Postpartum Pelvic Health Advice From a Physio
It’s helpful to understand the role of the pelvic floor and how you can strengthen it with daily exercises.
With Caitlin Day, Pelvic Health Physiotherapist from Unity Studios. unitystudios.co.nz.
Q: What is the pelvic floor and what is its role?
The pelvic floor muscles sit between the pubic bone and the tailbone. They are the 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 controlling the opening and closing of the passageways so that we can control continence which is when we decide we want to open our bladders and bowels. They help to support the pelvic organs and prevent prolapse. The pelvic floor also gives us sexual function and supports our lower back, hip and pelvic joints.
Q: What effect can birth have on the pelvic floor?
The pelvic floor muscles stretch up to two and a half times their resting length during a vaginal birth, which is really amazing! No other muscle in the body can do that without completely failing. This not only shows us how incredible the pelvic floor muscles are, but also how much rest, rehabilitation and recoiling they need, even after an uncomplicated vaginal birth. It also shows that the muscles will likely be much weaker after a vaginal birth, and need time and work to get them stronger again.
On top of this, a vaginal birth can result in pelvic floor issues like:
- Prolapse – approximately 50% of women who have been pregnant have a prolapse.
- Levator avulsion – where the muscle is pulled away from its attachment to the pelvic bones.
- Perineal and vaginal tearing – approximately 80% of vaginal births end up in a tear, but most tears are minimal and heal well. About 5% of vaginal births end up in a third or fourth-degree tear or one that extends into the muscles/tissues around the anus.
Pregnancy itself has a big effect on the pelvic floor, so a C-section is not completely protective of pelvic floor changes either. The pregnancy hormones, extra weight of the baby, and change in posture during pregnancy can have a lengthening and weakening of the pelvic floor muscles too. So, they still need some rehab after a C-section. Furthermore, pelvic floor muscles can spasm in response to pain, so some people might need to focus on ‘downtraining’ or relaxing their pelvic floor after birth too.
Basically, after any kind of birth, the pelvic floor needs a little bit of love and attention, so that it can go back to doing its jobs of sexual function, bladder and bowel control, and pelvic support effectively.
Q: When should a woman see a pelvic health physiotherapist after birth?
A ‘postnatal check’ is recommended at about 6-8 weeks after birth, but it’s never too late to see a pelvic health physiotherapist. If you have pelvic floor dysfunction symptoms like bladder or bowel leakage, a third or fourth-degree tear, painful sex, prolapse, or pain, your LMC can refer you to the pelvic health physiotherapists at your DHB (district health board). Otherwise, you can seek help from your local private practice pelvic health physiotherapist (no referral needed).
Q. Can you explain how to do pelvic floor exercises correctly?
They’re tricky; 30% of women think they’re squeezing their pelvic floor, but they’re actually doing something different. The only way to really know if you’re contracting and relaxing them correctly is to have an assessment with a pelvic floor physiotherapist.
To activate these muscles 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 aren’t:
- 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!
A good way to start is squeeze and hold your pelvic floor for five seconds, relax fully for five seconds and then repeat for five sets.
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.