Pelvic floor muscle exercises have been shown to decrease the risk of urinary incontinence (leakage) during pregnancy and after birth by 62% (Woodley, 2020).
Thankfully, women’s secret business is out from behind closed doors. Owing to increased openness, robust discussions relating to the female anatomy, hormonal change, sexuality, and pelvic floor awareness are now more readily available.
Time to sit up and take note.
No longer can the adverse effects experienced by women, including urinary and faecal incontinence (leak of urine or stool), pelvic prolapse, or associated conditions, be responsibly ignored.
Focusing on the antenatal period, hormonal changes, a shift in load distribution in the lumbopelvic region and pelvic floor strain, women can likely expect some pelvic floor dysfunction.
Related to this, the pelvic organs also undergo potential physiological and anatomical change, which can impact this dysfunction.
Constipation is experienced by 38% of the pregnant women. Altered bladder function (increased urinary frequency, urgency, and leakage) and flatus incontinence (inability to hold on to wind) are common signs of pelvic floor dysfunction during pregnancy.
Understanding the Pelvic Floor structure
The muscular construction of the pelvic floor, which hammocks the opening of the pelvic bone at the bottom, is pierced by the urethra, the vagina, and the rectum. The function of the pelvic floor muscles is to aid with urination and defecation while providing support for the pelvic organs.
The pelvic floor muscles also have an important role in sexual function, and are part of the core muscles that coordinate load distribution in the lumbopelvic region.
Can you afford to sit on this?
The main contributors to pelvic floor dysfunction include:
- increased load to the pelvic structures as the baby develops;
- hormonal changes, that soften the connective tissues of the body and promote joint laxity;
- the body’s need to better accommodate the foetus in the pelvic cavity to allow for vaginal birth;
- maternal age, body weight, and genetics.
It is important to reiterate that the gradual change in the mother’s body shape and posture, as the foetus develops, promotes a shift in the centre of gravity and alters the mechanics of the abdominal and pelvic floor muscles.
Preventive strategies to minimise Pelvic Floor dysfunction
There is strong evidence for intensive, supervised, pelvic floor muscle training during pregnancy, to prevent ongoing pelvic floor dysfunction. This approach is currently underprovided throughout antenatal care and awareness of this dysfunction and its debilitating effects is grossly unknown.
A regulated combination of preventive exercises will greatly support more positive outcomes and quality of life for mums to be.
This is not as simple as isolating a regime that focuses on the pelvic floor muscle health alone, even though this is crucial.
Good bladder and bowel habits, which maintains healthy Pelvic Floor function;
- a healthy diet, rich in fibre to help with bowel transit and stool consistency;
- drinking 1.5-2 litres of water daily for bladder and bowel function;
- take your time to fully empty your bladder;
- practice correct toilet positioning – (relaxed tummy, tall spine, lean forward, feet flat when emptying your bladder or on a foot stool when emptying your bowels).
General exercise a contributor
According to Sports Medicine Australia: maintaining a general exercise routine of 150min/week that consists of a combination of moderate intensity aerobic exercise (puffed but can still chat), and of resistance exercises can be very beneficial for many reasons, including:
- reducing Gestational Diabetes Mellitus by 38%;
- reducing Pre-eclampsia (combination of high blood pressure, protein in the urine, and swelling of the extremities) by 41%;
- reducing gestational hypertension (high blood pressure) by 39% (Davenport et al 2018);
- decreasing fatigue, stress, anxiety, and depression (Daley, A. et al, 2014);
- reducing instrumental delivery, improving outcomes for babies (davenport 2019).
N.B. Even though most exercise does not pose risk or adverse effects to birth outcomes; it is important to modify the exercise regime as the pregnancy progresses.
Don’t forget the… Vulva
Good practice for maintaining mucosa health also positively contributes to Pelvic Floor function by potentially decreasing vulva irritation and infections. This could include:
- wear cotton underwear;
- avoid soap in the mucosa area of the vulva;
- avoid the prolonged use of pads and sweaty gym clothes;
- always wipe from the front to the back.
Focusing on Pelvic Floor training
Pelvic floor muscle training consists of exercises that aim to improve the pelvic floor muscle parameters. These include strength, endurance, power, relaxation, and coordination. Individual assessment, under professional supervision (such as a Physiotherapist) is key to determine which parameters need more attention for an individual.
This assessment can be done via vaginal examination or real time ultrasound if vaginal examination is not recommended or preferred.
Do consider that verbal education alone, for Pelvic Floor Muscle exercises, can risk incorrect muscle engagement.
More specific, at the 3rd trimester women instinctively engage in more relaxing exercises that focus on pelvic relaxation and breathing leading to birth.
From 34 weeks onwards a perineal massage protocol can be started and is certainly recommended for women that haven not birthed before, as it reduces the need for interventions (forceps; vacuum extraction; and episiotomy) during birth, potentially reducing the rates of perineal tears.
Where to from here?
The stigma around topics associated with Pelvic Floor dysfunction, which dangerously comes with connotations of cultural shame, cannot be kept confined any longer. This would cause further discomfort and unease for many women.
We cannot control the outcomes of labour, but we can make the most of the tools available to us. We must best prepare physically and emotionally for the demands asked of the Pelvic Floor. My professional advice would be that every pregnant woman consult a Women’s and Pelvic Health Physiotherapist throughout the antenatal period to ensure their wellbeing.
Renata Asinelli is a dedicated women’s and pelvic health physiotherapist with her own stories to tell.
Having initially qualified as a Physiotherapist in Brazil, Renata was involved in establishing and pioneering the first physiotherapy clinic in the border of Colombia and Venezuela, in the Amazon.
Her love of travel and adventure eventually brought Renata to Australian shores 17 years ago.
Since then, she has been happy grounded on the beautiful Gold Coast with her Husband, who is an Osteopath, and their two teenage daughters.
Winding back over a decade, Renata experienced herself the physical challenges related to her first pregnancy. These led her to specialize in women’s health and continence and last year she was completed a Masters in this area of specialization at Curtin University, WA.
Renata continues to focus on creating and facilitating educational events to inform women on tacking pelvic floor related dysfunctions and to support girls in developing a greater understanding and awareness around body and pelvic health.
Find Renata at www.livmotus.com.au/pelvic-health