Anasayfa » The Impact of Alcohol on Pelvic Floor Health
The anatomy of the female pelvic floor is complex. This large group of muscles, ligaments, and connective tissues supports the bladder, uterus, and rectum. They also form a ‘sling’, or network, of muscles attached to the pelvic bone that maintain the bladder in place. Urinary incontinence (UI) affects 50-60% of women worldwide with a history of childbirth, and many will delay seeking help for their symptoms due to embarrassment. UI can cause women to avoid physical and social activities and withdraw from life. Risk factors for UI include family history, age, obesity, menopause, smoking, and chronic obstructive pulmonary disease, and few risk factors are modifiable. One modifiable risk factor that is consistently associated with UI is alcohol consumption. Alcohol has a strong, short-term diuretic effect (increasing urine production), and in lower doses can stimulate the bladder to contract prematurely. Additionally, alcohol can irritate the bladder and contribute to an overactive bladder.
Despite the evidence that reducing alcohol intake is one of the best treatment options available for incontinence symptoms, addressing drinking habits is not commonly included in lifestyle interventions for UI patients. The primary focus is often on strategies such as exercise, stress reduction, and bladder training. To help women better understand the impact of alcohol on pelvic floor health, as well as provide healthcare providers the knowledge they require to better educate patients, this study presents a comprehensive summary of the current evidence-based literature. The primary objective is to help this new generation of patients and healthcare consumers understand the relationship between alcohol and urinary incontinence, and the long-term foreign health effects of alcohol on the pelvic floor, and bladder or bowel control. This paper reviews the impact and effectiveness of alcohol reduction as a treatment for bladder and bowel control complaints. Results will help promote behavior change and decrease the impacts of problems such as urinary incontinence in health-conscious youth and educative health enthusiasts.
The pelvic floor musculature plays a crucial role in bladder and bowel control, sexual activity, and childbirth, supporting the pelvic organs and providing trunk stability. Although the skeletal support of the body is maintained by the bony structures of the pelvis, the pelvic organs largely rely on the function of ligaments and muscles of the pelvic floor. Damage to these supporting structures can lead to pelvic floor dysfunction. Clinically, the term pelvic floor includes the muscles within the bony pelvis (levator ani and coccygeus) and the pelvic diaphragm. The pelvic diaphragm, consisting of the levator ani, perineal membrane, and perineal body, supports the pelvic organs, guarantees urinary and fecal continence, and is essential for sexual function and childbirth.
The levator ani muscle group consists of several muscles: the puborectal muscle, which is oriented in an almost transversal manner, the pubococcygeal muscle, which is located more frontally and has a more vertical orientation towards the dorsal side of the muscle, and the most dorsal iliococcygeal muscle have a poorly characterized function. The external urinary and anal sphincters of the perineum, which also contribute to continence and pelvic floor support, and the perineal body, which lies at the junction of the distal vagina and the anal canal, are essential for the support of the levator ani and the perineal membrane. The external urinary and anal sphincters and the perineal body are innervated by the superficial perineal branch of the pudendal nerve. The puborectal muscle is innervated by the other two branches of the pudendal nerve, the inferior rectal nerve and the dorsal nerve of the clitoris/penis.
Alcohol has a diuretic and irritative effect on the bladder, as a result of which the volume of urine increases. This is then accompanied by hyperactivity and can lead to urinary incontinence, preferring to develop into a mixed form with the presence of genital prolapse, reducing the quality of life of women. Alcohol also has a direct toxic effect on the kidneys, which can lead to urinary tract infections. Initially, the dehydrating effect of alcoholic beverages is associated with an increase in urine output due to the diuretic action of ethanol and its metabolites, but with the reduction in antidiuretic hormone levels, a decrease in urine osmolality, polyuria, and polydipsia occur. The latter make alcohol an intoxication, which the body uses for locus claudicationis, another peculiar aspect of the polyuria induced by alcohol. This is irritating to the bladder with the subsequent risk of increase in hyperactivity and incontinence.
The consumption of alcoholic beverages has multiple acute and chronic effects on the body. Active alcohol consumption can lead to a direct suppression of the peripheral organs of the micturition system, and the general toxification of the organism affects the exchange of certain minerals and neurotransmitters that can lead to long-term changes in the state of the structural elements of the pelvic floor. In the very near future, this will lead to the development or intensification of mixed forms of urinary incontinence, and in the most serious case, overactive bladder syndrome, or “northern incontinence.”
The majority of studies conducted on overactive bladder syndrome have focused on the normal and serious causes. However, it may be that bladder fill-void dysfunction is frequently caused by overdrinking, yet not recognized and addressed as a causal factor by healthcare professionals. Overdrinking may be responsible for the ischaemia and hypoxia observed in the pelvic floor that may lead to acute and chronic ischaemic prostatitis, the symptoms of which certainly overlap clinically with those of overactive bladder syndrome. Indeed, one clinical study, identified the classic presentation of overactive bladder syndrome in 57% of chronic pelvic pain patients as acute urinary frequency, urgency, or profound voiding difficulty, thus highlighting the overlap in symptoms and supportive treatment.
Both men and women can be affected by alcohol-associated incontinence. However, given the anatomical differences in the urinary tracts of men and women, this incontinence may present itself in varying patterns and occur to different degrees. Men have the advantage of a longer urethral length and a stronger sphincter, but changes to both can occur due to poor lifestyle choices, such as overdrinking and smoking. Persistent eying can result in a delayed action of the interstitial cells, which consequently prolong the duration of detrusor muscle contractions, resulting in an overactive bladder and leading to greater urgency, detrusor instability, urinary frequency, and, in some cases, incontinence. In the case of urinary symptoms, the bladder neck and pelvic floor become damaged and catheterization may be required.
