Pelvic Floor Health in Pregnancy and Beyond
Recent reports highlight a growing issue: many women in the UK experience pelvic floor dysfunction, and a large number of these battle on without seeking help. Pelvic floor dysfunction can have many symptoms, including leaking urine when laughing or coughing, a feeling of heaviness in the pelvis, or even pain during sex are common. Unfortunately, many women endure these issues in silence, possibly due to embarrassment or fear of stigma an judgment. It’s important for women to know that there are ways to manage and treat these problems.
How Pregnancy and Birth Affects the Pelvic Floor
The pelvic floor consists of muscles and ligaments that support the bladder, uterus, and bowel. When you’re pregnant, the extra weight of the growing baby puts pressure on the muscles surrounding these structures. Hormonal changes can also cause the muscles to soften, leading to potential weakness even before labour starts. Childbirth can further affect the pelvic floor, particularly if there is a long stage of pushing during the second stage, an episiotomy, or forceps. In these situations the muscles can stretch and sometimes become damaged. It’s a common misconception that having a caesarean will avoid pelvic floor issues. Although having a vaginal birth that’s prolonged or comes with interventions is a contributing factor, the strain of pregnancy itself is the most significant component to pelvic floor dysfunction.
Some women notice symptoms right after giving birth, such as leaking urine when they sneeze or struggling with gas. Others might not experience problems until many years later. A more serious issue that can arise is pelvic organ prolapse. This occurs when severely weakened muscles allow the bladder, bowel, or womb to drop into the vagina, leading to discomfort and a heavy feeling.
Protecting the Pelvic Floor
While some strain on the pelvic floor during pregnancy is unavoidable, there are things that you can do to strengthen these muscles both before and after you have a baby. One effective method is doing pelvic floor exercises, also known as Kegels. These exercises can be performed throughout pregnancy to help build and strengthen the muscles. To do these exercises correctly, think about trying to stop the flow of urine midstream. It’s important not to make this a habit, as it can negatively affect bladder function. Holding the contraction for a few seconds and then releasing it can help keep the muscles strong.
Diet can also influence pelvic floor health. Although hormones during pregnancy can contribute to constipation, a poor diet that lacks in fibre, or enough water, is a contributing factor that can be avoided. Straining to pass stools can weaken pelvic muscles, in addition to causing haemorrhoids. Ideally you’ll want to drink plenty of water and consume fibre-rich foods to maintain regular bowel movements and minimise pushing.
Perineal massage during pregnancy is a great way to reduce the risk of significant perineal tears during birth, and research has proven this to be effective. Starting at around 34 weeks of pregnancy, women can try perineal massage, which involves gently stretching the area between the vagina and anus a couple of times per week.
Postnatal Recovery
After giving birth, it’s normal for the pelvic floor to take time to regain strength, but with a proper approach, a good recovery is more likely. Women should restart pelvic floor exercises as soon as it feels comfortable or when your health care provider advises you to. Even if the muscles feel weak initially, staying consistent is key.
Many women are excited to get back into exercise after having a baby. Gentle walking and stretching is recommended in the early days when you are feeling up to it, but high impact exercises that involve running or jumping should be avoided for a while, as these can put more strain on the pelvic floor. This gradual approach allows the body to adjust without overloading weakened muscles. There are many postnatal recovery physios and fitness coaches that are able to give good advice on exercising after birth. After a caesarean, its generally considered safe to start low impact exercising after 6 weeks, as long as all is well.
When to Seek Help
If symptoms such as leaking urine, pain, or a feeling of heaviness in the vagina continue beyond the early postnatal period, it’s crucial to seek help. Any bowel incontinence should be discussed with your doctor. Pelvic health physiotherapists specialise in assisting new mums in regaining strength and function in the pelvic area and core. They often use tailored exercises and hands-on treatment to assist with recovering.
Sadly, many women think that pelvic floor issues are simply a part of motherhood and do not seek the help they need. However, assistance is available, and treatment can drastically improve quality of life. The Royal College of Obstetricians and Gynaecologists has emphasised the need for greater awareness of pelvic floor dysfunction, acknowledging that these problems should not be viewed as an inevitable outcome of having children.