Can Collagen Help the Pelvic Floor and Diastasis?Oct 28, 2022
Will Collagen Help Strengthen My Pelvic Floor?
The pelvic floor is an often-overlooked part of the body with regard to preventive health, but one of the most thought-about parts of the body for those suffering from common conditions such as incontinence and organ prolapse.
I speak from both personal and professional experience, having experienced stress urinary incontinence after the birth of my second child, a stage 2 uterine prolapse about 7 or 8 years after my first was born, and a stage 2 rectocele that slowly progressed, and I lived with for 9 years. Even though I knew a few things about prevention in childbirth, I had overlooked recovery and also developed chronic constipation (due to the hormone upheaval of perimenopause and an autoimmune response) I still developed pelvic floor dysfunction. I know the physical and emotional toll it can take. I also know that so many things are treatable and ‘figureoutable’ (to quote Marie Forleo) with the right information and regimen in place.
What Is The Pelvic Floor?
The pelvic floor is a group of muscles responsible for maintaining our continence, pelvic and spinal stability, sexual response and organ support. There are 3 layers of pelvic floor muscles in the pelvis, as well as ligaments, tendons and a huge vascular network. We need strong pelvic floor muscles, ligaments, and tendons, as well as good blood flow and circulation for optimal function. Many women birth babies, and every woman will go reach menopause which are 2 pivotal times in the life of our pelvic floor.
It is also important to note that as we age, we lose muscle mass, hyaluronic acid and collagen, which can all directly influence the functioning of the pelvic floor muscles. It is also common for people with existing pelvic floor challenges to stop exercising, which can inhibit blood flow even more while also contributing further to decreases in muscle mass and strength. Strengthening the pelvic floor muscles is a key part of improving and maintaining function; however, can we possibly gain benefit from supplementing with collagen in addition to pelvic floor exercise?
This is a question I get asked all the time, and I wanted to look deeper into the research to see if it supported my belief and also to present what we currently know about collagen so others can make their own decision.
What is Diastasis Recti?
The term diastasis means separation and recti is referencing the 2 straps of muscle on the outer abdomen known as the rectus abdominis (the 6 pack muscles). The linea alba is a meshwork of connective tissue that holds the 2 rectus muscles in place at the midline. During pregnancy in particular, this connective tissue stretches and can contribute to the 2 straps of the rectus moving away from the midline and creating a larger than normal gap. To be clear, there is always a gap between the rectus. The muscles are never fused together. It used to be thought that the size of the gap was an indicator of function however we are now becoming clearer on the fact that the size of the gap is not as important as the integrity of the connective tissue.
What is Connective Tissue?
Connective tissue refers to the tissue in the body that supports, protects gives structure to other organs and tissues in the body. Connective tissue is made up of cells, fibers and gel-like substances that can help move nutrients between tissues and can also help repair damaged tissues. Connective tissue can be categorized into 3 sub groups - loose, dense and specialized. Loose connective tissue helps hold organs in place and is made up of extracellular matrix and collagenous, elastic and reticular fibers. Dense connective tissue is associated with tendons and ligaments with a higher density of collagen fibers. Adipose tissue, cartilage, blood and lymph are examples of specialized connective tissue. Connective tissue contains a lot of Type 1 Collagen which is the most abundant collagen in the body.
What Is Collagen?
Collagen is the most abundant protein in the body and provides structural support to what is known as the extracellular matrix of connective tissues. Collagen is what contributes to our skin’s firmness and resiliency and is often thought of as the ‘glue’ that holds everything together. While it is mainly thought of as a skin-supporting supplement, collagen is also found in muscles, bones, tendons, ligaments and blood vessels. As we age, we produce less and less collagen – about 1% less each year starting around the age of 20. This can lead to less buoyancy and resiliency in our tissues as well as drier, thinner skin.
How Does Collagen Relate To The Pelvic Floor and Diastasis Recti?
