Elizabeth Evans outlines the reasons why maintaining pelvic-floor muscles is so important during and after pregnancy.
Until the childbearing years, many women don't pay much attention to their pelvic-floor muscles. Then they enter a phase in which they are suddenly advised they should be exercising this part of the body.
The problem is, women often feel confused as to exactly what they are supposed to be doing, and instructions in brochures don't really help. It ends up being just one more item on an ever-growing to-do list during pregnancy. And as there are often no signs of pelvic-floor weakness before pregnancy, it drops further and further down the list of priorities.
However, women need to understand the role the pelvic floor plays, and the effect the childbearing years have on these muscles' function.
Role Of The Pelvic Floor
The pelvic floor is a group of muscles that sit deep within the pelvis, running from the pubic bone at the front, wrapping around your bladder, vagina and bowel, then connecting to your tailbone. There is always a certain level of subconscious activation in the muscles called 'resting tone', which helps with spinal support and maintaining continence during low-level activity.
The muscles also can increase strength during higher-load activities such as lifting, sneezing and running, or when you have a strong urge to go to the toilet. If the muscles are unable to increase strength when needed, symptoms such as urinary and bowel incontinence and pelvic organ prolapse (when pelvic organs bulge or sag into the vagina) can appear.
The pelvic floor also plays an important role in sexual function, as it must be able to relax to allow penetration, and then contract for sensation and orgasm.
Effects Of Pregnancy, Delivery And The Postnatal Period
Pregnancy is often the first time the pelvic floor is really challenged, and as a result many women experience the first signs of weakening, such as leaking during a sneeze. This is because there is an average weight gain of 12kg-18kg during pregancy, which dramatically increases loading through the pelvic floor and bladder. There is also a natural softening of the pelvic-floor muscles due to hormonal changes, which helps minimise obstruction to the pelvic outlet during birth.
Whether a woman has a vaginal delivery or caesarean, there will still be a degree of pelvic-floor weakening due to changes during pregnancy. However, a vaginal delivery places additional stress on the pelvic-floor muscles. In particular, women who have babies weighing more than 4kg, have a forceps or ventouse delivery, or push for longer than two hours, will have greater strain on their pelvic floor and will need to work at strengthening the muscles in the postnatal period. During this period, the pelvic floor starts to recover from the pressure of the birth, the healing of stitches and the hormonal effects of pregnancy. However, there is a new load placed on the pelvic floor from constantly lifting a newborn (and in many cases a jealous toddler as well). As the baby gets heavier, so does the load, and learning how to activate your pelvic floor during lifting plays a crucial role in minimising further pelvic-floor weakening.
So What Can You Do?
The truth is, many physical consequences of the childbearing years are unavoidable, so don't be too hard on yourself. However, there are a few things you can do to minimise ongoing effects on the pelvic floor, such as:
• Avoid becoming constipated, as this strains the pelvic floor. Increase your water intake and ensure you are getting large amounts of soluble fibre from foods such as porridge, dried fruits, and psyllium husks (a type of plant seed available from supermarkets, chemists and health-food stores). In some cases, a supplement may be needed. Consult your doctor or pharmacist.
• When opening your bowels, take your time. Lean forward, place your elbows on your knees and rise up on your toes. This position helps to open your bowels with the least amount of pressure on the pelvic floor. Be sure not to hold your breath, push or rush, as an extra minute on the toilet can make a difference to your pelvic floor in the long term.
• Minimise heavy lifting, and if you do weights at the gym, sit on an exercise ball to do arm weights, and ensure you are not holding your breath.
• Learn to activate your pelvic-floor muscles during increased loads, such as when you sneeze, cough or lift.
The most useful activity is regular pelvic-floor exercises. A health professional such as a physiotherapist or gynaecologist can teach you the correct technique. Try to make these exercises a part of your daily routine, such as during your normal exercise routine or while breastfeeding. Pelvic-floor exercises play a vital role in preventing and treating symptoms such as incontinence, prolapse and sexual dissatisfaction, and are most important during the childbearing years.
Elizabeth Evans is a senior physiotherapist at Sydney's Royal Hospital for Women and is founder of physiotherapy clinic Women In Focus, specialising in women's health.