What you need to know about the pelvic floor during and after birth

Many people haven’t given their pelvic floor much attention before falling pregnant, if it’s functioning well. Hopefully, your health professionals start to mention it throughout pregnancy, or maybe you’ve heard it from your friends who have been pregnant. So, what is it? And why do you need to pay attention to it now that you’re pregnant? What happens to it during pregnancy, birth and after birth?


What is your pelvic floor?

The pelvic floor muscles sit at the floor of the pelvis. They are a ‘hammock’ of muscles that sling around the three pelvic openings (urethra, vagina and rectum) and help to give us bladder and bowel control. The pelvic floor is responsible for:

-      Giving us control over our bladder and bowels and prevent leaking of urine and feces.
-      Giving support to the pelvic organs (bladder, bowels and uterus) and preventing prolapse.
-      Supporting our lower back, hip and pelvic joints.
-      Sexual function.


What happens to your pelvic floor during pregnancy?

The pregnancy hormones (namely relaxin) can have a lengthening and weakening effect on the pelvic floor muscles. Plus, the weight of the baby, uterus, placenta, breast tissue and extra fluid can stretch these muscles over the course of pregnancy. When the pelvic floor isn’t working properly, you might have symptoms such as:

-      Urine leakage when coughing, laughing or running.
-      You can’t hold on to your bladder for as long as you used to be able to.
-      Bowel urgency (not being able to hold onto your poo).
-      Heaviness or bulging in the vagina (prolapse – where the pelvic organs drop down into the vaginal region).
-      Difficulty emptying your bladder or bowel properly.
-      Reduced sexual sensation or painful sex.


What happens to your pelvic floor during birth?

During a vaginal birth, the pelvic floor muscles stretch about 2.5 times their resting length. Which is really amazing actually; no other muscle in our body can do that without completely failing! But it does highlight why many people have pelvic floor issues after birth: 1 in 3 women will leak urine, 50% of people that have ever been pregnant will have vaginal prolapse, up to 25% of people will leak feces or gas after childbirth. All of these things are really common, but not normal. Luckily, there are lots of things you can do to improve your symptoms.


How can I prepare my pelvic floor for childbirth?

Individualised pelvic floor exercises during pregnancy have been shown to reduce the rate of these things afterbirth. The reason pelvic floor exercises need to be individualised, is that we all need to work on different things: strength, endurance, co-ordination or maybe relaxing these muscles. Also, 30% of women think that they are contracting their pelvic floor correctly, but they’re doing something different. That’s a lot of people! The only way to really know if you’re doing it right is to have a pelvic floor assessment with a pelvic health physio.


How do I activate my pelvic floor?

To activate these muscles, try squeezing the pelvic floor muscles inwards from the sides, and lift them up inside of you. Try the following cues:

-      Imagine stopping the flow of urine.
-      Try to hold in wind.
-      Visualise squeezing and holding a tampon in.

When you are trying to activate them make sure you’re not:

-      Holding your breath.
-      Squeezing your butt cheeks/legs/tummy muscles.
-      Straining or bearing down.

No one should be able to tell that you’re doing it!


What are some good pelvic floor exercises? 

A good way to start is squeeze and hold your pelvic floor for 5 seconds, relax fully for 5 seconds and then repeat 10 times. You can also try “quick flicks” where you contract then relax your muscle 15 times as quickly as you can. Remember to relax completely in between each contraction! Try these exercises 2-3 times per day.


If you want to do the best thing possible for you and your pelvic floor during and after pregnancy, do these things:

-      Book in for a prenatal pelvic floor assessment with a pelvic health physio to make sure you’re doing your exercises correctly, and learn ways to keep your pelvic floor healthy.
-      Do your pelvic floor muscle exercises 3 times a day, every day, right up to birth.
-      Start your pelvic floor exercises again, a few days after birth.
-      Spend the first 4-6 weeks afterbirth resting, doing your daily pelvic floor exercises, and gently walking for exercise to help your pelvic floor rest, recover, recoil and rehab.
-      See your pelvic health physio again at 6 weeks postnatal for a postnatal check and to start a whole body rehab programme.

Your pelvic floor will thank you for it, both now, and in the future after menopause!

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