We need to talk more about the METABOLIC risk factors for pelvic floor dysfunction and prolapse
By now you might have heard that stacked alignment of the spine and ribs and management of intrabdominal pressure can help to prevent or reverse pelvic organ prolapse.
Habits like breath holding, bearing down to lift weight, sucking in the stomach or shallow chest breathing) puts pressure on the pelvic floor or can create chronic tightness or laxity in the muscles and ligaments.
So when we learn to move and breath differently in the body we can sometimes completely do away with all symptoms of prolapse.
After all, aligning the spine, ribs and pelvis in a neutral manner helps us to better access the glutes and core appropriately. This supports the body and helps to not overtax the pelvic floor while simultaneously using it appropriately activate it as necessary to support our trunks and pelvic organs when we walk, lift, bend over, run, skip, hop, whatever!
More and more we are addressing the fact that in pregnancy and early postpartum, momma's tissues and ligaments are stretchy.
The increasing weight of a growing belly, changes in alignments and movement habits...these things ALONE can cause a woman's pelvic floor to stretch and organs to prolapse WITHOUT her adding in lots to crazy strenuous exercise and lifting.
But a quick search of the peer-reviewed literature on pelvic organ prolapse (the falling of the uterus, rectum or bladder) reveals that in developing nations where food scarcity is a acknowledged as major issue, pelvic organ prolapse is STRONGLY associated not just with physical movement habits and load, but with malnutrition and metabolic syndrome. Further reading: Here Here and Here to start!
And there’s this great article by Chris Kresser on how Americans are under-nourished!
Yet in the United States, the land of plenty, online and in doctors offices we rarely hear about nutrient deficiency or metabolic syndrome when discussing pelvic floor problems.
We have doctors that are keen (a little too keen, if you ask me) to point out the connection between a high BMI and the incidence of prolapse, because just like in pregnancy, additional load on the body can put additional pressure on the pelvic floor and pelvic organs. Unfortunately this completely neglects the the fact act it isn't necessarily the SIZE of the person, but how they move in their body the is negatively impacting their pelvic floor.....and the metabolic syndrome that is CAUSING the weight gain, COULD potentially be causing the prolapse as well.
But the real issue isn't necessarily JUST about body size and even when it is, this size problem is tied to another cause of pelvic organ prolapse.
A 2014 study in Nature makes the point that Americans are starving. We aren't lacking for food, but we ARE lacking in vitamins, minerals, and enzymes that make us healthful human beings.
Our Standard American Diet (SAD) is nutrient deplete.
And why wouldn't it be with our processed foods and our soil that has been ravaged by mono-cropping systems heavily reliant upon herbicides that kill all the life-giving microbes in our soils?
Did you know that without soil-based microbes there are loads of nutrients that a plant can not extract from even the most fertile of soils?
And if the nutrients aren't in the plants (that we consume), then they are not in the animals or animal that eat the plants (that we also consume).
And if the nutrients aren't in our food, then they certainly are not in our bodies.
Interestingly enough, even when we eat food from sustainably operated farms with healthy soils rich in microbes. It doesn't necessarily make up for decades of exposure to antibiotics, anti-depressants, birth control pills, pesticides and herbicides ingested intentionally or absorbed via our environment. All of these chemical concoctions kill the microbes that should be residing in our gut. And just like plants and when we don't have the necessary microbes living in our guts then WE TOO can't absorb nutrients.
Our lifeless soils, dysbiotic guts, processed food diets, and sedentary lifestyles are ALL working together to contribute to the problem 1 in 4 (maybe 1 in 3!) women having some degree of pelvic organ prolapse.
SO THE PROBLEM is that we need to start seeing the average the American woman that consumes the Standard American Diet and or most likely has dysbiosis of the gut, as potentially at risk for developing metabolic syndrome and pelvic organ prolapse.
Because at the end of the day, food or no food, BOTH populations of women whether in developing nations or developed countries are struggling with metabolic disorders and nutrient deficiency. It's just that it less apparent here in the United States.
How is nutrient deficiency causing pelvic organ prolapse?
Well there's still lots of research to be done in this area as far as fully understanding the mechanisms by which the muscles of the pelvic floor begin to weaken. But we do know a few things right now.
We know that a loss of collagen contributes to and in many cases might cause pelvic organ prolapse. (Reference) In multiple studies the tissues of pre-menopausal women with pelvic organ prolapse show high levels or collagen degrading enzymes (Matrix-Metallaproteinase 1 or MMP-1). (Reference)
AND we also know that MMP expression is associated with inflammation. For example we lots of MMP's expressed in the inflamed and ulcered colons and intestinal walls of patients with irritable bowel syndrome (IBS) and inflammatory bowel disorder (IBD).
IBS and IBD both are medical issues that start in the gut AND are strongly associated with pelvic floor dysfunction and pelvic organ prolapse AND that the colon is a VERY CLOSE neighbor of the pelvic floor. (Reference)
We know that sarcopenia or muscle wasting (as seen in individuals that are malnourished, suffering from a disordered eating condition like anorexia, and elderly populations) negatively impacts the structure and integrity of muscles, ligaments and fascia and pre-disposes someone to pelvic organ prolapse. (Reference)
And we know that in order to absorb nutrients from our food and bring it into the cell for use, we need a healthy gut microbiome and that MOST people right now are displaying symptoms of some degree of dysbiosis. It's impossible not to. We live in a world that is sterile in all the wrong ways, yet RIPE with environmental pollutants in our food and bodies that annihilate beneficial microbes. (Reference)
So while we aren't necessarily sure of the exact mechanism by which state of a person's metabolism and gut is going to play a role in the health of their pelvic floor and their risk for pelvic organ prolapse.
Metabolic syndrome that isn't properly managed is going to cause weight gain-risk factor
Dysbiosis of the gut is going to cause elimination troubles like IBS that must pressure on the pelvic floor and pelvic organs-risk factor
Malnutrition caused by the Standard American Diet and a gut microbiome that lacks diversity is going to compromise the integrity of the ligaments and muscles built and maintained by the body via sarcopenia, poor collagen production -risk factor
The question is, what do we do about it?
Well for starters, we have to start talking about the gut and metabolism when we talk about pelvic floor problems and pelvic organ prolapse.
And we all have to start asking more questions about how the health of our metabolisms and guts are putting us at risk for pelvic organ prolapse, especially during pregnancy or the postpartum time when MANY a mom is focused on not gaining too much weight or losing her baby weight.
Nutrition and gut health combined with strength training and daily natural movement practices are going to be the solution to preventing and healing pelvic organ prolapse. We just have to keep asking the right questions....and looking for answers.
Sarah Smith is a trainer, lifestyle coach and postnatal fitness specialist that specializes in helping women feel strong, confident and capable in their bodies!
Her specialties include kettlebells, gut health and optimization for fitness goals, pelvic floor health and function and making fitness fun! Check her out on social media here or email her!
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