There are many different types of collagen, with the most common types being Type I through IV. Type I collagen comprises over 90% of the collagen in the human body, and with regards to the pelvic floor, we find Types I and III. Collagen is one of the most important parts of the extracellular matrix and plays a support role in the pelvic floor. A study by Norton et al showed that women with joint hypermobility have a significantly higher prevalence of pelvic organ prolapse, from which we can infer that connective tissue integrity plays a role. Fibrous connective tissue and the pelvic floor muscles support the vaginal walls, with collagen types I and III playing a significant role in tissue tensile strength. One study found conclusively that women younger than 53 years of age with pelvic organ prolapse have 30% lower collagen concentration compared to age-matched controls, which indicates a constitutional tissue weakness contributing to prolapse development. Another study wanted to see if there was a correlation between the clinical stage of pelvic organ prolapse (POP), histological structure and results of immunohistochemical study of the vaginal wall. There were 60 postmenopausal women who had undergone some type of pelvic surgery during which a biopsy of the vaginal tissue was taken. There were 3 groups in this study - group 1 was women with a stage I or II prolapse while the 2nd group was women with a stage III or IIII prolapse. The third group was women with no prolapse. They found a significant significant difference in the connective tissue of group 2 namely degradation of collagen fibers with a decrease in connective tissue strength and elasticity. They found that women with POP had a low ratio of type I:III collagen. Analysis of the collagen content in the vaginal wall in patients with mild POP (I-II) revealed a significant increase in the level of collagen type I and a decrease in the content of type III, compared to patients with more severe POP (III-IV).
We also have evidence to show that pelvic organ prolapse and other collagen-associated disorders may have a common etiology originating at the molecular level of the collagens. A gynecologist and a molecular biologist completed a rodent study and were able to demonstrate that prolapse is caused by a combination of loss of elasticity and breakdown of proteins in the vaginal walls. Chen et al looked at collagen metabolism and turnover in women with stress urinary incontinence and found increased collagen breakdown as a pathologic etiology of incontinence. A similar study found a reduced expression of types I and III collagen in the anterior vaginal wall tissues which may play an important role in the onset of POP.
When looking at connective tissue at the midline of the body, this study compared women with and without diastasis. They found that both type I and type III collagen were less abundant in women with diastasis recti than in those without the condition, and the difference was statistically significant.
This study looked at collagen turnover in urogenital tissue in women with stress urinary incontinence (n=71) and in urologically healthy women (n=31). The study concluded that the low tissue collagen marker levels in women with SUI suggest a reduced collagen turnover, which may negatively affect tissue strength and elasticity.
This small study set out to determine whether there is a difference in collagen metabolism between comparable urinary stress-incontinent and continent women. The research suggests that women with urinary stress incontinence have an altered connective tissue metabolism causing decreased collagen production, which may result in insufficient support of the urogenital tract.
To further understand what we know about collagen and the types in the pelvic floor as well as possible links to POP and other disorders, I highly recommend giving this article a read.
Does Collagen Supplementation Help?
There is no evidence specific to collagen supplementation and the pelvic floor or diastasis recti…yet. Until we have research, we can look at how collagen supplementation helps with other factors in the body, such as skin, muscles, bones, hair, and nails. This study used a specific collagen that is more easily absorbed - bioactive collagen peptide (BCP) - called Verisol®. In the study, they wanted to determine the effectiveness of the BCP on eye wrinkle formation and stimulation of procollagen 1, elastin and fibrillin biosynthesis. Elastin, like collagen, is also a key extracellular matrix protein. Fibrillin is a glycoprotein that gets secreted into the extracellular matrix by fibroblasts and is thought to provide a ‘scaffolding’ for the deposition of elastin. They found that ingestion of the specific BCP promoted a statistically significant reduction of eye wrinkle volume in comparison to the placebo group after 4 and 8 weeks (20%) of intake.
Moreover, a positive, long-lasting effect was observed 4 weeks after the last BCP administration. Additionally, after 8 weeks of intake, a statistically significantly higher content of procollagen type I (65%) and elastin (18%) in the BCP-treated volunteers, compared to the placebo-treated patients, was detected. For fibrillin, a 6% increase could be determined after BCP treatment compared to the placebo, but it was not statistically significant. Their findings demonstrate that oral intake of the specific bioactive collagen peptides (Verisol®) reduced skin wrinkles and had positive effects on dermal matrix synthesis. Knowing that the pelvic floor and abdominal wall have type I collagen, we can speculate that oral intake of this specific BCP may also influence those tissues. With no known risks or adverse reactions to collagen it seems a very low risk option.
Will Collagen Cure My Prolapse or Incontinence or Diastasis?
