, and we notice that the walls of the vagina are very distended, it is a sign that the exercise we are doing is not enough to tone the muscles. 

What exercises do I recommend and can you do at home to tone your pelvic floor?

1 Lie on your side with your legs bent and place a small ball between your knees.

2 Take a deep breath and when you release it, activate your pelvic floor (close your urethral and anal sphincters at the same time and squeeze the ball). You will notice your pelvic floor contracting (sensation of cutting off the flow of pee) and your abdominal muscles flattening. Hold the contraction for five seconds and relax for another five seconds. Repeat 15 times on each side.

This is a type of exercise that voluntarily activates the sphincters and strengthens them. It can be practised during pregnancy, postpartum and menopause in order to prevent the loss of urine, gas and faeces.

I also recommend that every time you go to pee you should consciously squeeze the muscle for a couple of seconds after the flow of urine has stopped. Many women do not do this and suffer from incontinence later on. In this way we combine exercises like the one I mentioned above with this conscious contraction every time you go to the toilet. 

Our pelvic muscles need to be exercised regularly and frequently. Over the years, women lose the collagen in all the muscles of our body. In order for the pelvic floor to fulfil its function of supporting the internal organs, it is important to exercise them regularly. I invite you to take care of these muscles now!😘

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