The Pelvic Floor – No Laughing Matter!? by Colleen Burns, Physiotherapist. Founder of www.pregfit.com.au
Everyone’s heard the saying: “I laughed so hard I nearly wet myself!” But nothing rings closer to the truth than when you’re heavily pregnant. As I write this article, I myself am 38 weeks pregnant, and have had a few ‘close calls’ when I’ve decided this really is no laughing matter!
The truth is, that urinary incontinence (or leakage) is very common during pregnancy, and that one in three women continue to suffer these symptoms for months or even years after the birth of their baby. So it is a VERY common problem, and we really need to talk about it!
To get to the bottom of this embarrassing issue, I think we need to have a quick look at the anatomy ‘down below’:
Firstly, your pelvis: This is a big bowl-shaped set of bones that houses your bladder, uterus and bowel. Interestingly, this is actually a ‘bottomless’ bowl. It is completely hollow – in fact, there’s just enough room to let a baby pass through! Pretty smart design really. It is in fact, your pelvic floor muscles, which sling across the underneath of your pelvis (like a big hammock) to hold your bladder, uterus and bowel up inside. Apart from this, the pelvic floor has one other very important job, it is the traffic controller for your waste matter – it’s controls what stays in and what goes out – depending on when it is appropriate timing! When the pelvic floor squeezes, it holds urine in, and when the pelvic floor turns off, it allow urine to pass through. In fact, in order to go to the toilet, we are simply just relaxing our pelvic floor.
So why are we more likely to have a little accident during pregnancy? When your pelvic floor is trying to hold up the added weight of a growing baby that is pushing down on your bladder, the demand on this muscle to contract and stop urine from exiting is much harder work. If the pressure is too great, and our pelvic floor isn’t strong enough, we may experience leakage. This is often made worse when the pressure in abdomen increases from things like laughing, coughing, lifting, exercise or even orgasm.
Most women don’t like the idea of this, and there is increasing debate about the option of having a ceasarean in order to preserve the pelvic floor from the traumatic birth process. Unfortunately, it is not this simple. The latest studies tell us that the incidence of incontinence in the post-partum period is not necessarily different between women who have had a vaginal birth compared to a ceasarean.
So it looks like it’s just the process of carrying the baby that is the bigger issue. (And unless you’re Sarah-Jessica Parker, carrying the baby is not really negotiable).
But don’t worry – it’s not all gloom and doom. Your pelvic floor is a muscle – just like any other muscle in our body – and responds to exercise and training in exactly the same way! The more you work it, the stronger it gets. This means we cannot only reduce our risk of incontinence, but that in a lot of cases, we can actually reverse these symptoms. (It may also be of interest that strong pelvic floor muscles are also known to improve sexual satisfaction for both ourselves and our partners – so it can go a long way in restoring our post-baby sex life! – I’m sure if you tell hubby this, he won’t mind doing the washing up while you do your ‘exercises’).
So how exactly do we do pelvic floor exercises?
Good news: no gyms, yoga mats, free weights, stretch bands, or running shoes required. In fact, you can do them anywhere, any time, and no-one will even know (unless you have an intense look of concentration on your face). Regardless of whether you are preparing for pregnancy, currently pregnant, or recovering post-baby it is NEVER too late to start these exercises. Remember, everyone’s starting strength is different, so this is only a guide:
1) To find your pelvic floor muscle: Imagine you are stopping a wee – mid stream. You should feel a gentle tightening ‘down below’ in the region of your vagina. If you are having trouble ‘finding’ your pelvic floor, try doing this visualization lying down first.
2) Now – to be a bit more specific (and graphic, sorry) – imagine you have a tampon (or a penis) inside your vagina, and you are trying to use these same muscles to grip it tight and pull it in a bit deeper. The most important thing is you are not pushing. It is a drawing upwards and inwards!
3) Draw your pelvic floor muscles up as high as you can. Keep breathing! Start by holding for 5 seconds (if you can). Then release for 3 seconds. Repeat 5 times.
4) Try to do this at least 3x day (or as often as you think of it).
If you find you can’t do this much, start with less. If this is easy, hold for longer and do more repetitions. Your goal is to increase these amounts as your strength improves.
For best results, I recommend doing these exercises under professional guidance. Remember, there are lots of specialised pelvic floor physiotherapists who are experts on helping you find and retrain these muscles. If you think you would like some assistance, or professional advice, please contact the Australian Physiotherapy Association for more information on a physiotherapist near you.