Taking Care of Your Pelvic Health in Pregnancy

With Caitlin Day, Pelvic Health Physiotherapist from Unity Studios.

ABOVE Caitlin Day

What is the pelvic floor and what is its role?

The pelvic floor muscles are those that 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.

What is prolapse in females?

Prolapse is when any of the pelvic organs, such as the bladder, uterus or bowel, bulge or drop into the vaginal space. It is commonly caused by a stretching or weakening of the muscles and ligaments in the pelvic floor.

What effect can pregnancy have on the pelvic floor?

The pregnancy hormones can have a softening effect on the pelvic floor muscles. Plus, the weight of the baby, uterus, placenta, breast tissue and extra fluid can lengthen and weaken these muscles over the course of pregnancy. If you have pelvic floor dysfunction, you might notice symptoms such as:

• Bladder leakage when coughing or jumping.
• You can’t hold on to your bladder for as long as you used to be able to.
• Faecal urgency (not being able to hold onto your poo).
• Heaviness or bulging in the vagina (prolapse).
• Difficulty emptying your bladder or bowel.
• Reduced sexual sensation or painful sex.

How can people maintain optimal pelvic floor health while pregnant?

The current statistics tell us that one in three people who have ever had a baby will wet themselves and one in two people who have ever had a baby will experience prolapse. The evidence tells us that pelvic floor strengthening is a successful treatment to manage these conditions. So, do your pelvic floor exercises three times a day, every day, for your entire pregnancy!

Also, avoid or limit activities that can put excessive strain on the pelvic floor, such as:

• Constipation – keep your fluid and fibre up, and maybe add in a daily kiwifruit extract or fibre supplement.
• Coughing or sneezing – talk to your LMC about managing a cold, flu, and hay fever.
• High impact exercise – running, jumping, heavy weights, intense abdominal exercises.

And keep fit throughout your pregnancy with 2.5 hours of moderate intensity exercise per week. Walking, Pilates, yoga, stationary cycling, swimming and appropriately modified gym classes are all fantastic forms of pregnancy exercise.

Can you explain how to do pelvic floor exercises correctly?

They’re tricky; 30% of people 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 physio.

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 two to three times per day.

When should someone see a pelvic health physio during pregnancy?

I recommend, at the very least, a ‘Prenatal WOF’ appointment at about 20 weeks, to make sure you are doing your pelvic floor exercises correctly, exercising appropriately and addressing any aches or pains you might have. On top of this, seek help from a pelvic floor and maternity physio at any time during your pregnancy if you have pelvic floor issues from a previous pregnancy or are experiencing any of the following:

• Leakage of urine or faeces.
• Bulging, heaviness or dragging in the vaginal region.
• Excessive doming of your abdominal muscles.
• Low back, hip or pelvic pain.
• Rib, upper back or neck pain.
• Wrist issues such as carpal tunnel syndrome.

We can also assess your risk for pelvic floor dysfunction from birth at about 37 weeks of pregnancy. And finally, we usually see people for a ‘Postnatal WOF’ at about 4-6 weeks after having your baby. So get in touch with your local pelvic health physio for a check-up today!