First things first: what is the pelvic floor?
Kegels, squeezes, pelvic floor exercises – whatever term is familiar to you, the pelvic floor is essential for all women, especially if you are planning to have a baby, are pregnant, or have a baby already. Now is the time to start thinking about the muscles down there! If you are like me, the pelvic floor didn’t even enter my radar until I was pregnant. Also, if I’m honest, I had no idea what I was doing when I tried to strengthen them.
Yes, I’m a pelvic health physiotherapist now, and the pelvic floor is my life and passion, but back then? They were just another group of muscles – muscles that I could not see and, therefore, difficult to connect with them. I am a visual learner, so what helped me understand where they were and what they did was understanding the anatomy and educating myself about their function and movement. Educating and knowing about the pelvic floor can be a game changer in our journey as a mum and beyond.
The pelvic floor muscles are a sling or group of muscles that span the whole base of your pelvis, attaching from your pubic bone to your tailbone and both sitting bones. It wraps around your orifices – anus, urethra, and vagina – and acts like a sling or a hammock, supporting our pelvic organs (bladder, bowel, and uterus).
Why are the pelvic floor muscles important?
These muscles are a powerhouse and have many impressive roles in our body, or the five S’s:
- Support: They support your pelvic organs against gravity and against an increase in abdominal pressure (like coughing, sneezing, jumping). When pregnant, they support your growing baby.
- Sphincteric: As they wrap around the opening of the bladder and anus, they help us control wind and urine, especially with increases in abdominal pressure. They also relax to allow you to empty your bladder or bowel.
- Stability: The pelvic floor is part of your ‘core’ along with your deep abdominals, diaphragm (breathing muscle), and deep back muscles. They act to support your pelvis and your back.
- Sexual function: These muscles are essential for orgasm and sensation during intercourse and, if too tight, can cause pain during intercourse.
- Sump-pump: The pelvic floor acts to pump lymph and blood in the pelvis. Lack of this action can cause congestion or swell within the pelvis.
When any one of these functions is compromised, it can lead to dysfunction. Here are signs to recognise when the pelvic floor is under stress or not working well:
- Urinary leakage with coughing, sneezing, movement, exercise, or on the way to the toilet. Urinary frequency and urgency, when the number of times we run to the toilet increases (>8 times), or we feel high urges to pass urine and need to go urgently
- Bowel symptoms such as constipation, leaking, unable to control wind
- Pelvic organ prolapse – when one or more of the pelvic organs (bladder, bowel, or uterus) descend into the vagina or rectum
- Sexual pain
- Painful, heavy periods
- Pelvic pain
If you experience any of these symptoms, it is a must to visit your OBGYN and see a pelvic health physiotherapist to help you on the road to recovery.
What happens to the pelvic floor during pregnancy?
Pregnancy and delivery can put significant physical stress on your body. The growing baby’s weight during pregnancy puts pressure and stress on the pelvic floor muscles and the surrounding connective tissue. They have to work much harder than usual to support your baby and can become weaker.
Emotionally, pregnancy can be a joyous and beautiful nine months, but for some, it can be a challenging and anxious time. Many women can hold stress within their pelvic floor, leading to tension and tightness. Your pelvic floor muscles will be affected, whether you have a vaginal birth or a C-section. Pelvic floor issues during pregnancy can lead to urinary incontinence, pelvic girdle pain, and pelvic organ prolapse in some instances.
I encourage all pregnant women to start pelvic floor exercises during pregnancy to help prevent dysfunction, and the guidelines agree. However, it can be hard to know how to do them. In some ladies, the pelvic floor may have increased tone, and pelvic floor exercises will need to be altered and tailored to focus more on relaxation initially. I highly recommend seeing a pelvic floor physiotherapist who will assess and coach you on how to do the exercises correctly. More on this is coming up!
What happens to the pelvic floor during delivery?
“The pelvic floor is your baby’s door” – I love this saying by Diane Lee, a physiotherapy guru. During vaginal birth, the pelvic floor needs to be able to relax and lengthen considerably during delivery to allow your precious baby to pass through. Vaginal births (especially those with forceps) stretch the pelvic floor, ligaments, and connective tissue, and therefore may cause tearing. These tears will often heal naturally. However, more serious tears can affect the pelvic floor muscles or muscles around the rectum, complicating recovery.
