If you’ve just had a baby, you probably keep hearing the words ‘pelvic floor’. You may have heard it – from your midwife or antenatal teacher – during your pregnancy, too. If you’re not too sure what it is exactly and why it is so important for you right now, you are not alone – this part of our anatomy tends to not come up much in conversation!
But what’s important to know is that pregnancy and childbirth have a definite effect on the muscles of your pelvic floor: they become weakened – sometimes so much that it leads to conditions such as prolapse and incontinence. It may be something that you notice straightaway; it may be that you only realise it over time. But none of us need to put up with a pelvic floor that’s weaker than it was before we had a baby, let alone more serious problems.
What is my pelvic floor and why does pregnancy and childbirth weaken it?
Your pelvic floor is a group of muscles that work like a hammock to support your internal organs, as well as ensure bladder and bowel control, and sexual function.
It’s also possible that labour and childbirth can damage your pelvic floor – it’s known that tearing, an episiotomy or a forceps delivery can affect the function of the pelvic floor post-partum.
Contrary to the idea of our “core” just being made up of our abdominals, our core is better thought of as a 360° canister that comprises our abdominals in the front, our back muscles, our diaphragm (that sits like a dome under our ribcage) and our pelvic floor underneath. In order for us to have a functional core, we need all 4 of these parts to have the correct tone – which means that they have the ability to both contract and release.
When these 4 parts all work together in a co-ordinated way, they manage what is known as “intra-abdominal pressure” effectively. This means that, when there’s a quick increase in pressure, like when you’re coughing or sneezing, this whole system can work together to absorb that increase in pressure.
However, in the cases of pelvic floor dysfunction or with something called “diastasis recti” (which is where the connective tissue between the two sides of your abdominals – your 6-pack muscles – stretches and loses tone in pregnancy and postpartum), the mechanics of your core canister are faulty and no longer able to handle increases in intra-abdominal pressure. It’s important, therefore, that pelvic-floor exercises address the abdominals, too.
Why is it important to strengthen my pelvic floor after pregnancy?
Pregnancy does transform this “core canister” of yours over a fairly rapid period of time. Your body may be able to adapt to these changes and then revert to normal function within a few months of the birth of your baby. But, this may not happen to you. The connective-tissue separation of your abdominals might remain weak and wide, bringing with it lower back pain, or you have some incontinence, or you may have a feeling of heaviness and drag in your pelvis, which could indicate a prolapse.
Current statistics reveal that around 50% of woman who have had a child will have a degree of pelvic organ prolapse (POP). POP can come with numerous symptoms including stress incontinence and pelvic pain or heaviness. Depending on how severe this is, it is vital that you ask to see a women’s health physiotherapist who can give you the right exercise rehabilitation programmes.
But there’s more to it than that. Even if your core canister does revert right back, it’s important to know that as you age your muscles tend to lose strength. And, as your pelvic floor is a muscle, if we don’t do something about it, it will lose strength and the competence of our core canister will diminish. And when we reach menopause, that can also have an effect on the strength of the pelvic floor – so age and time will not make this situation any better!
How can I find out how strong my pelvic floor is now?
Most women realise there is a problem with their pelvic floor when they sneeze, cough, laugh, jump, run and they leak a bit of wee. For others it may be the heaviness and drag of a prolapse, and for women who have diastasis recti, the tone of their abdominals do not seem to have improved several months after the birth and they may also experience lower back pain. If these are things you are experiencing, it is an indication that your pelvic floor needs attention.
Our core canister should be able to withstand an increase in pressure and the fact that it is not consistently doing that, is an indication that things are not 100% and help should be found.
Unfortunately, the current 6-week GP check and sign-off for exercise mostly does not involve an internal check and may not involve questions about incontinence. And, in many cases a new mother may not know or be told if they have a prolapse or have their abdominals checked to see if they have a diastasis recti.
I therefore think that seeing a women’s health physiotherapist (you can ask your GP to refer you) is vital in knowing where you are at post-partum, and if there are any issues you need to start dealing with. A women’s health physio can do an internal check to test your pelvic floor and, if you are not engaging it properly, they will give you cues and feedback to know where and how to engage it.
The exercise you do in the early weeks after birth is crucial in how you piece back together your true core. And if you have suffered any birth injury, just like any other physical injury, proper rehabilitation is imperative for successful recovery.
What can I do to strengthen my pelvic floor – and how can I tell I’m doing it right?
Kegels (see how to do them below) are the most common method of pelvic-floor exercises and these are the exercises that may have been recommended to you by by your midwife or GP. They should be done 3 times a day and the general advice is to do both long holds for up to 10 seconds and quick-fire squeezes. The NHS Squeezy app is good for setting reminders for you to do them.
How to do a Kegel (you can do them anywhere)
- Relax the muscles of your thighs, bottom and abdomen (tummy)
- Squeeze in the muscles around your front passage as if trying to stop the flow of wee
- Squeeze in the muscles around your vagina and suck upwards inside your pelvis
- Squeeze in the muscles around your back passage as if you’re trying to stop passing wind
What if Kegels don’t work for me?
Kegels do not work for everyone. If they are not working for you, there are other options worth trying. In France, Belgium and Spain and, increasingly, in Brazil and the US, there is an approach to pelvic-floor rehabilitation called Hypopressives.
The method I teach uses the breathing technique of Hypopressives and is called Low Pressure Fitness. It is a core and pelvic floor training system that was devised in Spain by Dr Tamara Rial and Piti Pinsach. Whereas a Kegel relies on conscious control of the pelvic floor, a Hypopressive works with the reflexive nature of the pelvic floor – to improve the functionality of the core canister so that it can absorb the increase in pressure when it happens, as it does in life.
The word Hypopressive means “less pressure” and, in performing a Hypopressive (or stomach vacuum, see picture above), it is possible to strengthen your core without adding unwanted pressure.
It also works to strengthen your posture by focusing on strengthening the back of your body (the posterior chain) so that your skeleton can align better. This means that the forces that go through your body to your pelvic floor start from a place of less downward pressure.
For women with pelvic floor dysfunction, including prolapse, diastasis recti and incontinence, this technique can be life-changing. It gives women a toolkit to be able to work to regain strength and function in their own bodies so that they can heal from the momentous act of growing and bringing a baby into the world.
Pics: Anna Bachelor, Getty Images
About our expert Simone Muller
Simone Muller is the founder and creator of re-centre, an online platform that shares the Hypopressives technique with women, with the intention of making giving women the tools to empower their own body. Simone was a professional dancer for 15 years and has taught Pilates for 13 years. After training in Low Pressure Fitness in Spain in 2017, she now specialises in postnatal rehabilitation. She and her husband live in London with their 2 children
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