Pregnancy and your pelvic floor
Many of us barely give a thought to our pelvic floor muscles before or during pregnancy, only turning our minds to them when they give us a startling reminder that they are there (or, rather, have gone AWOL): the accidental leak during a sneeze or cough or while laughing is a classic one we hear of time and time again.
It’s a typical case of out of sight, out of mind!
Even though we cannot see them, our pelvic floor muscles (and the nerves and soft tissues that support them) are changing during pregnancy, just like our boobs and bellies. The pelvic floor muscles attach like a muscular hammock from our tailbone at the back to our pubic bone at the front, and from one sitting bone to the other. They help to support our bowel, bladder and uterus. Pregnancy, however, can take its toll on this support system, affecting the pelvic floor in various ways.
As the pregnancy progresses, the weight of the baby and the pregnant uterus put extra strain on the pelvic floor ‘hammock’. Studies using ultrasound imaging techniques have shown that the angle between the bladder neck and the urethra increases during pregnancy, producing an increased opening of the bladder neck. The hormonal changes of pregnancy also give the bladder more mobility. These changes can result in urinary or faecal incontinence during pregnancy. Even a period of relative inactivity of the pelvic floor muscles can be associated with atrophy (debulking) of the muscles, which can also contribute to weakness. In total, these changes can also contribute to pelvic organ prolapse, when one of the pelvic organs bulges into the vagina.
So what can you do to help your pelvic floor muscles during pregnancy?
· First thing’s first: we want to raise awareness, not alarm or obsession. Knowledge is power but only until it starts holding you back! As you read the rest of this blog, remind yourself that your body is incredible. It is resilient. It is designed to withstand pregnancy. It’s also worth bearing in mind that if you are constantly tense and worried about pelvic floor dysfunction and the possibility of leaks, this may result in your pelvic floor being less able to respond and do its job as and when you need it to.
· The initial strength of your pelvic floor muscles influences the development of incontinence during pregnancy (Morkved et al, 2003). If you’re reading this before trying to conceive a first or subsequent baby, try to make your pelvic floor muscle exercises a habit now. The guidelines suggest that we should be performing 10 slow contractions and 10 fast contractions 3 times every day. If this feels totally overwhelming and unmanageable, try to start with just one set, and build from there. You might find you can’t even hold the slow contractions for 10 seconds initially: that’s fine, perhaps start with 5 seconds and build up. Something is better than nothing. Remember, though, that technique is important. If you’re not sure whether you are doing your exercises correctly, or if you are already experiencing incontinence or prolapse symptoms, try to see a women’s health physio for a pelvic floor examination. You can read how in this blog.
· Ensure you are exercising your pelvic floor muscles throughout pregnancy, even if you are not experiencing leaks. It’s helpful to get and stay connected with these muscles as the pregnancy progresses.
· Try consciously to contract your pelvic floor when you cough or sneeze. You can even practise this with a forced cough so that your pelvic floor muscles are more prepared when a natural cough comes.
· Be mindful of your pelvic floor in day-to-day and sporting activities; after all, the pelvic floor muscles aren’t designed to be used in isolation! Breath-holding can send a lot of pressure down to the pelvic floor so try consciously to exhale and engage your pelvic floor when you are exerting yourself, whether picking up your toddler or lifting weights in the gym. You don’t need to do a full lift for every exertion: pick the right amount of tension for the task in hand, as per Antony Lo Physiotherapist.
· Try to adopt a risk v. reward mindset with your prenatal fitness choices. For example, running is thought to put 2.5 times our bodyweight through our pelvic floors. Low impact activities may be a more pelvic floor friendly choice during pregnancy, when the pelvic floor is already being taxed in other ways. You can still get a sweat on and an endorphin fix with a low impact activity like spinning. And remember: all pregnant women should be aiming to clock up at least 150 minutes of moderate exercise a week, as well as undertaking muscle strengthening activities twice a week alongside this. This is really important for bone health.
· Try to avoid constipation by adjusting your diet if required and drinking plenty of water. Due to the high levels of progesterone relaxing the walls of your digestive system, constipation is really common during pregnancy, but straining and bearing down on the loo can put even more strain on your pelvic floor. When you poo, place your feet on a small stool so that you are in a squat position, with knees higher than hips. Lean forward, relax your tummy muscles, breathe and allow yourself 10 minutes to pass the bowel motion.
· Evidence suggests you are at an increased risk of incontinence if you are obese. If you are reading this before pregnancy, consider getting to a healthy weight before trying to conceive. If you are already pregnant, trying to keep within the ACOG guidance for pregnancy weight gain may be beneficial.