One of my gorgeous pregnant ladies in class once said to me "I don't need to worry about doing pelvic floor exercises now cause I'm having a section, right?"
There is this myth that Pregnant Women don't need to get their pelvic floor in order before, or during pregnancy, just after the main event. Couple this with the common 'preggo stance' of an overarching low back, where you stick your belly out in front and backside behind, you are setting yourself up for abdo-pelvic-back disaster once baby arrives!
My lovely lady was also carrying twins, so I'll tell you what I told her:
First off, let's talk anatomy - what is the 'pelvic floor'?
It is a large hammock of muscles which run from the tail bone at the back to the pubic bone at the front. There are two layers of muscles which are intertwined around and within each other. They control each of the 3 openings in women, and two in men. The pelvic floor muscles also serve as a passageway for baby during a vaginal delivery. To keep the pelvic floor muscle in good health, it needs to be contracted but also lengthened and released.
Photo thanks to the Women's Health Foundation
Its role is to:
Prevent your pelvic organs from falling out
Control the opening of the 'sphincters'
Allow for healthy sexual function
Provide a stable base for your pelvic joints, core and lower back
Simply by being pregnant, you will be putting plenty of extra pressure onto your pelvic floor - regardless of the delivery you have. Plus, changes in hormones levels can also cause weakness. Once women then head into the menopause, further hormonal changes can exacerbate a fairly minor pelvic issue, turning it into a more serious situation. So ladies, let's just keep it strong while you are pregnant to minimize the chances of having problems later in life.
If you have any weakness or injury to your pelvic floor, you could experience some of the following issues:
Incontinence - i.e. leaking wee or poo
Very limited ability to 'hold' your pee, so needing to leg it to the toilet with very short notice
Prolapse - when some of your pelvic organs fall into the vaginal canal
Lower back or pelvic pain
Incontinence, in particular, is actually really common - much more so than us ladies talk about. After having a baby, about 30% of women will wee themselves. That's a pretty high stat girls! Just because it is common, does not mean it should be classed as normal.
Ok, so what can we do?
See a physio who is specialised in women's health, or your gynecologist. The following are also a few things you can do on a daily basis...
Be aware of your pelvic floor. If you 'can't find' your pelvic floor hammock of muscles, try this: Sit on a chair, with both feet placed firmly on the floor. I'm going to give you 3 instructions. 1. On an exhale, imagine you are trying to stop 'wind' ;-) Basically imagine you are in a quiet doctor's waiting room and you feel a fart coming...try to stop it! Then release and relax completely. 2. On an exhale, imagine you are squeezing a tampon. Release and relax completely. 3. Finally, on your next exhale, try to visualize that you are bursting for a wee...then stop it. Release and relax completely. Nobody should notice that you are doing this...so no buttock clenching, no funny scrunching up of your face...just breathe, hold and release. You are trying to lift the muscle up towards your heart...that general direction, from the back passage, through the middle and up to the front.
Watch your posture. Whether you are pregnant or have a new baby, your posture is probably pretty poor. So sit back down on that chair and feel your sitting bones glued into the chair. Then tilt the pelvis forward and backward a few times - move the pubic bone down towards the front of the chair, then roll on your sitting bones to bring the coccyx (your tailbone) back towards the back of the chair. Do this in front of a mirror if you are struggling. Your back should be arching as you tilt forward and rounding as you move back. Keep tilting a few times until you feel you are somewhere in the middle. You should have a slight curve in your low back - this is normal. You need to keep focusing on holding yourself in this 'neutral' position. At the same time, try to bring your shoulder blades slightly together to open those chest muscles as many of us hunch the shoulders forward which leads to pain in the upper back. During the day, try to place your body weight on both feet evenly, and in the evening, don't slouch back into your couch when pregnant. For lots more information on Posture, see here.
TA - the Transverse Abdominis muscle is the deepest of your core muscles. It is like a corset which wraps around the entire trunk of your body, inserting into the pubic bone at the front. Having a strong TA during pregnancy and after will help enormously to prevent back and pelvic pain. To engage it during pregnancy, you should feel like you are giving your baby a little hug. Pregnant or not, place your two hands just above the pubic bone and on an exhale try to gently draw your low belly away from your hands. Inhale to release...and repeat. This will also aid in your quest for a better posture, help prevent back and pelvic pain too.
Do a series of contracting and lengthening exercises. Don't get too technical here. Follow point 2 on how to engage and release the muscles, without clenching any other part of your body. Once you have that sorted, then hold for 5 seconds and release, and work your way up to 10 seconds. You can then add another exercise when you 'squeeze' and 'release' the muscles at a faster and shorter pace.
Yoga will help enormously to bring stretch and tone the pelvic floor muscles, in particular poses like cat/cow and squats, pictured below.
In part 2 of this blog, we'll go into more detail about what to do in those first few days after having baby, how to heal the pelvic floor post-delivery, and when you can recommence exercise.
Until then, happy gripping, releasing & stretching ;-)
Helen Plass works with women and their birthing partners to achieve a comfortable, healthy & happy journey into Pregnancy, Birth and Motherhood. She has built a successful business in Dublin, Ireland, as a Yoga Instructor, specializing in Pre- & Post-natal health and fitness, Active Birthing workshops, Baby Massage and Mama & Baby Yoga classes. She is known for her very practical & non-judgmental approach to pregnancy and the crazy times of motherhood! Helen has trained in the UK and Ireland, and is mega proud of coming first in her Yoga Teacher Training (she’s a bit of a swot) at the gorgeous Samadhi Studios in Dublin. She’s a proud wife, mama to two energetic little boys, former corporate marketing professional, keen runner and lover of all things related to sport…and is an avid supporter of Irish Rugby.
When she’s not becoming all teary and emotional with messages from her clients about their gorgeous births, you can find her walking along the rocks and beach with her boys, cheering on the sidelines of football and rugby pitches, experimenting with essential oils, baking and preparing meals for the non-stop-eating men in her life…and in general just trying to keep it all together. Check out all her communication at NurtureMamas.com, and if you are in Ireland, her local business Mumandbaby.ie
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