The PELVIC FLOOR and BLADDER CONTROL….
Women who have had a baby are nearly three times more likely to leak urine and wet themselves than women who have not had a baby…
(New Zealand Continence Association)
Why does this happen?
The pelvic floor is a sling of muscles and fibrous tissue that runs from the pubic bone at the front, to the tail bone at the back. They form the “floor” or the base of the pelvic outlet (see diagram). During childbirth the pelvic floor muscles can become stretched and weakened as the baby moves through the birth canal (or vagina). This can result in leaking of urine as the muscles are no longer strong enough to keep the bladder from leaking.
What do the pelvic floor muscles do?
- Support the bladder, uterus and rectum (see diagram)
- Assist in bladder and bowel function (helping to keep us “dry”)
- Contribute to sexual arousal and function
- They also assist in stabilisation of the pelvis and spine
So, as you can imagine, the pelvic floor is especially important during pregnancy to support the weight of your growing baby.
The above diagram also shows that the pelvic floor has three openings. The muscles can lift and squeeze around these openings, preventing leakage of urine from the bladder (and also to prevent the unintentional escape of wind or faeces from the bowel).
Many pregnant and post-natal women experience occasional leakage of urine when they have an increase in pressure down on the bladder – such as when laughing, coughing, sneezing, lifting or exercising.
This is more likely to happen with a full bladder, during pregnancy or soon after birth, when the muscles have been stretched & weakened.
What causes weakening of the pelvic floor muscles?
- Pregnancy; this is due to both hormonal changes and also the extra weight associated with baby.
- Childbirth can also weaken the pelvic floor. When the baby moves down the birth canal, the pelvic floor muscles are stretched and this can cause weakening.
- Being overweight.
- Increasing age (these muscles do tend to weaken as we age)
- Repeated heavy lifting, coughing, sneezing or vomiting.
- Chronic constipation, chronic diarrhoea or anything that causes straining on the toilet.
How do I know if my pelvic floor muscles are weak?
If you do have some weakening of your pelvic floor muscles then one or several of the following symptoms may be present:
- You might experience leakage of urine when you cough, laugh, sneeze or lift something.
- You may notice you have more difficulty controlling wind.
- You might feel increased “urgency” to empty your bladder/bowel and be worried about having “accidents”.
- You may sometimes feel like you have difficulty emptying your bowel properly.
- You might notice decreased sexual sensation.
- You could feel a sensation of “heaviness” or “dragging” in your vagina. This may be a pelvic organ prolapse and you should see your Doctor about this.
What is a Prolapse?
A pelvic organ prolapse occurs when muscles and ligaments are stretched; often during childbirth. Weak pelvic floor muscles can allow the pelvic organs (bladder, uterus or bowel) to sag into the vagina. A “dragging” or “heaviness” felt in your vagina could be an early sign of prolapse.
A bulge visible at the vaginal opening could be a prolapse and needs to be assessed by your Doctor. If a prolapse is mild then pelvic floor exercises will often be prescribed. However, professional assessment is essential to ensure correct technique. This is usually done by a women’s health physiotherapist or specialist continence practitioner.
How do I locate my pelvic floor muscles?
- Pelvic floor exercises can be a little tricky at first. As you can’t ‘see’ the muscles, it is not always easy to be sure if you are doing them correctly.
- Begin by lying down or sitting in a well supported position with legs about shoulder width apart.
- Ensure that your bottom, thighs and tummy are relaxed.
- Now squeeze inwards and upwards (as if you were trying to stop the flow of urine).
- You are aiming to feel the pelvic floor lift. If your muscles are weak then this movement may be very small or hard to feel.
- Alternatively, you might try squeezing around the back passage as if you were trying to prevent wind from escaping.
- Some women find it useful to imagine squeezing a tampon up inside their vagina.
- Ensure you “relax” your muscles in between each squeeze.
How many exercises should I do?
After birth, when your muscles are usually weakened, it’s important to do pelvic floor exercises regularly throughout the day. Each person is an individual and pelvic floor strength will vary accordingly.
Once you feel confident locating your muscles, a good starting point might be:
- 6-8 repetitions of 4-5 second holds, resting briefly in between each squeeze. Try and squeeze as strongly as you can.
- Follow this with around 10 fast contractions (squeeze and lift quickly and tightly and then let go).
- Then after a short rest, repeat this again (complete 2 sets).
- Aim to do this all at least 3-4 times per day.
- Please note: If you find this difficult and cannot feel your muscle “relax” after each squeeze, then you may need to start with even shorter holds (2-3 seconds) and even less repetitions (4-5).
