We’re sure you’ve heard of the term ‘Pelvic Floor’ now that you’re pregnant. Maybe your obstetrician or midwife has mentioned that you should be getting your pelvic floor checked, or you’ve read somewhere that you should be doing ‘kegels’ to help strengthen your pelvic floor. Or worse, a friend has told you about their friend who experienced severe pelvic floor issues having their baby.
We are here to provide you with the info you need, including what you should be doing during both your pregnancy and post-natal journeys.
Let’s start at the beginning, the basics of the pelvic floor.
The pelvic floor is a group of muscles, fascia and ligaments that sit deep in the pelvis, starting at the pubic bone at the front and finishing at the tailbone at the back, forming a floor-like structure at the base of the pelvis – hence the term pelvic floor.
The pelvic floor has a number of important roles, including
- Keeping closure around the bladder to prevent leakage of urine
- Keeping closure around the rectum to prevent bowel leakage
- Providing a support system to the uterus, bladder and bowel to prevent prolapse
The pelvic floor also works closely with our abdominal muscles to help stabilise our spine, hips, pelvis and ribs. Whilst having a strong pelvic floor is important for all these functions, it is also essential that we can effectively relax our pelvic floor to allow the emptying of our bladder and bowels, and most importantly, birth a baby!
Prolapse – the term is enough to make a lot of women shudder. But what exactly is a prolapse?
Pelvic Organ Prolapse (most commonly just called Prolapse or even POP in the women’s health world) is when one or more of the pelvic organs (bladder, uterus or bowel) is insufficiently supported by the pelvic floor, and therefore starts to bulge down into the vagina (or out of the vagina in more severe cases).
It is VERY important to remember that the vagina isn’t made of concrete, but rather soft tissue. It is meant to have some movement in it. In fact if you performed a pelvic floor assessment on 100 women, approximately 50-80 of them would have some form of ‘prolapse’ even if they hadn’t had kids. Our lifestyle, including the exercise we do and hayfever or chronic coughs we may have, are examples of other things that have an impact on our pelvic floor as well.
Prolapse becomes a concern when you start feeling symptoms or when it starts to have an impact on the things you would like to do on a daily basis – look after your kids, exercise and do housework for example. Symptoms of prolapse can include:
- Vaginal heaviness
- A dragging sensation in the pelvis or lower back
- A ‘bulge’ felt either inside or protruding from your vagina
- Bladder, bowel or sexual concerns
When should I get my pelvic floor checked?
Women’s Health Physios strongly believe that all women should get their pelvic floor checked at least twice for each pregnancy – once during the pregnancy (ideally around 20-24 weeks gestation), and once about 6 weeks post-partum.
A check during pregnancy allows us to check that you’re activating your pelvic floor correctly, how strong your pelvic floor is, how tight or ‘overactive’ it is, and also whether you can fully relax your pelvic floor – this last part is really important if you’re planning a vaginal delivery.
Once you’ve had your baby, a pelvic floor assessment gives us the chance to have an in-depth chat with you about your birth – how you delivered your baby, if any interventions such as forceps or an episiotomy were required, if you sustained any tears, and how big your baby was. These factors can all have an impact on your pelvic floor.
Research show that pelvic strength is decreased by 25-35% on average after having a baby, with up to 1/3 of women experiencing some form of urinary incontinence. The assessment will allow us to check your strength, assess for any prolapse, and help tailor an exercise program to your individual needs, including working to address any incontinence you may be experiencing.
I don’t have any pelvic floor symptoms after having my baby. Why should I get my pelvic floor checked?
Many people don’t experience any incontinence, heaviness or bulging post-birth, which is fantastic. But this doesn’t necessarily mean that your pelvic floor is at the same level of strength it was pre-baby. It’s still really important to get your pelvic floor assessed so we can get on top of any weakness as soon as possible, so that your pelvic floor is as strong as possible as you return to exercise (especially if you are considering something more high impact like running, netball or F45 classes), or so that your pelvic floor is in optimal condition prior to your next pregnancy.
It sounds a bit scary and embarrassing to get my pelvic floor checked - What does it involve?
A pelvic floor assessment is no more scary than a pap smear! The assessment will start off with a chat with our women’s health physio and some general questions about your health, exercise and any symptoms you may be experiencing, as well as your birth story if you are coming for a post-natal pelvic floor check. The physio will then go through how the assessment will work and if you’re comfortable to proceed, gain your consent prior to starting.
A pelvic floor assessment will start with the physio observing how you contract your pelvic floor – this may include holding for a number of seconds to check your endurance, and seeing if you can maintain that pelvic floor contraction while you cough. For the internal part of the assessment, the physio will insert one gloved, lubricated finger which will allow them to accurately assess the tone and strength of your pelvic floor. For a post-natal pelvic floor check, a gloved, lubricated wooden tongue depressor may also be inserted to help us check for prolapse – this is a lot more comfortable than a cold metal speculum used for pap smears!
At each stage of the assessment, the physio will explain what is happening, and you can ask to stop the assessment at any stage if you are experiencing any pain or discomfort, or are uncomfortable proceeding. The exam itself takes no more than 5-10 minutes.
If you have any more questions about the pelvic floor, or about a pelvic floor assessment – or you’d like to book a pelvic floor check - please reach out to us via phone or email, or speak to one of our physios when you're here next!
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