Post Pregnancy Tips: Strengthening Your Pelvic Floor

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Post Pregnancy Tips: Strengthening Your Pelvic Floor

Posted 08 Jun 2019

Pregnancy & Childbirth

Amy Gilbert

Post Pregnancy Tips: Strengthening Your Pelvic Floor

Imagine being able to talk openly and freely about your journey post birth, and have someone with an expert ear to guide you through the process of healing. Picture a fourth trimester where the change that your body went through is addressed with the same empathy and understanding as the former three. It is a relief to find tools and solutions to symptoms that impact your quality of life but at the same time can be a struggle to address.

If your friend asked you to go to a trampoline class tomorrow, would you go? Do you have to cross your legs whilst you are sneezing? My patients face these situations quite often and many accept the dilemma, inconvenience or fears associated with those activities as a normal part of life. However it is not normal. A pelvic floor that isn’t functioning normally can result in: incontinence, pelvic pain (during exercise, normal daily life and sexual intercourse), low back pain and prolapse.

It is not normal to have urinary incontinence after giving birth, whether it be standing up from your chair, or going for a run. It is however helpful and normal to have an awareness of your pelvic floor, how it works for you and what changed. It is also normal to exercise your pelvic floor (after all it is a muscle).

What is the pelvic floor and how does it work?

When the pelvic floor functions normally it supports the pelvic organs, keeps us continent, and allows us to participate in the exercises we love doing. The pelvic floor is part of the global support system for the lower body and is it interconnected with the larger muscles of the lower body.

Everyone has a pelvic floor, both women and men alike. The pelvic floor is a large sling like muscle that spans the underside of the pelvis supporting the pelvic organs. I often describe it as: 2 hands sitting under the pelvis, that rise and support when needed, and relax and let go at rest. For women specifically, the great news is that the pelvic floor is flexible and during a natural delivery stretches to 4-5 times its normal length! Sometimes, the pelvic floor might be slow to return back to its original state. It may need extra help for example with guided pelvic floor re-education and exercise from a woman’s health physiotherapist.

The American College for Obstetrics and Gynecology (ACOG), released guidelines in 2018 for pre and postnatal care. ACOG describe a comprehensive post-partum check, which includes an assessment of physical, social and psychological well-being. An important domain is the assessment of the pelvic floor, presence of incontinence and guidance provided on resumption of physical activity, with a referral to a Women’s Health physiotherapist as standard.

How to exercise the pelvic floor

I am often asked what it feels like to contract the pelvic floor, which can feel different for everyone. Elevation is key! You can picture it like an elevator moving up, or a tent being pulled up from the apex. However, a common misconception is breath holding and an abdominal contraction. Being able to isolate the pelvic floor can be quite a challenge. Whilst contracting or activating your pelvic floor, there should not be any abdominal contraction, glute/bum contracting or shaking in your legs and holding of your breath. Try this. Sit or lie on your back in a quiet room – breathe in and as you exhale, picture your pelvic floor; draw up through the pelvic floor and picture the internal elevator I spoke about earlier; then let go; inhale and repeat. Check in with yourself that your bottom muscles aren’t trying to join in; your tummy isn’t tightening with the effort and that your toes aren’t gripping.

There is alot to think about with this exercise, which is often why people struggle to feel the elevation, or are unable to elevate their pelvic floor without a bum squeeze or breathing easily.

If you could grasp a pelvic floor contraction pre-pregnancy and now you are struggling to feel it, that is common. The reason for this is the stretching of the pelvic floor that occurs during delivery that decreases the receptiveness of the pelvic floor. This increases the importance of correct pelvic floor contraction postnatally to encourage the pelvic floor in its supportive role and to help facilitate your return to exercise safely.

Whether you are a gym goer, yogi, pilates queen, runner or just dabble in the odd class - a normal functioning pelvic floor should be working alongside your core and other muscles without you even having to think about it. The key to exercising your pelvic floor and making it stronger is through having an increased awareness of what your pelvic floor is and how best to activate it.

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Derek says:

8 months 2 weeks ago
My wife and I found this useful after recently having our first child, and being new to subject areas and remedies such as the 'pelvic floor' .... say whaaattt!!! ;) Cheers for the great tips.

Amy_Gilbert says:

8 months 1 week ago
Hi Derek, Congratulations on having your first child. I am so pleased to hear that you found the information useful. Pregnancy and being new parents often opens up a world of new subject areas, the pelvic floor being one of those. Enjoy your new journey through life as parents.

Michelle says:

8 months 2 weeks ago
Found this really insightful and helpful advice that I will put to use after I've delivered in a few months. Michelle

Amy_Gilbert says:

8 months 2 weeks ago
Hi Michelle. Congratulations on your pregnancy, I am so pleased to hear that you found the advice useful. It is worth trying the exercises now whilst pregnant too, this gives you a good idea about how your pelvic floor is functioning before you deliver, and works as a benchmark for post partum. Let me know how you get on, and if you need further guidance by all means get in contact.

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