If you experience bladder or bowel control issues, pain, or heaviness vaginally post-delivery, you must talk to your OBGYN and get referred to a pelvic health physiotherapist. If you had a C-section, the nerves, skin, and fascia (connective tissue throughout the body) are affected and may contribute to symptoms after delivery. When immersed in new motherhood, putting yourself and your health and emotional needs on the back burner is easy. However, focusing on your pelvic health will be worth it. I always recommend seeing a pelvic health physiotherapist from six weeks post-partum.
I believe that this should be as routine as seeing your OBGYN at six weeks. We thoroughly assess your body – posture, movement, strength, abdominal wall, and pelvic floor. From this assessment, we can guide you on what’s best for your body. We provide an individualised, tailored, and achievable home exercise programme focusing on your goals and needs. Your health and strength are essential when seeing your baby through infancy and beyond.
I’m planning on getting pregnant in the future. Should I do pelvic floor exercises?
Yes! The more awareness and connection you have to your pelvic, the increased likelihood of success with pelvic floor strengthening. However, research has shown that over 50% of women perform them incorrectly under verbal instruction. Therefore, I strongly recommend getting a pelvic health physiotherapist assessment to guide you along the right track.
How do I do my pelvic floor exercises?
- Firstly, I recommend familiarising yourself with the pelvic floor and what it looks like. Visually knowing where the pelvic floor muscles are can help with the connection. You can also use a hand mirror to look at your external anatomy, aiding in connection.
- Lie down with your knees bent in a comfortable place with no distractions. Start with a connection to your breath. Your pelvic floor works in unison with your diaphragm (breathing muscle at the base of your rib cage). Therefore, connecting with your breath can help connect to the pelvic floor. Inhale into the bottom of your rib cage, shoulders relaxed. Imagine your ribcage like an umbrella, gently opening as you breathe in, and air fills your lungs and closes as you breathe out. Please do not force your breath. Aim for relaxed breathing in and out.
- After a few rounds of relaxed diaphragmatic breathing, bring your awareness into your pelvis and visualise the pelvic floor muscles. On your exhale, think of stopping passing wind and urine. You should feel a gentle squeeze and lift of the pelvic floor. If unsure, place your hand on your perineum (area between the anus and vagina), and you will feel a lift as you perform the exercise. You can also use a mirror to see the perineum gently lift. Inhale, let go, and relax. Other analogies I like to use are gently lifting a blueberry or blackberry with your vagina or thinking of your tailbone, pubic bone, and sitting bones moving towards each other.
- Once happy that you can connect and hold for the exhale, hold for 5-10 seconds, and repeat up to 10 times. It is crucial not to hold your breath; tighten your buttock, thigh, or abdominal muscles as you perform the exercise.
- The relaxation is as important as the contraction. Therefore, in between repetitions, the relaxation phase should be as long – if not longer – than the contraction time. During this time, relaxed breathing and thinking of the tailbone, pubic bone, and sitting bones gently moving away from each other or visualising the pelvic floor like a sling or a hammock, soft and relaxed.
- The pelvic floor consists of two types of fibres: slow and fast twitch fibres. Therefore, we also need to perform quick contractions to train the fast twitch fibres. These fibres react reflexively or under conscious control to increased abdominal pressure like coughing, sneezing, or jumping. Perform these quick contractions for one second 10-15 times.
- Once happy with your contractions (both slow and fast), performing pelvic floor exercises in different positions and functionally is a must. Start with lying, then moving to sitting, four-point kneeling, standing, and movement. Your pelvic floor physiotherapist will guide you on this.
As a woman, your pelvic health will play an important role throughout your journey through life. Your pelvic floor is essential, and it’s never too late or early to begin your pelvic health journey.
Neasa Barry is a Pelvic Health Physiotherapist at Heal Hub Rehabilitation Centre. Visit @herphysio and @healhub_rehab for more information.
