Let’s talk about pelvic floor health

When I start working with mums after they give birth one of the first things I ask them is ”how is your pelvic floor?” to which they usually say… Not too bad… okay not great… yeah okay I accidentally did a little wee the other day when I laughed at a joke.

Ok now we are getting somewhere with honesty…

It’s extremely common that after you give birth your pelvic floor muscle has become weak so when you laugh, cough, jump, skip or jog you run the risk of accidentally pissing your pants. I’m sorry but it’s true.

I like to use the hammock and the bowling ball analogy… The hammock being your pelvic floor muscle and the bowling ball being your growing baby.

Imagine if you can, your pelvic floor as the hammock, when there is no weight on it, it’s sitting there with a nice amount of tension. If you were to place a bowling ball on the hammock, the tension is dramatically increased and the fabric then becomes extremely taut.

This is exactly how your pelvic floor muscle acts when it has to withstand the weight of your baby during pregnancy.

Make sense? So pelvic floor health isn’t just important to think about if you have a vaginal birth, it’s actually something that all pregnant women need to work on – before, during and after giving birth.

To get a bit technical for just a minute, it’s important to know that you pelvic floor is a group of muscles (and connective tissue) that is located at the base of the pelvis. Check out the illustration below.

The pelvic floor muscle provides structure for the pelvis as well as the organs within in. As your baby grows, the pressure on the pelvic floor is increased which can then lead to your pelvic floor muscle not being as strong once you have given birth as the muscle has been stretched so much that it needs some help to regain its strength and become taught again.

Don’t freak out – the pelvic floor muscle is just like any other muscle in the body, you can work on it to increase the strength so that you don’t have to worry about doing a little wee when you cough and laugh. It just means you need to know how to strengthen the muscle so that you don’t have to live with the pee fear for the rest of your life.

Pelvic floor activations are perfect for those women who need help strengthening the muscle. This is very common for women during their pregnancy (especially in the later stages) and during the early post-natal period.

Something I want to stress here is that pelvic floor activations are not suitable for everyone. If you have an overly tight pelvic floor muscle (otherwise knows as hypertonic) your focus needs to be on finding ways to relax and release the muscles, not on activating them.

It’s always a good idea to check with your physiotherapist to check if your pelvic floor muscle is hypertonic or weak so that you can know what the best plan of action for you will be.

I will say though, it’s not an easy muscle to get working and it’s possible that you might not feel your pelvic floor muscles working for the first few days after giving birth. Don’t worry, this is completely normal, and happens because the nerves in your pelvic floor will have been stretched (a lot) during pregnancy and birth.

Here’s how you can get your pelvic floor working…

Step #1

• Get yourself into good alignment by sitting on a chair with good posture. Think about being tall from the tailbone to the crown of your head while maintaining a neutral curve in your lower back.

Step #2

• Now it’s important to focus on your breathing so that you are recruiting your core muscles together as a team.
• Put one hand on your belly and the other hand on your ribs.
• As you inhale, breathe into your hands and think about pulling your pelvic floor up like an elevator. Some women find it easier to think about stopping the flow of a wee while they are doing this.
• As you exhale, feel your hands release and imagine the elevator going down.

Step #3

• Hold the squeeze for about 2-3 seconds, while you continue to breathe in and out as normal.
• You may feel your lower tummy muscles tightening, and that’s fine. If you are tightening your upper tummy muscles (above your belly button) or your buttocks, you’re trying too hard!
• If you can’t hold the squeeze for 3 seconds, don’t worry – do your best and hold for as long as you can. We are after quality contractions – not quantity! As you practice and your muscles get stronger, you should be able to hold each contraction for longer – aim for 5-6 seconds by six weeks postnatal.

Karen’s Top Pelvic Floor Activation Tips   

• It is important to continue to breathe normally through the exercise and keep the muscles in your legs, buttocks and tummy relaxed.
• These exercises can be done when lying down, sitting or standing. It is useful to combine these exercises with everyday activities such as feeding your baby, having a shower or sitting at red lights in traffic, just to help you to remember to do them often in your day.
• Tighten your pelvic floor muscles every time you lift your baby, cough, sneeze or laugh to protect your pelvic floor and help prevent leakage of urine or wind.

Just remember, even if you are struggling with continence post-birth, don’t lose heart. Even women who experience severe poor bladder control after giving birth will improve in the first 6 months as the pelvic floor tissues, muscles and nerves mend.

Don’t forget to look after yourself and seek help from a specialist physiotherapist who is trained in pelvic floor health to help you recover and get back on top of this as quickly and as safely as possible.

As always if things are not getting better for you, speak to your physio and make sure you are getting the care and the treatment plan you need. You don’t have to live with incontinence, this is something you can fix by working the muscle correctly.