We have no data on the use of collagen supplementation as it pertains to prolapse, incontinence or diastasis but we also don't have data to show that it doesn't. While I know people with early-grade prolapse or urinary incontinence or diastasis who have seen or felt improvements in their symptoms after using collagen, collagen will not cure the conditions outright. The specific bioactive collagen compound used in the above study shows wonderful results for the skin, and knowing that we lose collagen as we age and that it was mainly type I collagen, which we have in the pelvic floor and abdominal wall, supplementing with collagen seems like a good option for some who are wishing to support their bones, skin, muscles, ligaments, tendons, blood vessels and pelvic floor.
Supplementing with the bioactive collagen peptides and other known beneficial therapies, namely exercise, must be considered. Combining resistance training with collagen peptides can help with bones, muscles and even strength, as found in this study. The objective of the study was to assess the influence of post-exercise protein supplementation with collagen peptides v. placebo on muscle mass and muscle function following resistance training in elderly subjects with sarcopenia. 53 subjects (all male) underwent a 12-week guided resistance training programme (three sessions per week) and were supplemented with either collagen peptides (treatment group (TG)) (15 g/d) or silica as a placebo (placebo group (PG)).
Following the training programme, all the subjects showed significantly higher levels for fat-free mass, bone mass, isokinetic quad strength and sensory-motor control with significantly lower levels for fat mass. The effect was significantly more pronounced in subjects receiving collagen peptides. We can again speculate that there may be a benefit to oral supplementation of a specific bioactive collagen peptide and perhaps see even further benefit if it is combined with the whole body and pelvic floor muscle-specific exercise. A similar study looked at 77 premenopausal women and found that resistance training in combination with supplementation of specific collagen peptides induced a significantly higher increase in fat-free mass and hand-grip strength than resistance training and placebo supplementation.
In addition, there was a significantly higher loss in fat mass and a more pronounced increase in leg strength in the treatment group compared to the control group. We know from this systematic review that collagen peptide supplementation is most beneficial in improving joint functionality and reducing joint pain. We also know from this study that the intake of specific collagen peptides increased bone mineral density in postmenopausal women with a primary, age-related reduction of bone mineral density. In addition, specific collagen peptide supplementation was associated with a favourable shift in bone markers, indicating increased bone formation and reduced bone degradation. Knowing this information and also that as we age, we lose muscle mass and that the menopause transition increases our risks of osteoporosis, joint pain, weight gain and incontinence, perhaps supplementing with collagen would be worth considering as a possible way to slow down or minimize the increased risks we face around midlife? I know that I am not waiting for research about collagen and the pelvic floor. I am supplementing now.
What Else Helps Collagen Production?
This was an interesting article that evaluated the effect of vitamin D in preventing pelvic organ prolapse by aggregating elastin and collagen expression. They looked at cell cultures from the utero-sacral ligament from female patients undergoing hysterectomy. They divided the cells into various groups that would be exposed to different levels of vitamin d and one group that was not exposed to vitamin d at all. They found that vitamin d exposure had a significantly positive effect of increasing extracellular matrix expression with the most effective dose of vitamin d for collagen expression being 800 μM. It is also interesting to note that there is a correlation of low vitamin d with pelvic floor disorders. This study looked at postmenopausal women in particular while this study looked at a broader age range and found that mean vitamin D levels were significantly lower for women reporting at least one pelvic floor disorder and for those with urinary incontinence, irrespective of age. The researchers observed significantly decreased risks of one or more pelvic floor disorders with increasing vitamin D levels in all women aged 20 or older and in the subset of women 50 years and older. Additionally, the likelihood of urinary incontinence was significantly reduced in women 50 and older with vitamin D levels 30 ng/mL or higher.
Which Collagen Supplement Is Best?
There are so many collagen supplements on the market which can make it hard to know which form is best. I have tried a lot and never really noticed much and was always researching new ones because I wanted the best. Then I heard about Verisol® and the associated research (some listed above) and set out to find a product with it because it makes sense to use the one backed by research. The ones I found and now use are Totally Derma (powder form) the ones from Sparkle (see below).
