Can Creatine Supplementation Help The Pelvic Floor?

In the realm of fitness and wellness, creatine monohydrate has long been celebrated as a powerful supplement for enhancing strength, muscle mass, and overall athletic performance. However, its benefits for women have often been overshadowed or misunderstood. Contrary to common misconceptions, creatine monohydrate is not just for men pumping iron in the gym. In fact, emerging research suggests that women can also harness the transformative power of this supplement to unlock their full potential in various aspects of physical fitness …maybe even pelvic floor fitness? Let's delve into the science-backed benefits of creatine monohydrate for women.

What is Creatine?

Creatine is a naturally occurring compound found in small amounts in foods like meat and seafood. Your body makes it from 3 amino acids; arginine, glycine and methionine. Your liver, kidneys and pancreas make about 1 gram of creatine daily that gets transported to your muscles which store about 95% of your creatine. (Of note here is that women have 70-80% fewer creatine stores than men which is one reason why supplementing is beneficial). We benefit from 4-5 grams of creatine daily which means if we were to rely on diet alone you would have to eat A LOT of meat and seafood (over 2 lbs) which is why supplementing is beneficial and arguably essential.

Creatine plays a vital role in energy metabolism, particularly during short-duration, high-intensity activities like weightlifting or sprinting. Creatine supplementation can enhance muscle strength and performance by increasing ATP availability, promoting muscle protein synthesis, buffering lactic acid build-up, and improving recovery between workouts. These effects make creatine a popular and effective supplement for athletes and fitness enthusiasts looking to maximize their training results, however you don’t need to be an athlete to benefit from the effects of this amazing supplement.

How Does Creatine Help With Muscle Strength? 

Increased ATP Availability: Adenosine triphosphate (ATP) is the primary energy currency of cells and is required for muscle contractions. During intense exercise, ATP stores become depleted rapidly. Creatine helps by serving as a rapidly available reserve of high-energy phosphate groups that can be used to regenerate ATP from adenosine diphosphate (ADP) during short bursts of intense activity. This regeneration of ATP allows for sustained muscle contractions and improved performance during high-intensity activities.

Enhanced Muscle Cell Volume: Creatine supplementation can lead to an increase in water content within muscle cells, a phenomenon known as cellular hydration or volumization. This increase in muscle cell volume can contribute to the appearance of larger and fuller muscles, which may provide a psychological boost to athletes and bodybuilders. Additionally, the swelling of muscle cells may stimulate muscle protein synthesis and hypertrophy, leading to gains in muscle mass over time.

Improved Muscle Protein Synthesis: Creatine supplementation has been shown to enhance muscle protein synthesis, the process by which muscle fibers repair and rebuild themselves in response to exercise-induced damage. By promoting greater protein synthesis, creatine supplementation can accelerate the repair and growth of muscle tissue, leading to increases in muscle mass and strength over time.

Buffering Lactic Acid Build-Up: During intense exercise, the accumulation of lactic acid in muscles can contribute to fatigue and muscle failure. Creatine supplementation may help to buffer the build-up of lactic acid by providing additional ATP, allowing athletes to maintain higher levels of intensity and performance for longer durations before fatigue sets in.

Improved Recovery: Creatine supplementation has been shown to reduce markers of muscle damage and inflammation following intense exercise, leading to faster recovery times between workouts. This can allow athletes to train more frequently and with higher volumes, ultimately leading to greater gains in muscle strength and size over time.

How Can Creatine Benefit Women?

In this eloquent article the benefits of creatine throughout the female lifespan highlights the numerous and well-established benefits of creatine supplementation for women.  Of particular note is the arguably essential role creatine plays post menopause.  It is known that estrogen and progesterone alter creatine bioavailability as well as the enzymes that synthesize creatine in the body. Post menopause when estrogen and progesterone are low the uptake of creatine may be hindered which would support creatine supplementation especially for this population.

Enhanced Strength and Power: Traditionally, creatine monohydrate has been synonymous with strength and power gains among male athletes. However, recent studies have shown that women can experience similar benefits. Research published in the "Journal of the International Society of Sports Nutrition" indicates that women supplementing with creatine experienced significant improvements in strength and power output during resistance training, compared to those taking a placebo. This increase in strength can be particularly advantageous for women aiming to enhance their performance in sports, weightlifting, or everyday activities.

Another study demonstrated that older women supplementing with creatine had significant gains in muscle strength, especially when they combined creatine with resistance training for at least 24 weeks.

This study showed that Creatine supplementation among pre-menopausal females appears to be effective for improving strength and exercise performance. Post-menopausal females may also experience benefits in skeletal muscle size and function when consuming high doses and favourable effects on bone with combined with resistance training. When combined with resistance training, the vast majority of research supports the efficacy of creatine supplementation (≥5 g·d⁻¹) for improving measures of muscle accretion, strength and tasks of physical performance in post-menopausal females

A study published in the Journal of the American Geriatrics Society in 2003 investigated the effects of creatine supplementation on muscle strength and body composition in older adults. The researchers found that creatine supplementation combined with resistance training led to greater gains in muscle strength and lean body mass compared to resistance training alone in older men and women.

Sarcopenia: Sarcopenia is the age-related loss of muscle mass and strength. We need our muscles for exercise but also activities of daily living and for things like balance and mobility. A decrease in muscle mass increases the risk of falling and disability and death. A review published in the Journal of Cachexia, Sarcopenia and Muscle in 2017 summarized several studies indicating that creatine supplementation can attenuate the progression of sarcopenia by improving muscle mass, strength, and physical performance in older adults.

