Both women and men have a perineum, the anatomical structure of which differs. What is this part of the body for? How to muscle it? With what sports? On the contrary, what can weaken it?
Present in both women and men, the perineum, also called pelvic floor, is a hammock-shaped set of muscles that runs from the pubic bone to the coccyx. What is its function in women? In men? How to strengthen the perineum quickly? What should you pay attention to when exercising? ABS ? Perineal rehabilitation?
What is the perineum?
The perineum is a muscle located on the lower wall of the pelvis. It forms a hammock of criss-crossing muscles which constitute the bottom of the pelvis and which goes from the pubic bone in front to the coccyx behind. Its structure is different in man and woman.
What is the role of the perineum?
Its role is to support the lower digestive tract, the urinary tract (it is he who ensures the closing and opening of the bladder) and finally the genital tract, thus ensuring urinary and fecal continence. The organs located in the abdomen cause variations in pressure as they fill, empty, contract, etc. The role of the perineum is to exert resistance pressure exerted upwards in order to maintain a balance permanent. Finally, the muscles of the perineum are involved in the sexuality.
Anatomical diagram of the perineum
What is the female perineum?
Located between the pubic symphysis and the coccyx, the perineum is a set of muscles that covers the lower wall of the pelvis (small pelvis). It includes the lower end of the digestive, urinary and genital tracts. In women, the tThe urogenital angle includes the opening of the vagina and the clitoris.
What is the male perineum?
“In man, he understands the penis root and connected to it are the scrotum and the shaft of the penis. The perineum includes several muscles, including the transverse, ischiocaverneal, bulbospongiosus and superficial transverse muscles.explains Dr. Marc Perez, sports physician and osteopath.
What can weaken a perineum?
The perineum undergoes strong pressures, linked in particular to the weight of the viscera and especially to the weight of the uterus and then of the baby in pregnant women. Normally, nature is well made and the perineum is programmed to react to abdominal overpressure and counter them thanks to a reflex contraction. But when the muscles are weakened or the reflexes are impaired, the perineum is less effective. There is then a risk of urinary leakage, or even more serious organ descent (prolapse).
- There pregnancy puts a lot of strain on the perineum.
- Overweight. For a BMI greater than 40, the risk of urinary leakage is thus multiplied by 6. “A 10% weight loss can reduce leaks by 50%”, says Doctor Jean-François Hermieu, urologist at Bichat Hospital in Paris.
- THE tobacco because it can cause coughing spells, which will push on the perineum.
- There constipation : pushing presses on the pelvic floor and weakens the perineum. Carrying heavy loads is also a risk factor.
- There are also genetic factors : some people have lesser quality support tissues.
- drinking too much water during the day is not recommended when you have a weakened perineum. “An incontinent person should not drink too much water daily, just as they should avoid doing sit-ups“, recommends physiotherapist Marie Koehl-Le Brun. “A woman should not not drink more than 2 L of water per day. Beyond that is too much. Likewise, it is necessary beware of diureticsespecially tea and coffee,” she says.
- In addition, over time, certain factors make the perineum more vulnerable, in particular the menopausedue to the relaxation of muscles and estrogen deficiencies which reduce the tone of the perineum.
What are the causes of perineal pain?
” The perineum can cause various pains, including neuralgiaof the ligament painof the pain related to irritable bowel syndrome, pain of gynecological origin and endometriosis or even inguinal hernias”, notes the osteopathic sports doctor. However, the most common problem remains the loss of perineal tone, especially in women because childbirth causes a relaxation of the perineum. It is for this reason that we must perform postnatal rehabilitation sessions. As for men, they are not spared either. “In most cases, they realize the importance of their perineum after prostate surgery because they are advised to strengthen their perineum afterwards”, says the specialist.
In order to limit the risk of tearing during childbirth, we can carry out daily perineal massages from the eighth month of pregnancy. This will soften it and make it easier for the baby to pass through. How to do it ? After washing your hands and adopting a comfortable position, spread themassage oil between anus and vagina. We place his thumb inside vagina while exerting small pressure and stretching movements on the perineum.
What are the (effective) exercises to strengthen your perineum?
