GLP-1 and Your Pelvic Floor

GLP-1s are being used by roughly 10% of the US, and twice as frequently in women than men. Many of the common side effects of muscle loss and fatigue are obvious, but some of the gastrointestinal (GI) ones are not as apparent or even talked about. The pelvic floor muscles play an integral role in bowel, bladder and sexual function, resulting in pelvic health side effects too. While the overall weight loss benefits can override these side effects, understanding why they happen can help to prevent them from happening at all.

How they work plays an important part in why they create GI disturbances. GLP-1s mimic

hormones that are secreted by the lower GI tract in response to eating. They help to enhance insulin secretion, which then helps with regulation of blood sugar. They also cause other actions of the GI system that lead to slowed gastric emptying. This causes a sense of fullness and decreased appetite.

Constipation

The slowed gastric emptying and sense of fullness leads to overall decrease calorie

consumption and weight loss. But it also creates harder stools that are more difficult to pass.

Typically increasing fiber and water can help with constipation symptoms, but the feeling of

fullness can block hunger and thirst centers. However, eating meals heavy in fiber will cause

bloating and gas, because it is not emptied or absorbed the same. This contributes to the

feeling of nausea.

Constipation leads to chronic straining that puts excess stress onto the pelvic floor muscles

creating tightness and pain. It can also feed into symptoms of pelvic organ prolapse due to the constant downward force. Making sure to drink plenty of water even if you are not thirsty,

avoiding carbonated beverages (they create more fullness and bloating!!) and gradually increasing fiber will help.

Diarrhea and Vomiting

Diarrhea is another GI side effect. Because of its watery consistency, it puts more strain on the pelvic floor muscles to hold it in. Fun fact – the anal sphincter is not made to hold in liquid, and can only do this for about 90 seconds. The extreme reverse actions of holding in, and then quickly releasing puts extra strain on the pelvic floor, and over time can lead to anal leakage.

Vomiting has also been reported as a common side effect. The pelvic floor works with our breathing, contracting on the exhale, or as we blow air out (think cough, sneeze or laugh). The same contraction happens while vomiting. Our bodies are made to do this, and are usually completely fine and asymptomatic during vomiting. But over time, the chronic strain can stress and weaken the pelvic floor.

Sexual Health

GLP-1s affect mood and energy, which are integral for our sexual response system. They affect our brain signaling by influencing dopamine and norepinephrine, which aid in sexual desire, arousal and orgasm. These drugs also cause vasoconstriction, which reduces blood flow and oxygen to the genitals, sometimes causing erectile dysfunction and inability to orgasm. Tightness in the pelvic floor muscles from the strain of GI effects, can also cause pelvic pain with intimacy and intercourse (dyspareunia).

Ozempic Vulva Demystified

I haven’t heard this term used recently, but I know that it was popular for a while and thought it was worth mentioning. This is not a medical term. It does not happen from taking GLP-1s. This happens because of the sudden, extreme weight loss, making the labia appear thinned or sagging. It also happens as part of the loss of fatty tissue that changes the labias' appearance, but can also cause vaginal dryness.

Pelvic Floor Flip Side

GLP-1s have been shown to reduce stress incontinence due to loss of abdominal weight and

force through pelvic girdle. They have also seen some improvements with IBS in those that

were taking them.

This only touched on the side effects from a pelvic point view, but there are many others both good and bad. Many of the benefits to these drugs, have side effects that are the complete opposite. Such as GLP-1s affect mood, but weight loss improves confidence. Weight loss decreases stress to joints, but GI effects increase stress to the pelvic floor. Loss of fatty tissue will improve health, but loss of muscle and bone mass affects loading and function. But many of the side effects of GLP-1s can be avoided when they are followed with the proper nutrient diet, exercise plans (consistent weight training) and proper management from the prescribing doctor.