While resistance training is considered the gold standard for the treatment of sarcopenia, more and more evidence indicates that creatine supplementation may enhance the anabolic environment produced by resistance training, subsequently mitigating indices of sarcopenia. 

Most studies suggest that creatine is most effective when there is resistance training used as a stimulus but this study indicated that creatine supplementation without associated training in the elderly could potentially delay atrophy of muscle mass, improve endurance and strength, and increase bone strength, and thus may be a safe therapeutic strategy to help decrease loss in functional performance of everyday tasks

Muscle Growth and Lean Body Mass: One of the key mechanisms behind creatine's muscle-enhancing effects is its ability to increase intracellular water retention within muscle cells, leading to volumization and enhanced protein synthesis. While some women may be concerned about getting bulky muscles, the reality is that creatine monohydrate can promote lean muscle growth and improve body composition without causing excessive mass gain. A study published in the "European Journal of Applied Physiology" found that women supplementing with creatine experienced greater gains in lean body mass compared to those not taking the supplement. This is particularly beneficial for women striving for optimal body composition.

Bone Health and Injury Prevention: Maintaining strong and healthy bones is crucial for women of all ages, especially as they navigate the hormonal changes associated with various life stages. Interestingly, emerging evidence suggests that creatine supplementation may contribute to improved bone health and reduce the risk of injuries, such as stress fractures. A study published in the "Journal of Musculoskeletal & Neuronal Interactions" found that creatine supplementation positively influenced markers of bone turnover and bone density in female athletes, potentially enhancing skeletal strength and resilience. Compared with strength training alone, creatine can help support bone mineral density to reduce the risk of fractures and frailty.

This study showed that Twelve months of Creatine supplementation during a resistance training program preserves femoral neck bone mineral denisty and increases femoral shaft superiosteal width, a predictor of bone bending strength, in postmenopausal women.

Cognitive Benefits: Beyond its physical benefits, creatine monohydrate also exerts positive effects on cognitive function, which can be especially relevant for women in perimenopause and post menopause who are losing the support of estrogen while also juggling multiple roles and responsibilities. Research published in the "Journal of the International Neuropsychological Society" suggests that creatine supplementation may enhance cognitive performance, particularly in tasks requiring short-term memory and intelligence. This cognitive boost may help women to feel and stay focused, and mentally sharp, whether they're tackling demanding workouts or navigating everyday roles and responsibilities.

Creatine has also been shown to help women with a major depressive disorder. A review found that women who took 5g of creatine alongside their daily antidepressant responded twice as fast and experienced remission of their depression at twice the rate of women who took only the antidepressant. 

Does Creatine Help The Pelvic Floor Muscles?

There is currently no research on creatine specific to the pelvic floor muscles as a whole but given all of the benefits we have explored about creatine and its effects on skeletal muscle, and bone, we can infer that there could be benefit to the skeletal muscles in the pelvic floor and benefits to the bony scaffolding of the pelvis as well. There is one pilot study that looked at women with stress urinary incontinence who took a supplement containing creatine among other ingredients. The women also received daily pelvic floor muscle training for 6 weeks. The results of the pilot study showed that the women taking the supplement and doing the pelvic floor muscle training had significantly improved urinary symptoms. 

Creatine supplementation is most effective for high-intensity, short duration activities or repeated bouts of high-intensity exercise with short rest periods such as jumping, sprinting, and resistance training.  These are activities that many women avoid doing because they are afraid of leaking or of their prolapse worsening.  What if women supplemented with creatine while participating in whole body pelvic floor exercise like the buff muff method.  Starting with mind body connection, practicing activating and relaxing the pelvic floor with the breath and then adding this into whole body movement that you then progressively load?  We have no evidence yet but I for one am not waiting for the evidence.  We have loads of research to support the benefits of creatine as well as the safety of the supplement. 

I work daily to maintain my pelvic floor and whole body muscle mass and bone health and also promote this lifestyle to my community. The benefits of a strong and resilient pelvic floor are many and it also enables women to participate in high intensity activity without symptoms of leaking and prolapse which in turn will benefit their whole body and pelvic floor. Whole body resistance training is not enough to strengthen the pelvic floor – we need pelvic floor muscle training as well as whole body resistance training.  We have evidence to show that kegels done prior to resistance training is more effective than kegels alone and kegels done as part of whole body resistance provided earlier benefit…and this was in elderly women.  It would be interesting to see further research where we also compare both groups to those using kegels and resistance training and creatine.

 Standard pelvic floor muscle training itself is not considered high intensity per se but perhaps creatine would allow for a higher number of reps to be performed and/or better recovery after each set.  Pelvic floor muscle training intensity can also be increased with pelvic floor weights which is considered resistance training so we have a lot of opportunity for exploration here.

The scientific landscape surrounding creatine monohydrate has evolved, shedding light on its diverse benefits not only for male athletes but for women across different facets of health and performance. From amplifying strength and muscle growth to enhancing cognitive function and supporting bone health, creatine stands as a formidable ally for women striving to unleash their full potential. With informed guidance and strategic supplementation, women can harness the power of creatine to redefine their limits and embark on a journey of strength, vitality, and resilience.

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