Apart from pregnancy and childbirth, it is possible to avoid putting too much strain on your perineum by contracting this area when you carry heavy loads or when you cough or sneeze, for example. Practicing sport by pulling in your stomach with the effort without forgetting to blow through your mouth is also a good exercise.
► For women: sit on a chair, act as if you were holding back gas and a stream of urine. A feeling of “tightening” then appears. You must then hold this position for 5 seconds and then release 5 seconds. Then gradually, it will be possible to maintain this contraction for longer and longer. On the other hand, this exercise can be practiced everywhere, at the office, at home, on the train, or in the metro.
► For menthe best way to locate the pelvic floor muscles is to contract the muscles around the anus, like holding gas to automatically tighten the pelvic floor muscles.
What sports are recommended/not recommended?
Sports practice can be harmful to the perineum. It can lead to increased pressure on the perineum due to impacts on the ground and contraction of the abdominal muscles. In the long term, the repeated overpressures can be at the origin of a relaxation of the muscles of the pelvic floor, even of a urinary incontinence, in the woman. More than one in two high-level athletes would be concerned. “And even for amateur athletes, the perineum is not taken into account for the issuance of medical certificates while certain activities may be contraindicated”, laments Dr. Hermieu.
What sports in particular? Running, stepping, aerobics, trampoline, basketball and volleyball are particularly harmful to the perineum. It is better to choose a softer sport, such as swimming, walking, cycling or even rollerblading, which preserve the pelvic girdle. According to the French Association of Urology (AFU), when practicing a sport that exposes the pelvic floor to excess pressure, it is recommended to:
- Protect your perineum as much as possible by remembering to correct your posture by tilting your pelvis.
- When you work your abdominals: the exercises must be performed by locking the perineum (by contracting your muscles) by bending your knees and without inflating your stomach (bringing your muscles out). On the contrary, the belly must widen, a guarantee of efficiency and protection of the perineum and the back.
What precautions during perineal rehabilitation?
The perineum is abused during pregnancy. In the third trimester, nearly one in two women experience urinary leakage related to increased pressure on the perineum. Multiple factors solicit the perineum during this period, starting with the increase in the size of the uterus, then the baby’s weight and amniotic fluid. Childbirth further promotes distension of the perineum, especially when the baby is large. Finally, hormonal factors contribute to make it less tonic. The risks are generally increased beyond the fourth pregnancy.
A rehabilitation of the perineum is recommended for young mothers if they do not want to be victims of lesions during childbirth, then of incontinence or prolapse after the arrival of the baby. Rehabilitation of the perineum after childbirth helps prevent the appearance of urinary incontinence. On the other hand, poor control of the perineum can disrupt sexual intercourse and favor the appearance of a prolapse which is more commonly called a organ descent. About ten sessions are prescribed during the postnatal visit. Reimbursed by social security, they can be carried out by a physiotherapist or a midwife. It is advisable after childbirth to avoid practicing weight training exercises as well as abdominal exercises, but also to run and carry excessively heavy loads.
Why is it not good for the perineum to refrain from peeing?
In children, the perineum normally has no problem contracting. Any leaks are linked to an immature bladder, which contracts too often. On the other hand, they sometimes retain their desire to urinate. It is very common in children when they enter kindergarten. They dread going to the toilet, because it scares them or they find it dirty… and they hold back for several hours, even all day. Delaying their urination is not good for their perineum, which can become hypertonic. They then take on bad habits that will last a lifetime. Ultimately, holding back in this way can lead to:
- urinary tract infections : because the bladder does not empty or incompletely, germs develop in the urine;
- urinary leakage : by dint of holding back, the bladder ends up overflowing;
- constipation.
And the problem is that it’s not always easy to spot children who are holding back. “A child who runs to the toilet or has a stomach ache must cause concern for his parents”, alert Jean-François Hermieu, urologist. If necessary, rehabilitation can be implemented. Carried out by a physiotherapist, it allows the child to learn to relax the perineal muscles in order to obtain complete urination. “It is done in a fun way with screens adapted to children and requires the cooperation of parents”, says physiotherapist Marie Koehl-Le Brun.