- As your pelvic floor muscles get stronger, you can gradually increase the length of your holds and your repetitions. For more information on exercising your pelvic floor CLICK HERE or to order your copy of “The Core & the Floor” NOW!
What about when I cough or sneeze?
- It is also vital that you contract and hold these muscles prior to and during certain activities that could have a detrimental effect on your progress.
- When you cough, sneeze, laugh or lift something, the pressure inside the abdomen puts a downwards pressure on the pelvic floor muscles.
- By squeezing your pelvic floor, you help to counteract this pressure. The pelvic floor contraction will help to support the muscles as they recover following birth, and may also help to prevent leakage from the bladder or bowel.
- So Remember: Every-time you lift your baby, the pram, or your nappy bag: Squeeze your pelvic floor "in and up".
- Try and also remember to “squeeze when you sneeze” (and when you cough, laugh etc).
- While you may not have any concerns right now, pelvic floor problems are surprisingly common and prevention is always better than cure.
When should I do my pelvic floor exercises?
- Initially, try to set aside a few minutes each day to really focus on the exercises.
- To begin with it’s easiest when lying on your side or you back with your knees bent.
- Once you feel confident locating your muscles, try them whilst feeding baby, up to five times each day.
- For more great reminders on when to do your pelvic floor exercises CLICK HERE or to order your copy of “The Core & the Floor” NOW!
Tips to check you are exercising your pelvic floor muscles correctly:
- Squeeze and lift in and upwards inside the pelvis. Make sure there is not any downwards movement of your pelvic floor.
- Gentle lower abdominal flattening is normal but don’t pull your tummy in tightly.
- Your spine should stay still and not move.
- Everything above the belly button should remain relaxed.
- Keep breathing quietly, ensuring you don’t hold your breath.
- Make sure your other muscles aren’t helping out. Keep your thighs and bottom relaxed.
- You should feel a sensation of “letting go” when you relax your muscles.
If you still feel unsure the following methods may reassure you:
- Place a hand on your perineum (area between the vagina and anus). As you squeeze your pelvic floor you should feel it move inwards/upwards. You should also feel it “let go” as you relax your pelvic floor.
- Try using a mirror so you can actually see your pelvic floor contracting. You should see an inwards lifting of the perineum away from your mirror. You should not see any downwards movement of this region.
- See if you are able to stop your flow of urine mid-stream. This should only be used to identify the correct muscles – do not do this regularly or use it as an exercise. It is ok to use as an occasional test.
- Try sitting on a rolled towel when you do your exercises. This can give you more feedback as you squeeze and relax.
- Either lying on your side or standing; place a finger on the end of your coccyx (tail-bone) and as you squeeze your pelvic floor you should feel it move forwards slightly.
- If you feel comfortable, see if your partner can feel you tighten around him during sex.
- Some women might like to try inserting 1-2 lubricated fingers inside their vagina to see if they can feel their pelvic floor muscles squeezing and lifting upwards. Following vaginal delivery, make sure you wait until you have no perineal discomfort before trying this.
- Like to know more? Then CLICK HERE to order your copy or “The Core & the Floor” NOW!
- Alternatively, seek advice from a Women’s Health Physiotherapist or Continence Practitioner. It is really important that these exercises are done correctly and the best way to ensure correct technique is with an individual assessment and treatment.
Following pregnancy and childbirth the abdominal muscles are stretched and weakened. This is one of the reasons women experience that “saggy tummy” effect immediately after birth. Unfortunately this results in less support for the spine and pelvis; and can contribute to back or pelvic pain following delivery. When we combine stretched and weakened muscles with the physical demands of Motherhood, it is easy to see why new Mother’s can be vulnerable to injury.
The good news however, is that with the right advice and care you can strengthen this area, ensuring increased support and stability for your back, and improved appearance of this region. You may be interested to know that we no longer recommend sit-ups or curl ups post-pregnancy. These exercises can place unnecessary stress on the recovering abdominal and pelvic floor regions.
To learn more about your abdominal muscles and which exercises are safe following a normal or caesarean delivery then please CLICK HERE to order your copy of the CORE & THE FLOOR.
This programme will guide you through the abdominal anatomy and then carefully teach you how to activate your deep abdominal (“core”) muscles. These muscles are vital for stability, strength and to assist in achieving a trim stomach post-pregnancy.
The beginner to advanced exercises will ensure that you work at the most appropriate level to quickly achieve your fitness goals. CLICK HERE to order now!