Great interview with a Womens Health Physiotherapist with Newbornbaby.com.au regarding Pelvic Floor. No woman will get through her pregnancy without hearing these two little words, and the confusion which often surrounds them can be enough to trigger a minor panic attack. Most of us know it has something to do with bladder control but beyond that, its significance to our bodies and our lives can be vague. Yet it’s extremely important. And the impact on our pelvic floor by pregnancy and birth is something we can work to minimise from conception. To make things a little clearer, we spoke with Women’s Health Physiotherapist and Director of BeActive Physiotherapy, Shira Kramer.    

                              

What is the Pelvic Floor?

The pelvic floor is the base of a group of muscles referred to as the ‘core’. These muscles are located in the pelvis and attach to the pubic bone and the front and tail-bone (coccyx) and the back. “The pelvic floor muscles work together with the deep abdominal muscles and deep back muscles to support the spine,” says Dr Kramer. “They also help to control the pressure inside the abdominal cavity and assist in supporting the bladder, bowel and uterus in women. “In addition they help maintain bladder and bowel control and play an important role in sexual sensation and function.”

How does pregnancy and birth effect the Pelvic Floor?

In pregnancy the hormone ‘relaxin’ is released throughout the body and softens the tissues to accommodate for the growing baby. “This softening effect of relaxing along the increased weight of the baby (and body weight) places pressure on the pelvic floor muscles,” says Dr Kramer. The pelvic floor muscles and ligaments are stretched during childbirth to allow delivery of the baby from the pelvic outlet. 

Will the outcome be the same for everyone?

According to Dr Kramer, there are a number of risk factors that contribute to pelvic floor dysfunction.  These include:

• multiple births
• instrumental births (using forceps or ventouse)
• long second stage of labour
• severe perineal tearing, or
• large babies

Can we help to prevent or minimise Pelvic Floor issues?

“Absolutely!” says Dr Kramer. Pelvic floor muscle exercises are an effective way to maintain pelvic floor strength during and after pregnancy. “Good pelvic floor muscle tone enables women to maintain bladder and bowel control through pregnancy and into motherhood”. “They also help reduce the risk of developing prolapse during and after pregnancy and assist with recovery after birth.”

What can we expect following birth?

Childbirth is essentially a trauma to the pelvic floor muscle. Like any soft tissue injury there may be pain, swelling and inflammation. The pelvic floor muscles take time to get back to their usual state after birth. The effects of the hormone relaxin can last up to 6 months after birth and pelvic floor care post delivery is crucial in the recovery process. Dr Kramer recommends a regime of rest, ice, compression and elevation in the first few days following a vaginal delivery.

Is it important to have your pelvic floor professionally assessed following birth?

“Yes,” says Dr Kramer. Most hospitals have a physiotherapist come and do a postnatal check and give advice on how to care for pelvic floor muscles post delivery. If appropriate they will also teach you how to activate these muscles and give you advice to optimise recovery. Those not assessed in hospital or those requiring follow up should check in to see a local women’s health physiotherapist for assessment and management.

How can we determine the level of impact to our pelvic floor?

Being aware of what signs and symptoms to look out for is crucial.  If in doubt seek a professional opinion. It is recommended to seek professional assessment by a women’s health physiotherapist if any of the symptoms below are experienced:

• accidentally leaking urine when you exercise, laugh, cough or sneeze
• frequently needing to go to the toilet
• finding it difficult to empty your bladder or bowel
• accidentally losing control of your bladder or bowel
• accidentally passing wind, or
• sensation of bulging, dragging or heaviness in pelvic area  (prolapse)
• pain in the pelvic area

What exercises/steps should we take to get our pelvic floor back on track?

Pelvic floor muscle care should be prioritised in pregnancy and in the postnatal period. “For the first few days following delivery rest, ice and compression are recommended,” says Dr Kramer. “Integrating pelvic floor exercises as guided by health care professional is integral to recovery and optimising function. To perform a basic pelvic floor exercise tighten and lift around your front and back passage as if you are holding on to go to the toilet, and releasing. These can be performed during pregnancy as well. “Make pelvic floor exercise a part of your daily life,” says Dr Kramer. “Tightening your pelvic floor muscles every time you cough, sneeze or lift. “Doing some regular exercise such as walking. “Progressing your exercises by doing them during the day in different positions such as standing, sitting or leaning on your hands and knees.”

How do we know if we’re performing the exercises properly?

Ideally an assessment by a women’s health physiotherapist is recommended, as they have a variety of assessment tools which may include a gentle digital examination or an assessment with real-time ultrasound. “At home as a one off test to see if you are on the right track try to stop the flow of urine whilst you are on the toilet. If you can stop the flow you are likely on the right track. If there is no change to the flow you are unlikely activating the muscle correctly.”

Are there any activities to avoid following birth?

“Ease back into exercise and make sure your program is safe for your pelvic floor,” says Dr Kramer. “Avoid high impact exercise such as running and jumping, no lifting unless absolutely necessary and set your pelvic floor muscles before you lift, sneeze or cough. “Also try to avoid constipation, putting on too much weight and repetitive coughing and straining.”

How do we know if things are improving?

A professional can assess for progress by testing the strength (how hard you can squeeze) of the contraction as well as the endurance of the contraction (how long you can hold it for). For many women, it is important to follow a specific exercise program tailored to their individual needs. If you are unsure of whether you are exercising your pelvic floor muscles correctly or you have urinary problems, you should make an appointment with a women’s health physiotherapist. For those of you who are planning a natural birth and still deciding on a labour TENS for pain relief, consider the Elle TENS+ which is an all in one labour TENS, general/sports TENS and a Pelvic Floor Stimulator - which does the Pelvic Floor exercises for you! Alternatively if you don't need a labour TENS consider the  SensaTONE Pelvic Floor Stimulator.