The COVID-19 pandemic has impacted individuals on physical, psychological, and social levels, both as byproducts from the pandemic, and as effects from the infection itself. Our scientific understanding of the short-term and long-term implications of how the virus impacts various systems in the body is increasing, and in particular, new research shows that the COVID-19 pandemic and virus have adversely affected pelvic health. Negative pelvic health changes such as decreased bladder control, onset and exacerbation of sexual health issues, and worsening of prolapse symptoms are associated with changes in lifestyle, work-life, acces to care, and social habits related the pandemic, as well as physical effects from COVID-19 infections.
How COVID-19 Infections Affect Pelvic Health:
- Muscle Weakness: One of the most common symptoms and residual effects following a COVID-19 infection includes muscle weakness. The pelvic floor is a group of muscles spanning from the pubic bone to the tailbone that play important roles in managing abdominal pressure, maintaining urinary and fecal continence, and are part of the deep core system. Weakened pelvic floor muscles from the virus may lead to decreased core strength and an onset or increase in urinary or fecal leakage.
- Increased Leakage: Strength, control, and endurance of the pelvic floor muscles are critical in preventing urinary and fecal leakage with pressure changes in the abdomen. Essentially, the pressure of the pelvic floor muscles around the urinary and anal opening have to be greater than the pressure from above or leakage will result. Coughing generates a large pressure increase from above, which translates to increased demand on the pelvic floor muscles. Repetitive coughing, a common symptom of COVID-19 infections, means those muscles have to be able to fire over and over again, and the likelihood that those muscles will fatigue increases with a prolonged cough.
- Respiratory Effects Impacting Pelvic Floor: Given that COVID-19 primarily targets the respiratory system, the respiratory diaphragm muscle that sits just under the ribcage may be negatively affected by an infection. The pelvic floor muscles work in synergy with the respiratory diaphragm, and may be similarly impacted.
- Bowel and Bladder Changes: COVID-19 has been shown to enter cells through an important enzyme receptor. This enzyme, Ace2, plays important roles in multiple organs of the body, including bowel and bladder systems, which may lead to unwanted changes in bowel and bladder function. Similarly, the inflammatory effect of the virus can also impact the bladder and GI system, spiking symptoms such as bladder pain or urinary urgency.
- Effects of Decreased Activity: Overall effects of the virus, decreased activity from quarantine, and increased hospital stays may result in overall physical and pelvic floor muscle weakness and changes in bowel and bladder health. For example, prolonged catheterization or bowel complications in the hospital may have lasting impacts on pelvic health long after discharge from the hospital.
How the Pandemic Effects Overall Health & Pelvic Health
- A recent research article found that for women with pelvic symptoms including bladder control, prolapse, pelvic pain, sexual dysfunction, and fecal incontinence, the pandemic led to symptoms that were worse for 38% of people in the study (51% were unchanged, and only 10% improved)
- Decreased Activity: Increased sedentariness during lockdown led to increased BMI and weight gain for many people, with one study finding that over one third of women gaining weight during the pandemic. This associated BMI increase was also linked to negative mental health changes.
- Changes in Mental Health, Social Roles, and Sexual Health: The pandemic has also negatively impacted mental health for many, and for many reasons such as increased sedentariness, isolation, and uncertainty. One research article found that mothers in particular spent more time on unpaid care work during the pandemic, and changed their employment schedule more often than fathers did. Those women who spent long hours on housework and childcare reported increased levels of psychological distress. Other research has found that people have reported decreased sexual activity during the pandemic.
Access to Healthcare: Accessing healthcare, and particularly postnatal care, has been another challenge, especially in the early stages of the pandemic. One study found that access to medical appointments was difficult for 36.5% of women seeking care.
Pelvic Floor Physical Therapy can address unwanted onset or exacerbation of symptoms listed above. Reach out to us or your local pelvic physical therapist for more information or if you are experiencing any unwanted changes in pelvic health related to COVID-19.
Sources:
https://pubmed.ncbi.nlm.nih.gov/34191922/
https://www.sciencedirect.com/science/article/pii/S2772973722005513?via%3Dihub
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8920089/
https://pubmed.ncbi.nlm.nih.gov/34953756/
https://pubmed.ncbi.nlm.nih.gov/33782145/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8920089/#b20
https://pubmed.ncbi.nlm.nih.gov/30447797/
https://www.frontiersin.org/articles/10.3389/fmolb.2021.708336/full
https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03120-0