Understanding the Pelvic Floor with Physiotherapist Maria Moreno
WHAT IS THE PELVIC FLOOR? The pelvic floor is a group of muscles located at the base of our pelvis which are responsible for supporting our pelvic organs. These muscles are referred to as pelvic floor as they act as a “floor” for these organs. Both men and women have a pelvic floor. The organs supported by our pelvic floor muscles are the bladder and bowel (including the rectum) in both men and women, and also the uterus (womb) in women; the pelvic floor also provides a continence mechanism to the urethral and anal sphincters in men and women, and also to the vaginal sphincter in women. We refer to the back passage or posterior wall of our pelvic floor in terms of the support for our bowel and anal sphincter, and we refer to the front passage or anterior wall of our pelvic floor in terms of the support for our bladder, womb, urethral and vaginal sphincters. The anterior wall of our pelvic floor is therefore bigger and wider than the posterior wall. Both men and women can suffer with pelvic floor issues, however, women are more likely to experience these given the anatomical differences and also the hormonal changes that women experience throughout life. Pregnancy and birth can also contribute to this.
THE PELVIC FLOOR DURING PREGNANCY: As I have explained above, the pelvic floor is the main support for our pelvic organs. During pregnancy, as the baby grows and develops, our pelvic floor is put under extra pressure and demands. Not only does our pelvic floor have to support the extra weight of the baby (or babies in the case of twins or triplets), but also our lower back becomes more arched, our pelvis tilts more forwards and so our pelvic floor carries more pressure on its anterior wall.
Also, as we approach the end of pregnancy, the body starts releasing relaxin, the hormone responsible for creating more laxity in our pelvic ligaments in preparation for birth, which consequently affects our pelvic floor too. A common misconception that I find in my practice as a Women’s Health Physiotherapist and also as a pre-natal and post-natal Pilates & Yoga instructor, is that pelvic floor exercises should only start after a certain number of weeks of becoming pregnant. Many women think that they should not be doing any pelvic floor exercises or join a pre-natal class until they are on the second trimester, or until they are at 20 weeks or more... It is true that some exercises need to be modified from week 20, however, that does not mean that you cannot strengthen your pelvic floor before then. I believe this is due to the lack of information that is available to pregnant women, so let me tell you, the sooner you start strengthening your pelvic floor muscles, the better! (Unless of course there is a medical reason for you to not to). In fact, the later you start, the more likely it is that your pelvic floor muscles will already be under a lot of strain and consequently may have weakened.
Pelvic floor exercises are not just Kegel exercises, you can strengthen your pelvic floor by using your breath correctly and by using your own body weight, therabands or dumbbells for resistance; they can be done in different positions: lying down, lying on your side, on all fours, in sitting, standing, being static and also during movement. When we think of contracting our pelvic floor, we should be thinking of engaging our back passage and front passage, and we should also be training it in all different positions and with different amounts of load, to ensure it functions correctly.
THE PELVIC FLOOR IN THE POST-NATAL PERIOD:
The role of our pelvic floor is also very important during the post-natal period. Depending on how your birth was delivered - natural vaginal delivery (with or without the presence of a natural tear and/or the need of an episiotomy), instrumental delivery (forceps or ventouse) or C-section (planned or emergency) – your pelvic floor muscles will have suffered more or less trauma.
It is also relevant to mention the importance of our abdominal muscles and the impact that diastasis recti (separation of the rectus abdominis muscle) can have on our pelvic floor support. If our abdominal muscles are not functioning correctly, we will not be able to transfer load efficiently through our trunk (for example when you pick up your baby) and that will consequently exert additional pressure on the pelvic floor.
Post-natal women are expected to go back to normal after having carried a baby for about 40 weeks, after experiencing birth which unfortunately can sometimes be a traumatic experience, after going through a turmoil of hormones, after being sleep deprived and while continuing to look after their baby while their bodies are still healing.
I personally find quite shocking the lack of medical support that is offered to post-natal women both in public and private environments, the lack of information about how to regain your strength safely after birth, the lack of services provided from a rehabilitation point of view after having undergone a C-section (which is a serious abdominal surgery) and the lack of awareness around post-natal depression in our society.
In terms of recovery after birth, it is very important that we take care of our body. I often see how women put aside their needs after becoming a mother. Spending a few minutes for yourself every day (can be as little as 5 or 10 minutes) will make a huge difference.
This time can be used to do some basic pelvic floor exercises, postural stretches and mobility exercises, for example. Having the guide of a Women’s Health specialist to help you with these is always beneficial. If you have undergone a C-section, I always recommend to speak to a Women’s Health Physiotherapist so we can explain to you how to pick up your baby safely, how to transition between positions (from lying to sitting for example) and how to look after your scar. In the second half of this article, I give a bit more information on how to return to exercise safely.
The two main things I would say to keep in mind right after giving birth are breath and posture. If you breath correctly (using your diaphragm), you will manage intra-abdominal pressure better and consequently there will be less unnecessary forces on your abdominal wall and pelvic floor; if you have good posture (not always easy when carrying or feeding a baby, I know!), your spine (neck, middle and lower back) will suffer less strain.
Come back next week to learn about pelvic floor dysfunction and when to seek help!
About the Author:
Chartered Women’s Health & Sports Physiotherapist Certified Pilates, Yoga & Hypopressives Instructor IG: @maria_maxifisio YouTube Channel: https://bit.ly/MaxifisioYouTube M: +34 644 93 42 30
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