Pathophysiology

We have put together a few tips and exercises to help you recover after having your baby.

1 – Pelvic Floor Muscles Exercises

It is important for everyone to do some pelvic floor strengthening after they have had a baby.

The pelvic floor muscles are a ‘hammock’ of muscles underneath your pelvis. They attached at the front of the pelvis to the pubic bone and span backwards to attach at the base of the spine around the sacrum and coccyx (tailbone). The opening of the bladder, birth canal (vagina) and the bowel all pass through the pelvic floor.

What does the pelvic floor do?

1. The pelvic floor muscles are continually working to help support your pelvic organs and abdominal content (bladder, uterus in women and bowel) from underneath and stop them dropping down.

2. The pelvic floor muscles help with bladder and bowel control. The pelvic floor muscles circle around the opening for the urethra, vagina and back passage and stop you leaking urine, wind or faeces. The muscles need to work harder when you cough or sneeze or on exertion to avoid leaking.

3. The pelvic floor muscles have an important sexual function, helping to increased sexual awareness for you and your partner during sexual intercourse.

Common disorders of the pelvic floor include urinary incontinence (leaking) or prolapse of the vaginal walls or the uterus. Like other muscles in the body, ‘if you don’t use then, you lose them’. They weaken and are no longer efficient at doing their job. The pelvic floor muscles are affected and can weaken for a variety of reasons:

• Childbirth
• Pelvic surgery
• The natural aging process
• Hormonal changes for example the menopause
• Obesity
• Chronic constipation
• Repetitive heavy lifting
• Smoking
• Medical conditions such as diabetes, multiple sclerosis and stroke
• Repetitive urine infections
• Chronic cough, chest infection and conditions such as asthma and COPD
• Hypermobility (being very flexible)

Pelvic floor Muscle exercises

Pelvic floor muscles need to be exercised like any other weak muscles.

A pelvic floor muscle contraction is performed by closing and drawing up your front and back passage. Imagine you are trying to stop yourself from passing wind and at the same time trying to stop your flow of urine. The feeling is one of ‘’squeeze and lift’. In the beginning it may be easier to do the exercises lying, but you can progress them to sitting or standing. You can feel the correct muscles by placing your index finger or thumb into the vagina.

Do not:

• Pull in your stomach excessively
• Squeeze your legs together
• Tighten your buttocks
• Hold your breath.

There are two types of pelvic floor exercises you should do;

1. Quick and strong

Squeeze as hard as you can and then let go completely. Rest a second and then repeat. Aim to build up to 10 in a row. This exercise will help you to contract your muscles quickly when you laugh, cough etc.

2. Endurance

Perform a pelvic floor contraction and try to hold it for as long as possible. Try to build up to holding for 10 seconds. You must feel the muscle relax at the end of the contraction. Aim to repeat it as many times as you can, building up to a maximum of 10 times.

You must aim to do these exercises at least 3 times a day. Generally, it takes 3-6 months to get a muscle really strong again. Do not do so many that the muscle begins to ache remember it is quality not quantity!

2 – Urinary Incontinence

Urinary incontinence can occur after having a baby or for other reasons throughout life. Doing pelvic floor muscle exercises may help to prevent this. If you are struggling with any urinary incontinence you can chat to the GP or refer into physiotherapy.

Types of urinary incontinence:

• Stress Urinary Incontinence
  You may find you leak urine involuntarily when you cough, sneeze, laugh, run or jump. This is called stress incontinence. When you do any of these activities there is an increase in pressure in the abdomen and pushes down against the bladder and pelvic floor. The pelvic floor muscles can help by contracting (a reflex action) and squeeze the urethra shut.
• Urgency Urinary Incontinence
  Urgency is a strong desire to pass urine when the bladder is not full. You may suffer from a really strong need to pass urine which may result in urinary leakage. This is called urge incontinence. The bladder contracts when it emptying and the pelvic floor relax. The pelvic floor can contract to prevent the bladder from contracting.
• Mixed Urinary Incontinence
  This is a combination of both stress urinary and urgency urinary incontinence.

3 – Bowel incontinence

The muscles that control your bowel can also be affected after child birth. During child birth the sphincter muscles at the bottom of the rectum can be stretched or damaged. This can mean it is difficult to control wind or bowel movements. If you have any concerns about this, you can chat with your GP or refer in for physiotherapy for advice.

4 – Prolapses

The pelvic organs in a woman’s pelvis (uterus, bladder and rectum) are normally held well in place by ligaments, muscles and connective tissue. If the supporting structures are weakened or become overstretched, with the help of gravity, the pelvic organs can bulge (prolapse) from their natural position into the vagina. This is known as a pelvic organ prolapse (POP). Pelvic organ prolapses are common in women. For the majority of women prolapses are mild and do not cause any problems. However it may cause a heavy, dragging sensation and you may be aware of a bulge in the vagina. This can affect bladder, bowel and sexual function. If you have any concerns chat with your GP or make a referral to physiotherapy.

5 – Back or Pelvic Pain

If you are having back or pelvic pain you can refer in for advice from physiotherapy. Here are a few tips and exercises to help get you started.

Top Tips to ease pain

• Avoid standing for long periods.
• Carry shopping equally in each hand and carry babies in front of you, not on your hip. Remember the more you carry the greater strain on your pelvic joints.
• Wear low heels and shock absorbing footwear to reduce stress through the pelvis.
• Go upstairs one step at a time and plan your day so they you can reduce the amount of times you have to use them.
• Cuddle children sitting on your lap rather than lifting them.
• Avoid things you know will hurt such as squatting, vacuuming or other house hold chores. Listen to your body. A pain will take time to settle once it flares.
• Accept help form your partner/family/friends particularly in stressful postures or strenuous shopping trips etc.
• Sit down for task you would normally stand for e.g. preparing food, ironing, dressing etc.
• Only do essential lifting to avoid strain on joints.
• Maintain a good posture when feeding your baby. Have your back well supported

6 – Separated stomach muscles (diastasis recti)

Sometimes your tummy muscles can separate during pregnancy.

It’s common for the two muscles that run down the middle of your stomach to separate during pregnancy. This is sometimes called diastasis recti, or divarication. Normally the muscles will start to close in the few weeks after you have had your baby. You can self-refer in if you feel that the muscles are not coming together as they should.

7 – Exercising Post-Partum

You can start gentle exercises when you feel up to it. Anything higher impact it may be better to wait until your 6 week check up with the GP. You may wish to wait longer if you feel any signs of incontinence or prolapse as it takes time for your body to strengthen up again as it takes time for your muscles to strengthen up again.

Remember it will take many months for your body to recover fully! These are just some tips and exercises to help you on your way but if you have any concerns we are here to help.