So in amongst the 101 things that we need to think about during pregnancy and preparing for the birth, the one person we often forget about is our self. With our bodies going through so many physical changes, and undergoing child birth, it’s really important that we put some focus on strengthening our pelvic floor muscles.
I recently caught up with the lovely Lauren Clarke, who is a pelvic floor physiotherapist at Grow Physiotherapy in Yarraville and Kensington, to get a better understanding of what we can do to strengthen our pelvic floor muscles and when we might need to seek treatment to avoid longer term damage.
We all hear how important it is to do our pelvic floor exercises but could you explain the role that the pelvic floor muscles play and the impact that pregnancy and childbirth can have on them?
The pelvic floor muscles support the bladder, uterus and bowel. Pregnancy weakens the muscles due to load and hormonal changes. The pelvic floor muscles and nerves within the pelvis are stretched as the baby moves through the birth canal in a vaginal delivery. The muscles can sometimes be left damaged and not work as well as they normally would do (even if you have had a caesarean) resulting in bladder or bowel symptoms, vaginal prolapse or sexual pain.
After giving birth, what can we expect to feel with our pelvic floor muscles and what sort of exercises do you recommend in those early tender days?
Aim to start your pelvic floor exercises approximately 24 hours after giving birth (as long as your catheter is removed, your bladder is emptying well and you have not been told otherwise).
In the first two weeks the focus of your exercises should be to restore the connection between your brain and the pelvic floor muscles. Repeat short gentle holds (1-2 seconds only) every few hours in a lying or sitting position.
As you get stronger, try holding your contraction for a few more seconds. It is very important you feel the pelvic floor muscles tighten and then relax. Aim to do this 8-12 times in a row, repeating three times a day.
What do you recommend in terms of healthy amounts of exercise [walking/running] post birth to avoid further damage to your pelvic floor?
Returning to exercise following delivery should start with gentle walking (apart from pelvic floor muscle exercises of course!) when your pain and discomfort allows. Gradually increase your walking distance and pace. A 30-minute daily walk has been shown to improve your general health including mental well-being.
One of our main jobs as women’s health physiotherapists is to protect women and their ability to maintain physical activity for their overall health and wellbeing lifelong. The pelvic floor muscles can stretch up to 2.5 times their original length during a vaginal delivery and it can take 4-6 months for these muscles to fully recover. A caesarean scar can take more than 7 months to reach full strength.
Running is a high impact exercise which has almost 5 times the risk of creating pelvic floor related problems than low impact exercise (such as walking or swimming). Evidence shows that you are more likely to develop pelvic floor related problems if you start running before your baby is 3 months old, have any pre-existing hypermobility conditions (such as Ehlers-Danlos syndrome), are breastfeeding and have a caesarean or perineal scar.
So, head to a pelvic floor physiotherapist for advice and support on getting back into exercise that is safe and right for you.
What signs should we look for that our pelvic floor muscles aren’t functioning properly and when should we seek help from a pelvic floor physiotherapist?
It’s usually expected that we’re not going to look the same ‘downstairs’ as we did prior to having babies, but how do you know if there are abnormal changes to the labia/vaginal area?
All vulva’s look different regardless of whether you have had a baby or not.
Labial size and symmetry in most cases is not something to be concerned about as they come in all different shapes and sizes. Most variations are completely healthy and normal. Head to http://www.labialibrary.org.au as a reliable resource for anatomy and photo displays of the variations in normal tissue.
If you notice a distinctive change in the colour of your labia or observe lumps, bumps or differences in skin health it is essential you discuss this with a medical practitioner just like you would anywhere else on the body. Natural variation in colour is normal, some are pink and others are slightly brown and in most cases there is nothing to worry about but it is always best to double check.
Most importantly if there is any labial or vaginal discomfort, bleeding (beyond a normal period or the early postpartum loss) or irritation, you should speak to your GP. These can be signs of a vaginal prolapse, tissue that has less oestrogen, or potentially a vulval skin disorder.
Picking a GP that has a special interest in women’s health or somebody that you are comfortable with is essential for these appointments. I always encourage women to ask their obstetrician or GP to physically examine the vulval and vaginal areas following a delivery. Some will not routinely do this but I feel it helps empower you to understand the changes that have occurred, what is normal vs what is not and what steps you can take to help with tissue recovery.
What are your top tips for remembering to fit pelvic floor exercises into a new mum’s routine?
1. Link them in to an activity you do on a regular basis:
4. Check in regularly with your pelvic floor physiotherapist:
What can a patient expect when they visit your practice?
The session is usually broken up into four sections:
What conditions do you treat for pregnant/new mums?
Pelvic floor related problems including:
Musculoskeletal conditions associated with pregnancy and being a new mum: