Sneezing and not worrying about the aftermath is a luxury that for around 50% of women disappears in the pregnancy or after birth. After growing and delivering a new life into the world, the body has had to soften and loosen quite a lot. The pelvic and abdominal region essentially house the growing fetus through the pregnancy which in order to do so have had to elongate and widen significantly. Then as the baby passes through the birth canal the pelvic floor has to open right up to allow the baby to be delivered in the world.
But what exactly is this pelvic floor? The pelvic floor is one of the most incredible designs of human anatomy that most people have given little thought to. It is actually made up of 8- 9 individual muscles that join together to create a strong structure forming the ‘floor’ of the ‘pelvis’. It is a multilayered structure woven together made up of muscles, fascia, and ligaments sitting deep within the pelvis. It runs just deep to the gusset region, from the tailbone at the back, through to the pubic bone at the front
The pelvic floor has many important roles including:
- Producing a tight seal or ‘sphincter’ around the urethra and rectum to prevent leaking of urine, stool or gas from escaping ( which is something no one ever wants)
- Create a strong support structure to prevent the internal organs from descending downwards into the vaginal space ( when this occurs this is called a pelvic organ prolapse)
- Provide the sensation and muscle tone required for pleasure during sexual intercourse (yes please)
- Functions with other core muscles to create stability for the spine, strength, and prevent injuries
The pelvic floor is a very dynamic structure, which has the ability to change in every minute in response to what load is placed on it. At low level activities such as standing still it will be working to prevent urine or feaces from leaking, but at a low enough level that it doesn’t fatigue. If it contracts too hard unnecessarily then it won’t be able to work when it is really needed, such as during activities such as running or sneezing with a full bladder. These activities require the pelvic floor to have a momentary increase in activation at a strong level, and only a healthy pelvic floor will allow this to occur.
If any of these functions aren’t performing like the normally would, it is a sign that the pelvic floor may need a little TLC.
How do we know that something is wrong? Many women think that pelvic floor issues after having a baby are “ normal’ and they will eventually resolve themselves. Well the truth is they are not normal, and they are unlikely to resolve themselves if they are still present by around 3 months post birth.
Women should ask themselves the following questions to help work out if anything is wrong:
- Do you leak urine when you cough, sneeze, blow your nose, or exercise?
- Do you leak urine on approach to the toilet or have you had an unexpected accident when you didn’t think you needed to go?
- Do you find it difficult to control your bowels (wind or stool)?
- Do you feel a sense of heaviness/ dragging in the vagina or rectum?
- Do you feel something protruding from your vagina?
- When you pass urine on the toilet, is it difficult or does it seem different to before?
- Is sexual intercourse and intimacy painful?
- Does sexual intercourse lack sensation or feeling?
Ladies, if you answered Yes to any of these questions, then I would love you to get yourself to a Women’s Health Physiotherapist sooner rather than later, as the sooner we address the issue the better.
Are there any quick fixes? Just like exercises, fitness, and weight loss, sadly there are no quick fixes. The pelvic floor is a group of muscles and just like those in your bicep, they will only get stronger from consistently exercising in a challenging way. The term ‘use it or lose it’ definitely applies to the pelvic floor.
My main advice for women is firsty to learn how to do a pelvic floor activation the right way first. Many women can’t believe how different a correct pelvic floor activation is when I teach them compared to what they thought and have been doing for years. The best way to learn really is to have a one off appointment with a pelvic floor physio who can assess what you are doing, give feedback and guide you.
Then once you have it down pat, its important to add a little ‘spice’ to the program, as ill be the first to admit pelvic floor exercises are boring as anything. A few tips to prevent you from falling off the wagon, and keep you motivated:
– Individualised program: Get a Pelvic floor program that is specifically tailored to you. It is WAY more motivating to have a challenge specific to your own pelvic floor, and works on all the different muscle components rather than just a “ squeeze and hold and traffic lights” many women do.
– Pelvic floor equipment: Consider introducing pelvic floor weights, stimulation or specific probes. With some guidance from a professional, they can make it more effective and more interesting.
– Pelvic floor App: Consider using a pelvic floor App that reminds you, and allows yoiu to record your exercises. This means there are no excuses for forgetting either!
– To the beat: One of my favourites is to play a song once per day, and do pelvic floor exercises to the beat of the song for the whole song (Beyoncé is fun for this one!
– Try to sneak in some extra pelvic floor squeezes by strongly activating every time you sneeze, blow your nose, stand out of a chair or lift an object. This is called ‘the knack’ and as well as strengthening, it also often prevents leakage.