In a new survey of women ages 18 to 59 conducted by Origin, the leading provider of women’s pelvic floor and whole-body physical therapy in the US, reveals that the generational divide also hits below the belt. “There’s this myth that pelvic floor issues are only impacting women later in life, but the rates among millennials were either higher or as high as Gen X,” says Carine Carmy, Origin’s co-founder and CEO, of the study’s results.
Released yesterday, the company’s study, conducted in partnership with market research giant Ipsos, found that eight in 10 women, many of them millennials, are dealing with pelvic health problems. The study fills a gaping research gap. “The data around women’s health, and especially pelvic health, is really lacking,” adds Carmy. There have also been issues with how that research has been done historically: often the scope of what’s studied has been quite limited and it’s looked at pelvic health over a lifetime, versus a moment in time, which makes our understanding of how it affects women at different stages insufficient. What Origin’s new survey found was that millennials experience higher rates than their Gen X counterparts in bladder areas (like feeling as if they have to pee again right away and inability to fully empty their bladder); that more than half leak when they cough, laugh or exercise; and that more millennials than Gen Xers are contending with pain during intercourse and an inability to reach orgasm.
The most common cause for repetitive leakage (or stress urinary incontinence) among millennial women is childbirth (both vaginal and C-section deliveries), says Michele McGurk, PT, a Brooklyn-based certified pelvic rehabilitation practitioner and clinical specialist in women’s health. “Scar tissue from muscle and fascia tearing or cutting will change the integrity of the abdominal pelvic canister resulting in abnormal pressure distribution, and an inability to contract the deeper core and pelvic floor muscles to prevent leaking,” says McGurk. Because of that muscle laxity, when you exercise, jump, cough, or sneeze, you’ll also leak. A prior fall onto the pelvis can lead to the same leakage issue and, though research is, unsurprisingly, limited, says New York-based board-certified OB/GYN Heather Irobunda, MD, there may also be a genetic predisposition. “If your mother, sister, or auntie had issues with leakage, you are more likely to have it too,” she says. While strengthening exercises like kegels can be helpful, McGurk says manual treatment conducted by a pelvic floor PT is necessary to restore muscle tone, function, and symmetry first.
The bladder urgency and frequency that millennial women are experiencing can be caused, in part, by irritants like caffeine, alcohol, seltzer water, and chocolate, says McGurk, and also poor water intake and prolonged sitting. “Removing the irritants along with bladder retraining techniques such as diaphragmatic breathing in the moment of an abnormal urge can make a big difference,” says McGurk, adding that the goal is to retrain the bladder to tolerate longer stretches of storing urine. One reason more millennial women are having problems fully emptying their bladder could be a history of UTIs, says McGurk, which can cause scarring. A temporary fix to help fully empty the bladder, she says, is to move the pelvis forward and back five to 10 times while sitting on the toilet.
Frequent UTIs can also be a culprit for the higher number of millennial women experiencing pain during sex, explains McGurk. She points also to reasons like the irritation caused by chemicals in soaps, endometriosis, hormonal reactions – “Younger women taking the pill can develop vulvar-vestibulitis, irritation of the skin at the opening making penetration painful,” says McGurk, adding that the same applies during postpartum and menopause – and pudendal neuralgia, a debilitating genital pain caused by prolonged sitting, bike riding and pelvic trauma that is often misdiagnosed as a yeast infection because of the constant itching. And there’s a significant mental component too. “We know that sexual arousal and sometimes chronic pelvic pain can be associated with emotional stress and mental health,” says Irobunda. “It’s important to remember that general health issues will also affect your pelvic health. Unfortunately sometimes we look at the pelvis in a vacuum.”
There is in fact a deep connection between mind and body, and specifically the pelvis. Increased fear, stress, and anxiety can all manifest as a tight pelvic floor. “We know that millennials today, particularly post-Covid, are experiencing incredibly high rates of depression and anxiety,” adds Carmy. Stress and anxiety have a strong association with bladder urgency and frequency, says McGurk and studies have confirmed this. The adverse is also true: experiencing pelvic health issues like incontinence can cause women to develop anxiety, something Irobunda sees frequently among her patients. “Urinary continence is something we teach children and it becomes unnerving when you feel like you’re regressing in that way and you’re unable to hold it,” she adds.
What Irobunda does see most frequently among millennial women, more than other generations, is a willingness to discuss pelvic health issues and a concerted seeking-out of solutions. Many of these pelvic health problems aren’t new; what is new is the openness about them and desire to address them. “These issues have been known among women for generations but were either normalised or dismissed by the medical community and society, but we’re at a turning point now where things that have been the subject of whisper networks are now entering the mainstream,” says Carmy. And search trends back that up: Origin has seen a 300 per cent increase in search interest around pelvic floor health over the past year and the numbers of people visiting their free educational blog are in the hundreds of thousands every month.