08 Nov Caring for your Pelvic Floor….
By Anchen Verster – Registered nurse, midwife, SA Certified Perinatal Educator – SACPE, wife, mother to 4 children including a set of twins
“I am your pelvic floor. I realize you have so much to think about and plan but I need you to give me a little bit of your time and attention. I am important to you. If I stop working properly you will pass urine or perhaps even faeces when you’re not on the toilet. You will pass wind when you don’t intend to. Yes, I hope that gets your attention! If I’m working well I have a good effect on sexual function and pleasure.
I’m situated in your pelvis. Like a hammock of muscles that work together I prevent everything ‘falling out underneath’. I have ‘openings’ that allow the urethra (tube from the bladder that allows urine to pass), the anus and the vagina (in women) to ‘pass through’.
When you pass urine, feel where I’m working by stopping and starting the flow of urine. Yes, that’s me doing my job! When your baby is birthing, his head needs me to rest against. As the contractions force his head down onto me, I will be there to help him tuck his chin nicely onto his chest so that the right part of his head is birthed first. The resistance he gets from me will help him turn his head to face the right direction. Once his head is resting against me, I will help you force him through my passageway. You will use me to help push him out into the world. You need me!
I hope you have an idea of how important I am! Many women think that the best way to look after me is by having a caesarean, however, they’re wrong. I might be a little weak a few months after you have given birth but I usually recover very well! In fact, between 6 months and 5 years after a caesarean or vaginal birth the odds have equaled between pelvic floors that are working or struggling a bit. It’s ideal to have a normal birth in a position where gravity can help move your baby down and an episiotomy or instruments are not used. If this is not the case it can take me a little longer to heal.
You can imagine that through nine months of pregnancy, holding your growing baby in place with the help of your bony pelvis is quite a bit of work for me. There are also hormones circulating in your body during pregnancy that help me relax a little. Like hanging something in a wet T-shirt for nine months you can see how I might need a bit of work to get back in shape. You might even find that when you’re pregnant you pass a little bit of urine unintentionally when you cough or laugh. If you exercise me, this should get better and return to normal after the birth. It can even be beneficial while you are pregnant.
Find a time in the day where you can remember to exercise me. For example when you’re sitting at a red traffic light or when you’re answering whatsapp messages or you’re sitting in a meeting at work. You need to exercise me multiple times in the day. No one will know you’re doing it, so it doesn’t have to be in private.
Start by tightening the anal sphincter (hold it) then the muscles around your vagina and urethra. Make sure you’re not including muscles like buttocks, thighs and abdomen. Pretend you have fairy lights attached to your coccyx, which run between your legs and attach just underneath the middle front part of your pelvis bone (symphysis pubis). As you tighten the muscles from the back to the front the lights switch on one by one in your mind helping you visualize the process. Once all the lights are on you keep holding the muscles for 5-10 seconds (the lights stay on) and then you release the muscles (switch the lights off). You can do these 10 times a day doing 8-10 repetitions. These are longer holds – sustaining the muscle tension but I also need you to practice short bursts of tension.
Using the same fairy light image but this time the lights turn on and off without sustaining the muscle tension. Much like Christmas lights on a tree that flicker on and off. Tense the same group of muscles and then release them immediately. This you can do this 2-5 times a day, about 10 squeezes at a time. This helps me stay in practice and do my job well when you suddenly cough or sneeze.
It’ll help me stay active if you do these exercises during and after pregnancy. You can even exercise me during sexual intercourse.
One other thing that will help me while you are pregnant is using a small stool/ step under your feet when you sit on the toilet. This enables me to empty your bowel more effectively and prevents unnecessary pressure. Unnecessary pressure is not helpful for common pregnancy problems like constipation and haemorrhoids. When you use this step, it’ll feel more like squatting than the usual toilet position. Remember to do this after the birth too! It will help you to go to the toilet for the first time after a vaginal or caesarean birth.
If, once your baby is born, you are concerned that I am not recovering as I should, there are a group of specialists called women’s health physiotherapists who will be able to help us. It’s a good idea to see one sooner rather than later.
Thank you for paying attention to me! I don’t want to let you down!”