How Does the Pelvic Floor Impact Balance?
Hi, Bestie! Welcome back to this pelvic space where we chat all things relating to the pelvic floor. The other day, I was looking through some of the older research articles saved on my computer, as I’m trying to clean up and organize my digital space (I’m a little late to spring cleaning, okay?). While I was picking through old articles, I came across one that caught my attention. In the 2008 article, authors looked at folks suffering from stress urinary incontinence (SUI) and studied their balance (1).
Now, we already know certain urinary symptoms can have an effect on falls (2). Studies have shown that in elderly folks, symptoms such as urinary urgency, urinary frequency, and nocturia can impact the likelihood of falling (2). This is because such symptoms may result in individuals participating in riskier behavior than they typically would without urinary symptoms. For example, someone with nocturia may be getting up 2-4 times in the middle of the night to urinate. Many times, they will leave the lights off so as not to disturb their partner, but walking in the dark, while sleepy, among obstacles such as furniture and rugs, can result in falling (2). Similarly, a sense of urinary urgency or fear of an episode of urinary urge incontinence can lead to rushing, and potentially tripping, over objects that would not normally present as obstacles. In these cases, urinary symptoms are not necessarily affecting balance, but are still contributors to balance-related incidents (falls).
While this phenomenon has been relatively well studied, there is less certainty about whether the pelvic floor influences overall balance. Let’s talk about some of the research articles that exist and what your balance says about your pelvic floor.
First up, the article that sparked this entire conversation. While it is a bit of an older article (2008), it brings up some interesting points. Researchers concluded that women with SUI had decreased balance ability when compared to women without urinary leaking (1). They determined this by looking at each participant’s center of pressure (COP) and found that displacement of COP was higher in those with SUI than in those without. Of course, this could be due to multiple factors, and is not inextricably linked to the pelvic floor. For example, perhaps women with SUI are just more focused on avoiding episodes of incontinence and are therefore less focused on balancing. Regardless, this research provides an interesting jumping-off point for further studies.
In a more recent article from 2023, authors reviewed the current literature to determine whether the pelvic floor is related to athletic performance (3). The article dives into a breadth of current research which has shown that pelvic floor health “contributes significantly to core stability, balance, and overall muscle function,” as well as agility and muscle coordination. (3). It also talks about the importance of proper pelvic floor training for the prevention of injuries, especially when it comes to the lower back and hips (3). We know the pelvic floor is a vital part of the core and that the core is an important part of balance, so it makes sense that the pelvic floor might be a contributor to balance itself.
However, other studies have not necessarily shown researchers coming to the same conclusions. One paper from 2021 had scientists studying whether pelvic floor muscle training (PFMT) affects postural balance in elderly women (defined in the article as women over the age of 60 years) (4). During their study, they found that while PFMT did improve pelvic floor muscle (PFM) strength among this population, it did not improve balance among the participants. Overall, they concluded that the “improved ability to recruit PFM did not positively affect balance, mobility, and gait speed” (4).
Finally, an article from 2022 left researchers unable to draw strong conclusions in either direction, ultimately stating that “there may be some relationship between pelvic floor muscle strength and postural balance in middle-aged women” (5). Of course, this warrants further research, but doesn’t give providers a whole bunch to use in the clinic.
It’s important to take every bit of research with a grain of salt. Ultimately, a patient’s experience in the clinic will rarely mimic that of a research setting, so we can’t base every single thing we do off of what the research says–it just isn’t practical. There are so many factors at play when it comes to balance and I think it’s highly possible that the pelvic floor is a contributing factor. I believe it to be essential for providers to assess their patients holistically before determining a plan of care. PFMT may be especially beneficial in those with very limited core strength and/or poor muscle balance among the core musculature. Also, regardless of whether your balance is good, pelvic floor health can make a difference in reducing falls, as we talked about earlier on (2). If you have poor balance, your PFMs are almost certainly not going to be the first area you target, but if you have other things going on (such as SUI), they might just be playing a role in both issues!
XOXO,
Your Pelvic Bestie
References:
Smith MD, Coppieters MW, Hodges PW. Is balance different in women with and without stress urinary incontinence? Neurourol Urodyn. 2008;27(1):71-8. doi: 10.1002/nau.20476. PMID: 17623853.
2. Soliman Y, Meyer R, Baum N. Falls in the Elderly Secondary to Urinary Symptoms. Rev Urol. 2016;18(1):28-32. PMID: 27162509; PMCID: PMC4859925.
3. Elevating sports performance through pelvic floor training: A review of literature. International Journal of Sports Health and Physical Education. 10.33545/26647559.2023.v5.i2b.91.
4. PFMT doesn’t help in elderly women (over 60): Leme G.L.M., Prudencio C.B., Thomaz de Aquino Nava G., Barbosa A.M.P., Scheicher M.E. (2021). Pelvic floor muscle training and postural balance in elderly women: An exploratory single arm trial. Journal of Bodywork and Movement Therapies, 29, 279-285. https://doi.org/10.1016/j.jbmt.2021.09.019
5. Zanetti, M. R. D., Dourado, V. Z., Scudeller, T. T., Vieira, E. R., & Amaral, M. T. P. do. (2022). Pelvic Floor Muscle Strength and the Postural Balance in Middle-Aged Women: A Pilot Study. Physical & Occupational Therapy In Geriatrics, 40(4), 392–404. https://doi.org/10.1080/02703181.2022.2044968
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives
