Why did no one tell me this when I had my babies?

Following on from our recent Mama-to-be event, we spoke about the importance of looking after yourself through your pregnancy and after baba is born. Here we have Aoife Cullen with some essential advice and exercises...

As a Women’s Health Physiotherapist treating incontinence and prolapse, a question I get asked on a daily basis from my clients is why did no one tell me this when I had my babies?

Unfortunately for my clients now in their 60/70’s pelvic floor rehab was not given much consideration, apart from possibly being told to try stopping your urine mid-stream.

Thankfully Women’s Health Physiotherapy now play a prominent role in pre and post-natal education and Pelvic Floor Exercises are introduced in early post-natal classes. The problem is getting new mums to do them!

In my experience the biggest barrier to any new mum is time, at a period in their life where they are trying to cope with less sleep and the demands of motherhood, taking care of one’s self falls to the bottom of the priority list. It is useful to try tying your pelvic floor exercises to another activity, like doing ten reps during an advert break, or when you are waiting for the kettle to boil, or when feeding baby etc.

The main issues women can encounter post-partum that can benefit from a Women’s Health Physiotherapy assessment are leakage from the bladder and bowel, urinary urgency, dyspareunia (painful intercourse), prolapse, abdominal separation, difficulty emptying bladder and bowel, difficulty returning to safe exercise.

More than one-third of women experience involuntary urine leakage in the second and third trimesters of pregnancy and about one-third leak urine in the first three months after giving birth. About one-quarter of women have some involuntary loss of wind or faeces in late pregnancy and one fifth of women leak wind or faeces one year after birth.

The issues are usually worse for women who have had a prolonged second stage of labour or complications requiring forceps or vacuum delivery. In Ireland it is estimated that over 85% of women having vaginal deliveries will have some degree of perineal trauma, 60-70% of whom will require suturing (Fitzpatrick and O’Herlihy, 2007). Any woman who has suffered a third or fourth degree tear will most definitely benefit from seeing a Women’s Health Physiotherapist for Pelvic Floor Exercises.

So what are pelvic floor muscles?

A group of muscles located at the base of your pelvis. The Pelvic floor is a sling of muscles that stretch from your pubic bone at the front, to your tailbone at the back. They provide crucial support for the bladder, womb and bowel.

How do I find my Pelvic Floor Muscles?

In a comfortable position, breathing normally, become aware of where your pelvic floor muscles are.

Try to tighten your back passage as if stopping wind, then pull that contraction through to the front passage as if trying to stop the flow of urine mid-stream. You may also gently feel your bellybutton tighten towards your backbone as your deep abdominals engage.

You should feel your pelvic floor muscles squeeze and lift up, then release FULLY (from front to back) and let go.

The squeeze and lift is from Back to Front.

Don’t worry if you don’t feel very much straight away, weak muscles can be hard to feel and can take time to strengthen.

Lying is the easiest position to start exercising in because the muscle doesn’t have to work against gravity. Important:

Rest between contractions to allow the muscles to recover.

Keep breathing normally.

Avoid tightening legs and buttocks.

Pelvic floor training

Training any muscle means working it until it is tired. Training pelvic floor involves training different muscle fibres. Therefore it is important to do short and long squeezes.

Everyone is different and needs an exercise programme to suit their individual needs.

1. A Short Squeeze (100% effort)

Squeeze & lift your pelvic floor strongly & quickly (100%) and release. Rest FULLY and repeat x 10- 15 times

2. A Long Strong Squeeze (100% effort)

Next squeeze & lift the pelvic floor strongly and hold for at least 3 seconds before releasing FULLY. Count out loud to avoid holding your breath. Rest (for at least 4 seconds) and repeat x 10 times. Try and increase the length of time you are holding by 1 second each week.

Evidence for Pelvic Floor exercises post-partum:

• The International Continence Foundation recommends that Pelvic Floor Exercises are offered to women post instrumental delivery or delivery of large baby.

• A supervised intensive Home Exercise Programme, is likely to increase the treatment effect.

• Early exercise “facilitates adhesion and orientation of the regenerating muscle fibres and revascularisation and resorption of connective tissue scars.”

A lot of women struggle to isolate and connect with their Pelvic Floor, especially post-partum as there may be some nerve damage and muscular trauma.

An appointment with a Women’s Health Physio can ensure that you are using the correct muscles and will allow for faster resolution of symptoms.

For more info on Women’s Health Physiotherapy please see:-

http://www.blackrock-clinic.ie/services-procedures/physiotherapy-department/womens-health-physio/ or contact 01-2064364 for an appointment.

Aoife Cullen

Aoife Cullen (Clarke) Specialist Women and Men’s Health Physiotherapist.

Follow Aoife on Instagram @themumsphysio

Aoife completed her training in Women’s health in The Lois Hole Women’s Hospital in Edmonton, Alberta, Canada. She has worked exclusively in and Men’s Health for 3 years now and has worked at Blackrock Clinic since Nov 2016. Since moving back to Ireland, she has completed training courses on Men’s Health, Lower Bowel Dysfunction, Chronic Pelvic Pain and Management of Musculoskeletal Conditions in Pregnancy and Post-Partum. She is currently undertaking a Masters of Physiotherapy in Women’s Health via the University of Bradford.

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