Without a doubt, during your pregnancy you’ll hear the term ‘pelvic floor exercises’. But do you really need to do these regularly? And if so, how do you know if you’re doing them correctly?
Because the pelvic floor is an ‘invisible’ muscle, located within the pelvis, it’s shrouded in a lot of mystery. It’s not like your bicep muscle, or your quads muscles, where you can easily see if you are activating them correctly and whether or not your strength is improving.
But it’s an extremely important muscle group, which helps to stop leaks from your bladder and bowel, helps to support your pelvic organs (bladder, uterus and bowel) to prevent prolapse, and plays an integral role in sexual function and enjoyment.
Pelvic floor exercises, or ‘Kegels’, have been shown in many different studies to be effective in the treatment of bladder leakage during exertion (correctly termed ‘stress urinary incontinence’) and vaginal prolapse. Even better, it’s been shown in some studies that women who did regular pelvic floor exercises during pregnancy (as long as they were assessed to ensure they were doing these correctly), were less likely to develop these common problems, and less likely to have complications during birth.
The effect of pregnancy on the pelvic floor
The reason that pelvic floor exercises should be commenced during pregnancy is because this is a time of change for the muscles. There are two things that occur to make women more prone to pelvic floor dysfunction during pregnancy:
- The pressure from the always increasing weight directly onto the pelvic floor from the growing baby. Other things in life, like obesity and regularly lifting heavy loads, can increase the risk of pelvic floor issues in the same way.
- The hormonal changes that occur to make everything more flexible to allow the baby to be able to pass through the pelvis during delivery. The fact that this starts to occur right from conception means that some pelvic floor issues can occur long before the baby’s weight becomes a factor.
The effect of birth on the pelvic floor
Pregnancy is the time when the body is gradually preparing for a vaginal birth. The process of the space between the two sides of the pelvic floor getting bigger, and the softening of all of the connective tissue around the pelvic floor, doesn’t discriminate with regards to whether you end up having a Caesarean section or not. It’s being pregnant, rather than the way you deliver, that is shown in research to be the biggest predictor of having pelvic floor dysfunction down the track.
However, during a vaginal birth (or when labouring in general, even if you end up with an emergency caesarean), there is a very large amount of stretch and pressure directly onto the pelvic floor muscles.
It’s very common for injuries to occur to the pelvic floor and surrounding tissues, and although they usually heal very well (thanks to our body’s amazing ability for recovery), we do need to be aware that these injuries are the same as sporting injuries and should be diagnosed and rehabilitated properly to avoid long term issues.
Although with a Caesarean section (if you did not labour) the pelvic floor will not have undergone the same direct pressure and potential injuries, we still need to be aware of the effect that a surgical incision in the lower abdomen may have in the overall support and function of the pelvic region.
What can we do to prepare our pelvic floor muscles for delivery?
It is highly recommended that all pregnant women regularly exercise their pelvic floor muscles.
However, research has shown that by only being verbally instructed in how to do this, you are not necessarily going to end up doing these exercises correctly. In fact, studies have shown that approximately half of women may contract these muscles in a way that either doesn’t help, or actually may do harm by bearing down instead of elevating the area.
The health professionals who have undergone training to be able to assess and treat pelvic floor issues are called ‘Women’s Health & Continence Physiotherapists’ or ‘Pelvic Health Physiotherapists’.
These physiotherapists can use a real time ultrasound machine on your lower abdomen, or do a vaginal examination, and let you know if you are activating the muscles correctly. They can then take the results of the assessment and put in place a program that will specifically help you.
Because more is not necessarily better, and stronger squeezing is not necessarily the key. In fact, about 20% of women have what is called an ‘overactive pelvic floor’, which doesn’t relax completely and ends up being weak because it is tired and unable to function correctly. If this is picked up on assessment, the woman would be given ‘down training’ exercises. It is obviously very important in preparation for a vaginal birth to ensure that you know how to relax and let go of those muscles.
What can we do after birth to get our pelvic floor as strong as possible?
Pelvic floor exercises can be restarted as soon as is comfortable after birth – this could be in the first few days.
Ideally you will have been assessed during pregnancy to ensure that you are doing this correctly, and you can simply pick up where you left off.
At approximately 6-8 weeks post birth, it would be ideal to re-visit the specialist physiotherapist to recheck your pelvic floor and have any injuries assessed and managed before returning to sport and exercise. This time frame is when the bleeding has stopped and you’ve been given the medical all clear to recommence exercise.
However, even before the 6 week mark, there are plenty of other things that you can do to ensure that your recovery, and your pelvic floor health, is as good as possible. A gentle return to cardio exercise and strength work, a focus on good posture and lifting technique throughout the day, and a regular stretching regime will ensure that you are holistically looking after your pelvic floor and preparing yourself for a smooth return to your exercise goals and daily life as a new Mum.
Written by Taryn Watson
Pelvic Health Physiotherapist
Owner & Founder of FitRight Physio
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