Pelvic floor: Part One.

If you fail to plan … you plan to fail.

Not necessarily the whole truth when it comes to the birth of your child but a birth preparation program has been shown to help with urinary incontinence.

Urinary incontinence is the accidental or involuntary leakage of urine and it is actually quite a common issue – affecting one in three mums and 10% of women that haven’t had any children. Other forms of incontinence you may have heard of may affect the bowel and involve the uncontrolled passing of wind or faecal material.

What is the pelvic floor?

The pelvic floor is a strong muscular sling made up of your levator ani and coccygeous muscles. It supports the pelvic organs that rest on top of it, including the bladder, bowel and uterus. Weakness in the pelvic floor musculature can lead to issues with bladder and bowel function and incontinence.

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Why me?!?

In Australia, 4.8 million women (and men too) suffer from some degree of bowel or bladder dysfunction – you are not alone!

The most common causes of pelvic floor weakness include:
  • Pregnancy and vaginal childbirth – as well as multiple births, heavy birth weight bubs, births with intervention (instruments or cutting), severe perianal tearing during labour, long labours or a quick second stage (the active pushing part)
  • Increased body weight
  • A history of urinary tract infections (UTIs)
  • Long term constipation and coughing – leading to increased strain and force place through the pelvic floor
  • Lifting heavy objects (at work, your children or around the home) on a regular basis
  • Reduced hormone levels after going through menopause
  • Chronic low back pain
  • Diabetes

It’s more than just the floor!

When you are diagnosed with pelvic floor weakness this is done based on your signs and symptoms – the rushing to the loo and that little bit of wee when your girlfriends make you laugh. It is also based on how you contact you pelvis floor and your core stabilisers.

This can be done by your musculoskeletal therapist (ie Osteopathy, Clinical Pilates instructor or physiotherapist) and they will prompt you to lift and contract you pelvic floor and core and assess both the quality of the contraction (how strong and how you hold it whilst breathing) and quantity (how long you can maintain an efficient contraction) – this does vary between practitioners so ask yours’ if you have any queries

Along with your core muscles, your gluteal (gluteus maximus, minimus and medius) and piriformis (another butt muscle) are important for pelvic stability. These gluteal muscles can become tight as that hormone relaxin starts to kick in – really just your body’s way of trying to keeping the pelvis stable. This tightness can then lead to pain that travels down the leg (like sciatica or piriformis syndrome) or low back pain. Osteopaths love to look at the body as a unit and how it functions together! This a great example of this! The connective tissue covering for the gluteal muscles, as well as you low back muscles and hamstrings is called fascia. Think of it like glad wrap.

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This ‘glad wrap’ attaches in at the low back and continues to cover these butt and leg muscles too. So, when you glutes and hamstrings are tight, extra pull is added onto the low back – kind of like the overloaded coat hook when you put your wet coat on it! Relaxing these muscles through stretching and treatment can help reduce these low back and leg symptoms of tightness, pain and discomfort. Have a chat to your musculoskeletal therapist or health care practitioner about this.

Whilst your pregnant – making that plan!

What can also do to help is maintain a health balanced diet (this may include increased fibre as some pregnancy supplements can leave you a little blocked up!), keeping hydrated and having an optimal body weight.

I know weight is a contentious issue with pregnant ladies but each mum-to-be has a different amount of weight that they will gain (and need to gain!) to help the bub develop and grow. The practitioner looking after your pregnancy will be able to help you out with this.

During your labour there is a huge amount of force put through your pelvic floor (obviously), especially during that second stage when you are actively pushing. Each mum’s labour process is different and some of the medications and interventions you may require, may limit your ability to move around.

Unlike you see in the movies – shifting your body into more of a supported squat position or kneeling on all fours when pushing can change the direction of the force that is to be transmitted through the pelvic floor. Work with your birth assist or practitioner and make sure you also listen to their advice and guidance.

To come: Pelvic floor exercises, and a Pilates take on pelvic floor.

Written by Dr. Christine Fraser of Health Creation Centre, Ocean Grove.
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