We are very excited to team up with expert Women’s Health Physio Fiona Mitchell to talk about all things related to the pelvic floor during pregnancy and after having a baby.
Q: How did you get into the field of Women’s Health Physiotherapy?
A: I had been a muscular-skeletal physio for years and after I had my children, I realised that there was a missing link, the pelvic floor! Having kids yourself really opens your eyes to the issues facing women postnatally.
Q: Why do (pregnant and postnatal) women come to see you?
A: Pregnant women generally come to see me due to low back pain or pelvic girdle pain. Postnatally women come either for a check up, The Mummy MOT (R), to see how their pelvic floor is working or how their tummy gap is recovering. Others come with a specific issue such as ongoing PGP and LBP from pregnancy, stress incontinence, concerns about prolapsed or c-section scars. We usually find that one thing can lead to another and the best solution is to address everything together.
Q: Can you talk us through what usually happens when a client comes to see you in pregnancy or after having a baby?
A: First we have a chat and I ask what the Mum’s main concerns are as it’s great to be able to offer reassurance early on in the consultation. I ask all about this pregnancy or birth as well as any other children they’ve had. It’s important to have a clear picture of what bladder control is like or if they are constipated, whether sex is comfortable, what they are eating and drinking and how much sleep they are getting!
The second half of the consultation involves having a good look at posture, movement and tummy gap. Postnatally, If the baby has been birthed by C-section, I check the scar and the movement of the tissues around. I check to make sure that the new Mum is breathing well and can coordinate that with a pelvic floor contraction. I usually do an internal check but not always on the first visit.
Q: What should a pregnant or postnatal woman avoid doing in order to protect her pelvic floor?
A: I would say that the most important way to protect your pelvic floor in any stage of life is to ensure that you’re not lifting anything heavier than you can manage. This varies from woman to woman. If we exhale when we make any effort such as lifting, it decreases the pressure and bearing down through our pelvic floor. Postnatally, it is important to give your self time to recover from birth whether you’ve had a vaginal or C-section birth. Returning to high impact sport too soon, straining on the toilet, lifting shifting heavy furniture all put your pelvic floor at risk.
Q: In your opinion, does exercising appropriately help or makes no difference to pelvic floor health during pregnancy and after delivery?
A: Pelvic floor and diastasis safe exercise can make a huge difference to pelvic health during pregnancy and after delivery. Keeping yourself strong during pregnancy not only aids delivery, but also means that you are likely to move better after your baby is born.
Q: What are your top tips for pelvic floor health – particularly in pregnancy and postnatally?
A: The most important thing to remember is that you have one pelvic floor for life! Treat it with love and respect and it will serve you well. Pregnancy and birth will take a toll on your body including your pelvic floor but if you’ve prepared well and seek help if you have any problems then you’re helping yourself as much as you can! Remember that once you’ve had a baby, you’re postnatal...for life. Give your pelvic floor consideration when to return to sport and exercise, lift and shift and take up new hobbies. If you’re unsure as to whether your pelvic floor is capable of an activity, get checked out by a women’s health physio.
Q: What exercises (other than kegels) are brilliant for pelvic floor health?
A: Functional exercises are great. You can exercise your pelvic floor by moving your hips, legs, arms and back as well as doing specific pelvic floor exercises. A good antenatal fitness professional will teach you pelvic floor safe exercises. Some women like to do aqua classes which maybe useful if you have back or pelvic girdle pain.
Q: What are the top 3 things most clients say they wish they had known about looking after their pelvic floor (after seeing you)
A: They wish someone had explained the importance of Pelvic Floor Muscle Exercise, not getting constipated during or after birth and csection scar massage. Csection scars can cause sensations of frequency, UTI or contribute to pelvic, hip or low back pain.
Q: Ok, please tell us HOW to do our pelvic floor exercises correctly and how often?
A: Most women may do a exercise which creates the same sensation as stopping mid wee ( though you must not do your exercises whilst having a wee).
- I will start in lying, relaxed and focusing on breathing low and wide into the rib cage. Once a good breathing pattern is established, on the out breath, i will instruct a gentle close around the anal sphincter and then a lift forwards and up or a drawing together of the tail bone and pubic bone. On the breath in, relax. Once this becomes a natural, easy movement, the muscle contraction can be held for long with the relaxed breathing working up to ten time ten second holds. Some ladies need different instruction but with most this works.
- It’s important to do long slow holds and short quick ‘flicks’ on and off, of the pelvic floor and to move from lying into more functional positions such as sitting and standing, as soon as strength and coordination allows.
- It’s great to do your pelvic floor exercises regularly and integrate them into your daily routine.
- An important note to make is that some women may have an overactive pelvic floor and this can be a reason for painful sex, constipation and stress incontinence. These women need to do more relaxation exercises than strengthening. It can be confusing and is even more reason to seek help if you have any concerns about your pelvic health. You can access services via your GP or a private women’s health physiotherapist.