Alcohol-related pelvic floor disorder leads to impaired function and a lowered threshold for the urge to defecate, thus leading to worse fecal incontinence, proctalgia, and constipation. It is even more concerning that these subdivisions of pelvic floor disorder are closely connected with urinary incontinence. Urinary incontinence is the involuntary discharge of urine and one of the most common urinary symptoms, interfering with the patient’s health-related quality of life and participation in daily activities. Among individuals with urinary incontinence, 40%-70% report bowel dysfunction, a higher occurrence than in the general population. In conclusion, alcohol-related pelvic floor disorders should be better understood because of the several adverse effects that may lead to lifelong requirements for conservative managements.
Alcohol-related pelvic floor disorders. The impact of alcohol on pelvic floor health is not limited to the urinary system. It can also lead to a range of pelvic floor disorders that affect the digestive and sexual systems. Alcohol has direct effects on the anorectum and gut, such as temporary worsening of anorectal sensation and motor function. As a result, there can be a decrease in the number and strength of both abdominal and pelvic muscles that help maintain continence for the anorectum and the bladder or support for the pelvic floor during physical activities.
Pelvic organ prolapse is the descent of the uterus, vaginal walls, or the rectum outside the body because the pelvic floor is not able to support the organs in their respective areas. It is a common issue in older women, particularly due to decreased estrogen levels during menopause. However, younger women are not dismissing the problems either – pregnancy, childbirth, chronic constipation, lifting heavy weights, high impact sports, and other pelvic floor straining activities are the common causes of pelvic floor weakening which may further lead to pelvic organ prolapse. The hormone imbalance in postmenopausal women weakens and thins the vaginal and urethral tissue, thus making the organ prolapse more imminent. Connective tissues provide support to the uterus and in women who have experienced menopause and who have had multiple deliveries, the gradual loss of connective tissue strength and integrity is why long-term estrogen deficiency is one of the most important risk factors for pelvic organ prolapse.
While some good evidence appears in the literature, further studies are necessary, as is the production of quality files on treatment outcomes with these patients. In recent years, complaints related to the pelvic floor have shown an increasing interest. The inclusion of these themes in the Preventive and Health-Mental Education Programs integrating the Primary Health Care Guidelines is highly encouraged. Sending these professionals to their respective teams will act early in identifying these patients, reducing personal and external morbidity.
Despite the difficulty in linking alcohol consumption to an exacerbation of pelvic floor dysfunction, it is encouraging to know that prevention and treatment measures do exist. It should be highlighted that a prostate problem precipitated by alcoholism should be addressed first. Lifestyle modification is recommended. Conversely, the removal of the aggressor drastically enhances the prognosis. Pelvic floor physiotherapy, massage, and electrogymnastics have been shown to improve symptoms. The orthomolecular therapy process and other conservative measures are also an option. If anal incontinence symptoms persist, changing habits such as avoiding the direct application of ice can be helpful. Sacral neurostimulation, the silicone injection of the anal canal, and colostomy, although being more invasive, are still less commonly used, should such instances present themselves.
For the former, it is recommended to avoid drinking more than 4 units of alcohol per day if you are a female, and 3 units if you are a male. If the customers are at risk of pelvic floor dysfunction, it is recommended to drink less than these amounts. For the latter, it is suggested that the consumers avoid alcoholic beverages from the afternoon up to early morning, in order that urine concentration does not appear, especially in those who have a fast metabolism or urinary tract hyperexcitability. It is proven to be beneficial not only for the lower urinary tract, but also for the general and emotional health of the consumer.
Lifestyle modifications encompass diet and fluid intake. As far as alcohol is concerned, the impact of alcohol on the lower urinary tract is inversely associated with its hydration. When urine is concentrated, alcoholic beverages (especially those with a high alcohol content) promote bladder irritation and it can magnify the symptoms of urge incontinence caused by bladder irritation. On the contrary, when urine is diluted, alcoholic beverages have a diuretic effect, and it can make the problems of stress urinary incontinence worse. Such effects are influenced by the concentration and the type of alcoholic beverage and the hydration status of the consumer. Nevertheless, alcohol intake time management does not have a curative effect, but a preventive effect.
The results from this study suggest a need for intervention programs in healthcare settings with information about alcohol use, the symptoms of alcohol dependency, and other problematic drinking patterns in combination with sexual health.
The existence of positive or neutral experiences, such as self-knowledge, positive impacts on sexual performance, and gendered and/or hedonistic-related humor, were expressed in the male patient accounts. This research demonstrates the need to expand the measures of alcohol impact, including incontinence and pain issues, but also emotional issues, quality of life, and relationships, into broader areas of sexual health to help put men at ease with seeking assistance to manage incontinence and its treatment.
The duality of alcohol use as a co-producer of positive and negative sexual health experiences, along with the social acceptance for male alcohol consumption close to and during sexual activity, became particularly evident in the information about consensual sex founded on mutual decisions about alcohol and drug use.
For instance, some released patients in the present study reported that they had learned from their previous experiences of incontinence as a result of large quantities of alcohol and would now, as a preventive measure, drink fewer bottles due to a reduced amount of incontinence production. However, findings from this and previous studies suggest that this knowledge was not applied.
A mixed methods design that includes quantitative and qualitative approaches could provide important depth in future studies. Such designs are especially helpful for research within the context of alcohol use and its effects on sexual health.
There is a need for further research:
1) Studies that use a multiple informant approach, including reports from the patients, the partners, and clinical personnel; and
2) Population-based studies on the immediate and long-term consequences of alcohol consumption, such as UI.