The Pelvic Floor During Pregnancy
Women gain an average of 2 stone (12-13kg) in weight during pregnancy. Therefore, during pregnancy, your muscles have to work harder than usual. Your posture also changes and adapts during pregnancy. Regular post-natal exercises will help to regain your fitness and muscle tone/strength and help you regain your posture.
The pelvis consists of 3 bones and 3 joints, one of these joints is at the front of the pelvis (the symphysis pubis joint) and two are at the back of the pelvis (the right and left sacro-iliac joints). These bones form a protective basin for your bladder, womb and bowel. The spine consists of many small bones (vertebrae). The joints of the spine and pelvis are supported by ligaments and muscles, which provide stability and allow you to maintain a good posture.
Hormonal changes during pregnancy results in laxity of the ligaments and during this time your joints can become less stable. This can result in aches and pains in your back and/or pelvis, during, and for some time after pregnancy. The changes in your posture during pregnancy may also place further strain on your back.
Effects Of Pregnancy & Delivery On Bladder Function
For the pelvic floor, delivery is probably the most “stressful” period in a woman’s lifetime. However very little is known about the relationship between delivery, pelvic floor changes and stress urinary incontinence (SUI). It is widely recognized that stress urinary incontinence may be a consequence of pregnancy/delivery and that pregnancy usually worsens any pre-existing SUI (Hojberg et al 1999).
According to Koebel et al (2002), vaginal delivery might lead to Stress Urinary Incontinence (SUI) via four major mechanisms:
- Injury to “connective tissue supports” by the mechanical process of vaginal delivery.
- Vascular damage to the pelvic structures as a result of compression by the presenting part of the foetus during labour.
- Damage to the pelvic nerves and /or muscles from trauma during the birthing process.
- Direct injury to the urinary tract during labour and delivery.
Pelvic floor muscle strength decreases immediately after delivery. For some mothers it returns to within the normal range a few weeks after delivery (Peschers et al 1997), for other mothers there is persistent weakness (Dumoulin et al 2004).
Incontinence seems to be linked to several things:
- The use of forceps
- Duration of labour
- The number of deliveries
- Pre-existing bladder problems
- Episiotomies are often reported to increase the weakness of the pelvic floor muscles after giving birth
Helpful Incontinence & Pelvic Floor Hints
Women tend to have a peak of progesterone mid-cycle. If you have some incontinence you may find that you leak a bit more at this time in your cycle, as the muscles will be a bit weaker.
Learn “The Knack”
Pelvic floor exercises are very important during pregnancy and after giving birth. You can exercise these muscles to regain their strength by doing regular ‘invisible’ exercises.
Strengthen Your Pelvic Floor Muscles During & After Pregnancy
The floor of your pelvis is formed by very elastic muscles, which act like a small trampoline to support your baby during pregnancy. These muscles also support the bladder, uterus and bowel. Pregnancy and childbirth put pressure on the pelvic floor, and it is common for many women to experience that they lose a few drops of urine when sneezing or coughing – this is called ‘stress urinary incontinence’ (SUI). Many women have this problem during pregnancy and/or after delivery.
How To Do Pelvic Floor Exercises
• Sit with your knees apart
• Don’t hold your breath
• Don’t clench your buttocks
Tighten your back passage as if you were trying to stop passing wind. Now tighten the muscles you would use to stop a flow of urine. Do both together and you should feel your back passage, vagina and front passage all lift and close at the same time. Now you know what to do, you can do this exercise while standing, sitting or lying down.
Each day you need to do:
Slow exercises – tighten, hold (aim for up to 10 seconds) and relax, repeat 10 times.
Fast exercises – tighten and relax quickly. Repeat up to 10 times.
How often? – Always do a mixture of fast and slow exercises while seated on the toilet after you have emptied your bladder. Make this a lifetime habit. You can exercise in the shower, as you wash your hands, while ironing, etc.
Protect your pelvic floor: Make a habit now of always pulling up your pelvic floor before you lift, carry, push or pull light to moderate weights.
When you laugh, cough, lift or sneeze tighten your pelvic floor!
All information is based on up-to-date evidence based clinical practice.
The Chartered Society of Physiotherapy (UK) Association of Chartered Physiotherapists in Women’s Health.
The American College of Obstetricians and Gynaecologists (ACOG). Evidence Based Physical Therapy for the Pelvic Floor. Kari Bo, Bary Berghmans, Siv Morkved, Marijke Van Kampen. Koebel et al (2002).
Thanks for reading!
This post has been written by PhysioActive physiotherapist, manual therapist and women’s health specialist, Gail Craig (Grad Dip Phys, MCSP, HPC registered).
Thoughts or questions?