For those interested in trying the Totally Derma Collagen
Below are the coupon codes to get a discount
VAGINACOACH10 – for 10% discount on 30 day supply
VAGINACOACH15 – for 10% discount on 90 day supply
One other one that I am currently trying and like is Sparkle Wellness. They have Verisol as well as other patented and researched forms of collagen for bones and joints and skin. I am trying the skin and the bone ones. When I asked about which is best if I want ALL the benefits, they suggested starting with the one type you want to focus on. (I am starting with the bone one...I had a dexa scan recently so can see the improvement with another test). They also said that all forms of collagen will benefit all parts of the body but specific peptides are more formulated for certain things.
Finally, I am currently obsessed with Fulvic/Humic Acid. Fulvic and Humic Acid are mineral-rich compounds that contain vital nutrients, and vitamins and trace minerals that are in fruits and vegetables but because our soils are so depleted due to mass farming practices, we end up being depleted too.
Humic & Fulvic minerals contain a complex of ionic minerals found within the deep organic soil layers of four distinct climate regions in North America. The trace minerals, electrolytes and amino acids work synergistically together to help relieve the body of toxins, heavy metals and pesticides. Supporting the immune, gastrointestinal and digestive systems, the formula may reduce excess acidity, improve microbial balance and assist in the production of digestive enzymes.
Fulvic/Humic acid helps draw out toxins that hinder your body's ability to absorb nutrients. When you absorb trace minerals and nutrients your skin and hair will benefit. Fulvic/Humic also increases your body's own collagen synthesis and they are an antioxidant so they fight free radicals that can damage skin, hair and nails.
I am currently testing Fulvic/Humic and not taking collagen to see if I notice a difference. Stay tuned!
Female Pelvic Floor Anatomy: The Pelvic Floor, Supporting Structures, and Pelvic Organs https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472875/
- Genitourinary prolapse and joint hypermobility in women https://www.sciencedirect.com/science/article/abs/pii/002978449400386R
- Pelvic organ prolapse and collagen-associated disorders https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282004/
- Protein breakdown contributes to pelvic organ prolapse https://www.sciencedaily.com/releases/2011/05/110524070316.htm.
- Collagen metabolism and turnover in women with stress urinary incontinence and pelvic prolapse https://pubmed.ncbi.nlm.nih.gov/12054187/
- Oral intake of specific bioactive collagen peptides reduces skin wrinkles and increases dermal matrix synthesis https://pubmed.ncbi.nlm.nih.gov/24401291/.
- Collagen peptide supplementation in combination with resistance training improves body composition and increases muscle strength in elderly sarcopenic men: a randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/26353786/
- Specific Collagen Peptides in Combination with Resistance Training Improve Body Composition and Regional Muscle Strength in Premenopausal Women: A Randomized Controlled Trial https://pubmed.ncbi.nlm.nih.gov/31010031/
- The effects of collagen peptide supplementation on body composition, collagen synthesis, and recovery from joint injury and exercise: a systematic review https://pubmed.ncbi.nlm.nih.gov/34491424/
- Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women-A Randomized Controlled Stud https://pubmed.ncbi.nlm.nih.gov/29337906/
- Effect of Vitamin D on Elastin and Collagen Expression: In Vitro Study of Pelvic Organ Prolapse Prevention https://www.ejmed.org/index.php/ejmed/article/view/657/367
Vitamin D deficiency in postmenopausal women with pelvic floor disorders https://pubmed.ncbi.nlm.nih.gov/26167056/
Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey https://pubmed.ncbi.nlm.nih.gov/20308841/
Morphologic structure and immunohistochemical analysis of vaginal wall in women with pelvic organ prolapse https://pubmed.ncbi.nlm.nih.gov/32003161/
Expression and Significance of Metalloproteinase and Collagen in Vaginal Wall Tissues of Patients with Pelvic Organ Prolapse https://pubmed.ncbi.nlm.nih.gov/29263043/
Changes in connective tissue in patients with pelvic organ prolapse—a review of the current literature https://link.springer.com/article/10.1007/s00192-008-0737-1
Collagen I and III in women with diastasis recti https://pubmed.ncbi.nlm.nih.gov/29898006/
Markers of collagen synthesis and degradation in urogenital tissue from women with and without stress urinary incontinence https://pubmed.ncbi.nlm.nih.gov/15924353/
Decreased collagen synthesis in stress-incontinent women https://pubmed.ncbi.nlm.nih.gov/8090397/