Looking after your pelvic floor is not just required during and after pregnancy, it applies throughout your whole life, and it is a lot more than just doing Kegels.
The pelvic floor provides core stability, supports your pelvic organs, helps to maintain intra-abdominal pressure when coughing, laughing, and moving and maintains urinary and bowel continence.
Now, a little anatomy lesson
We often refer to the pelvic floor in general, but not many people know what it actually is. The pelvic floor is a range of different tissues that create a sling in your pelvis supporting your pelvic organs. It is made up of many layers, from your skin to subcutaneous fat, to the superficial perineal muscles, the deep perineal muscles (also called levator ani), pelvic fascia (connective tissue) and the pelvic peritoneum.
The pelvic fascia forms the strong ligaments that support the pelvic organs and the uterus, (especially during pregnancy). You may have heard of the broad or round ligaments, but there are 5 ligaments that make up the pelvic fascia. There are also a whole bunch of muscles that make up the pelvic floor, some important ones to know about include the transverse perineal which helps make up the perineal body. This is the area that may sustain damage during birthing if you tear.
All of these various tissues work together to create a strong base or “floor” to your body and just like biceps and thighs, they are particularly important to exercise so that you can control contractions, relaxation and lengthening of the structure.
Some issues that can occur because of weak, overdistended or from trauma can include:
Pelvic organ prolapse: This is when the pelvic floor muscles are unable to support the pelvic organs. There are 3 types of prolapses and it is important that these are either rehabilitated or treated to help regain function, control, and improve quality of life.
Urinary incontinence: Some may assume that incontinence is a normal fact of life for women if they have birthed or are ageing, but this definitely is not true! Maintaining or regaining continence can be achievable and something that can be addressed with a physiotherapist, so we can get you back to laughing, sneezing, and exercising without the worry of leaking.
Also relating to the pelvic floor can be constipation, reduced vaginal sensation or a “heavy” feeling vaginal canal and issues during labour and birthing such as perineal tearing.
How can a physiotherapist help with pelvic floor and why we all need to be doing much more than Kegels!
Physiotherapy can help you regain control over your pelvic floor. A pelvic floor should be able to contract AND relax AND lengthen (like stretching). Now exercising your pelvic floor is not just about lots and lots of Kegels like we were always told, it is important to focus on the correct isolation of muscles and controlled activation and relaxation. You can test your pelvic floor coordination by looking at your continence - if you either feel the need to strain to empty your bladder or experience leakage, you may have some sort of pelvic floor problem. You can also test your pelvic floor the next time you visit the bathroom by trying to stop the flow of urine midway though. This is also helps with identifying the muscles of the pelvic floor that need to be activating when exercising them. (Only use this as a test, it is not something that should be performed regularly in lieu of proper exercises as it could lead to bladder issues)
If you are experiencing anything you suspect may be related to pelvic floor dysfunction, having recently given birth or experience forms of incontinence, we have Annie, our Women’s Health Physiotherapist, here in the clinic that can help guide you through pelvic floor rehabilitation. You may be advised to wear something called a pessary, which is a ring that is inserted to help support issues like prolapses or incontinence, and you will be taught how to identify, isolate and activate your pelvic floor.
Some extra benefits of Pelvic Floor training
Training your pelvic floor before and during pregnancy can aid in labour and REDUCES incidences of tearing (and we love that!). It is important to know how to relax your pelvic floor muscles during birth, as it helps aid in the mechanisms of labour. The Australian Commission on Safety and Quality in Healthcare state that “Pelvic floor muscle training may help women prepare for labour and birth and reduce the risk of third- and fourth-degree perineal tears.”1
Recommendations about Perineal Tears and the Pelvic floor
It is also recommended by the Australian Commission on Safety and Quality in Healthcare that if you have experienced a third- or fourth-degree perineal tear birth, a referral or appointment should be main with a women’s health physiotherapist to follow up and provide support and treatment to improve pelvic floor function.