It seems as soon as we find out about our impending bundle of joy this anatomical area also pops up in conversation.
At every pre and post natal check up our commitment to pelvic floor exercises is investigated. However beyond questioning if we have been doing these exercises, to which many of us unconvincingly reply “um …. occasionally”, there is usually little more follow up and the old exercises get pushed to the back of our minds until we are reminded of them at the next check up.
So what is all the fuss and what on earth are we supposed to be doing about this needy muscle? Muscle you say? Yep that’s right, the pelvic floor is just a humble muscle like any other. What makes this one worthy of mention at every check up is that its function is a little more…..socially critical should it misbehave.
So here is the run down.
The pelvic floor is shaped like a hammock and attaches to our pubic bone at the front and to our tailbone at the back. Passing through it are the openings to our bladder, bowel and vagina. Unlike most muscles, whose job it is to move our joints, the pelvic floor is responsible for controlling the opening and closing of the bladder, bowel and supporting our pelvic organs. It is the gatekeeper to stopping us wetting or god forbid soiling ourselves and keeps our uterus and other pelvic organs inside our pelvis, where they should be. Being a muscle, the more we use it, the stronger it gets.
So why does it suddenly becomes so worthy of our attention when we are pregnant? Pregnancy is a pretty rough old time for this muscle. The weight of our growing babes and bellies means the pelvic floor is being stretched and placed under constant strain. Like any muscle if you strain it, it will weaken. In addition if you have had a vaginal delivery or spent prolonged time pushing it will be further strained, it may have torn or under gone an episiotomy, all of which will further weaken it.
The next question often asked is how do I know if my pelvic floor is weak? Common signs are wetting yourself when you cough, sneeze, jump or run. This is known as stress incontinence. A weak pelvic floor can also present as simply as a heavy, pulling or sagging feeling at the base of your pelvis. It is also worthy of mention that these muscles can also be over active. Interestingly an over active floor can also lead to incontinence but for different reasons. In an over active pelvic floor situation the muscle has difficulty relaxing and as a consequence the bladder tends to over fill. Eventually this will lead to urge incontinence when the bladder needs to suddenly release because it is too full. Often an over active pelvic floor can be accompanied by other symptoms such as pain during intercourse, difficulty with bowel motions and a painful pelvic floor area. In this case it is wise to avoid exercises designed to strengthen your pelvic floor but instead commence exercises designed to teach your pelvic floor how to relax.
If you find yourself experiencing symptoms consistent with either a weak or over active pelvic floor it is highly recommended you see a women’s health physiotherapist. They will take a thorough history and determine what specifically is happening with your pelvic floor and give the best advise and treatment on how to get things “back to normal” so you are not forever plagued with the fear evoking symptoms of an unhappy pelvic floor. Many, many women “put up with” these issues, likely because of the personal nature of its position and function. However if you injured another muscle to the point that it was affecting how you walked or moved your limbs the vast majority of us would see a health professional without a second thought. Our pelvic floor should be no different. Resorting to avoiding activities or wearing incontinence pads should not be how we manage pelvic floor troubles.
If you are not experiencing symptoms of a weak or over active pelvic floor and just need some help with exercises to keep the muscle strong and functioning well the Continence Foundation of Australia is a great resource that provides reliable and accurate step by step instructions on how to correctly and most effectively perform pelvic floor exercises. They also have a brilliant app, The Pregnancy Pelvic Floor App, which provides information on how to progress exercises during and post pregnancy plus reminders to do our exercises, which is half the battle sometimes.
So here’s to taking control of your pelvic floor, to honestly and proudly reporting that you are doing your exercises when interrogated at your check ups and to a long and fear free future of laughter and impact exercise.
Rebecca Annett is a physiotherapist based in Sydney.