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Why your pelvic floor needs you

By: Sally Wade BSc (Hons) Ost – Surrey Osteopathic Care


Pelvic floor problems are a common issue after having a baby and usually these issues are blamed on childbirth itself, however this is often not the case. During pregnancy there are lots of obvious signs that the body is changing but the changes that occur to the pelvic floor muscles and nerves are less obvious.


As the baby grows, the weight of the baby and the uterus will create structural changes to the bladder and the urethra. Studies have shown a change in the angle of the bladder neck which can lead to an increase risk of urinary incontinence and this is further increased by the hormonal changes that occur during pregnancy.


Interestingly in a recent study of first time mothers who delivered either by c-section or vaginally found that there was no significant difference in the prevalence of symptoms of incontinence 10 months on from the birth (Lal et al, 2003). This supports the argument that pregnancy is one of the main causes of pelvic floor dysfunction and incontinence in new mums. This being said childbirth itself will have an effect on your pelvic floor, especially if you have a tear or an episiotomy.


So how common are pelvic floor problems after birth?


  • - 60% of new mums report suffering with stress urinary incontinence

  • - 64% of new mums report sexual dysfunction in the first year following birth

  • - 77% of women had lower back pain that interfered with daily tasks

These problems are so common, yet they are so often not talked about and very rarely diagnosed properly. Since the current standard of maternal care doesn’t automatically include a referral for pelvic floor therapy, many women are left with lots of unanswered questions and concerns about their symptoms.


There is a lot of evidence to support the fact that a good pelvic floor training program can reduce urinary incontinence but knowing what to do and how often to do it can be really confusing for a lot of women. Urinary incontinence/leaking is thought to affect up to 1/4 of women however pelvic floor muscle training (PFMT) has been shown in several studies to significant improve or completely get rid of the symptoms of leaking. This is really encouraging for anyone who is suffering with these symptoms however up until recently there has been a lack of research into how best to train the pelvic floor and how often you should be doing the exercises.


A recent paper by Garcia et al (2019) analysed all of the recent studies looking at PFMT and has helped to answer this question. What they found was that PFMT using short sessions (10–45 min) and with a frequency of 3 and 7 days per week creates the biggest change in women suffering with urinary incontinence.

This is quite a big move away from the more traditional approach of women having to do lots and lots of sets everyday, which for most people is just not achievable. This makes sense, as the pelvic floor is still just a muscle and can be trained in the same way that you would train your glutes or your biceps. This also makes PFMT much more achievable - being able to do 10/15 minutes of specific exercises 3/4 times a week is something most of us can

fit in.


What is key is to make sure that you are activating your pelvic floor properly in conjunction with all the supporting muscles. The best way to start is with gentle breathing exercises and gentle contractions of the pelvic floor. Try to link in your breath and the pelvic floor exercises so create a connection between the two:


  •  Take a deep breath in, making sure you feel the ribs and the belly move

  •  Take a big breath out through your mouth right to the end of the breath so you feel like there is no air left in your lungs – at this point you should feel a little contraction of the pelvic floor

  •  Breathe in again and as you breathe out start to try and contract the pelvic floor consciously – try to think of bringing your tail bone and pubic bone closer together to create a contraction through the pelvic floor

  •  Once you are able to feel the squeeze you can try and think of bringing the tailbone and pubic bone together and then lifting as if you were bringing the pelvic floor up towards the ribs – make sure keep doing this on the out breath as this will help create more of a lift.

Using this knowledge of training your pelvic floor like you would any other muscle makes creating a training plan much easier. Like with any other training program we want to gradually build up the difficulty of the exercises that we are doing and gradually add resistance to make them harder.


For example, with the pelvic floor, you might start with just simple pelvic floor squeezes before building into doing these pelvic floor squeezes with more functional movements such as the bridge and the clam. Once you are feeling confident doing those then you can start adding in more difficult movements like the squat and the lunge - first just bodyweight and then adding something such as resistance bands or weights.


Training the pelvic floor should reflect what you do on a daily basis - the traditional way of squeezing your pelvic floor at traffic lights is not enough for a normal busy mum who is lifting their baby and running after their toddler. We need to up the game and add in movements such as squats which will build the strength to allow you to pick up your baby easily and with no leaking.


Sally Wade BSc (Hons) Ost – Surrey Osteopathic Care

 
 
 

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