Kiddipedia
(Osteopath)
As all pregnant women would testify, a fetus growing into a tiny baby puts pressure on your bladder. This causes you to do more laps to the bathroom than an Olympic relay. As the husband of a 3-time pregnancy champion, I’m just as awake as she is for those dashes to the bathroom. During our second pregnancy, my wife was surprised how less in control she was of those full bladder urges. She made this apparent to me almost daily, at 2am in the morning. I replied that the second time around, her pelvic floor was a little weaker having already been through one natural birth and she’s had less time to spend doing her strength work after baby No1.
Being an Osteopath, I’ve had the privilege to treat many women through their pregnancies. It’s given me a rare understanding of the changes a woman’s pelvic floor goes through. Although at 2am in the morning, explaining these changes wasn’t really what we both felt like talking about. Now we’re at baby No3, and she’s graciously allowed me to mansplain the role of the pelvic floor in pregnancy. So here goes:
The pelvic floor is a group of muscles, ligaments, connective tissue and fascia. They begin at your pubic bones, surround your vagina and anus, and connect to the bottom of your tailbone and the bottom of your pelvis (the part you sit on). Most muscles in the body are generally vertically aligned, meaning they go up and down the body. Think of your abdominal or back muscles.
The Pelvic floor is different because it cross-sections the body. So if you can imagine a room, the front wall is your abdominals, the back wall are your back muscles, the ceiling is your diaphragm, and the floor is, you guessed it, the pelvic floor. Like the diaphragm it goes across your body, and that’s why another name for it is the pelvic diaphragm.
The pelvic floor supports the organs sitting inside the pelvis, including your uterus, your bowel and your bladder. And through your pelvic floor, there are cavities to allow passage for your rectum and vagina. The pelvic floor is designed to stretch, move, contract and bounce back. It’s heavily active when going to the toilet and having intercourse.
During pregnancy the pelvic floor is under continuous stretching over the 9 months of pregnancy. And as your baby grows and the muscles stretch, it becomes harder for the soon-to-be mum to contract those muscles and control their function. Hence the bolt to the bathroom in world-record time.
The muscles of the pelvic floor attach to various parts of the pelvis, but also have connective tissue attachments to other muscles that control the hips, lower back and abdomen. This can play a contributing role in the development of lower back pain post birth. So knowing this, it’s easy how any of these areas can be affected by the pelvic floor and why pelvic pain can be so broad, and painful! But it’s not all bad news, the stretch of these muscles is necessary for the eventual natural childbirth and will eventually allow for the baby to turn and engage when the time is due.
During labor, a healthy pelvic floor will still provide some resistance against the abdominal muscles and diaphragm as mum attempts to push the baby out. This may help with speeding up the process once dilation happens and the party starts. With C-sections, a healthy pelvic floor takes up some slack from, and provides some control for the weakened abdominals.
So what can be done to help keep the pelvic floor healthy? Well a strong pelvic floor is a healthy one, and there a things you can do to make sure your pelvic floor is strong:
Pre-Pregnancy: Do some strength training. Women of pregnancy age have the capacity to be strong. Don’t waste your time here with Aerobics. This means lifting some weights. Do squats and deadlifts where you progressively and gradually increase the weight you use. Practice these using a Valsalva technique (holding your breath hard through the whole movement) and you will engage the pelvic floor muscles in the squats and deadlifts. Use a professional to help you with these.
Pregnancy: If you’re already adapted to squats and deadlifts pre-pregnancy, you should be able to continue to do them through your 1st and 2nd trimester. Doing these in your 3rd trimester will largely depend on your size and fatigue levels. The general rule is, if you’ve been doing exercises pre-pregnancy, you can continue. Don’t start anything new when you’re pregnant. You can do more targeted exercises like squeezing your abs and bum tight whilst holding a hard breath. MAintaining a heathy sex life thorugh this period will also hep will muscle function and blood flow.
Post-Pregnancy: If post C-section, wait for the go-ahead from your obstetrician to begin gentle exercise and then progress back up slowly towards the strength training you were doing pre-pregnancy. With natural births, given no complications (eg; seperrated pubis) you can begin the process of regaining strength much sooner and more aggressively. Returning to normal sexual function is a product and a sign of good pelvic floor recovery.
There are some more serious complications of pelvic floor dysfunction that you need to watch out for. Genito-urinary prolapse can happen when the pelvic floor becomes so weak that it is unable to hold the contents of the pelvis. This can also be accompanied with chronic incontinence. You should consult your GP who will work with a gynecologist to improve this condition. Sexual Dysfunction can also result from poor pelvic floor function, so it’s important to return this to normal as soon as possible.
For the most part, the dash to the bathroom will be the first sign of a stretching pelvic floor. Hopefully, if you pay attention and take care of your pelvic floor, it will take care of you in the hour of your need. There’s no reason that with good rehabilitation and a focus on strength, as well as a sprinkle of attention from your Osteopath/Physio/Chiro, that you can’t have multiple children and have a healthy pelvic floor that is totally under your control.
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