You know how when something’s really funny people say they ‘laugh so much they wet themselves’? Well, for millions of women, that isn’t actually a joke. Around one in four women is thought to experience some form of pelvic floor dysfunction, while all of us who give birth will have at least some weakening of the pelvic floor – and that’s whether you deliver normally or via C-section.
A weakened pelvic floor can lead to stress incontinence (peeing when you laugh/sneeze/jump on a trampoline), prolapse (in which the uterus, bladder and bowel may “drop” onto the vagina) and decreased sensation, amongst other issues. So what is this mysterious pelvic floor and how can we keep it in tip top shape?
Your pelvic floor muscles are the sling-shaped muscles that run from the pubic bone to the base of the spine and which support the pelvic organs – the bowel, bladder, uterus and vagina. We’ve all heard about ‘Kegels’ – the original exercises devised to help strengthen the pelvic floor muscles by gynaecologist Dr Arnold Kegel back in the Forties – but how many of us actually remember to do them or are doing them right?
Read more: 'Kegel exercises: the right way'
Very few, says CEO of Kuur Rehabilitation in Dubai. Katja Mechler. Pelvic floor training is an after-thought for most health professionals, who will generally advise doing the ‘stop pee’ exercise – which can actually damage the pelvic floor and lead to urinary infections if not done properly, says Mechler.
Luckily there are a host of new gadgets and apps that can help us to ensure we are doing our Kegels properly and effectively, and it’s not too late for your start a pelvic floor exercise regime – whether you’ve only just got pregnant or are already a mum of three. Katja Mechler of Kuur Rehabilitation gives us the lowdown on how to care for your pelvic floor:
At what point in your pregnancy should you start training your pelvic floor?
As soon as possible: Hormone changes and weight gain during the pregnancy weaken the pelvic floor. This can lead to incontinence during your pregnancy, especially in the last trimester, and explains why the same percentage of women have incontinence issues after C-section as after a natural delivery.
Strong pelvic floor and deep abdominal muscles can also help to stabilize the pelvis and spine thus reducing the risk of back pain during pregnancy.
But not all women need to strengthen their muscles. Some have tight and overactive pelvic floor muscles, in which case they need to learn how to relax them to avoid complication while giving birth.
How can you be sure you are doing the exercises correctly?
Alone: with difficulty. A lot of women are doing them wrongly or are practicing the ‘stop pee’ exercise, which can actually damage the pelvic floor, lead to urinary infections or other problems. Ask somebody qualified like a women’s health physiotherapist to train you how to do it correctly.
My advice, if you want to know if you are doing it right, is to check the following: Sit down on a hard chair, feel your sitting bones, imagine that you close them together like the door of a lift, and lift the whole area up. You want to create a space between the chair and your pelvic floor.
Are there any pelvic floor training devices that can help before or after delivery?
For safety reasons I would not recommend any devices for internal use, electronic or not, during pregnancy.
After delivery, wait for a complete healing of the perineum around the fourth week.
Then you have different tools:
- the educative probes, also called biofeedback. They are a good learning tool, especially when there is poor control as they give you visual cues and sometimes show the strength that you are applying. I like to use them in the clinic and as well as for home exercise programs. The probes itself have no strengthening property, you still have to do the exercises. One drawback: they sometimes give you a positive reading even though the exercise is done wrong, so are not 100% reliable.
- the weights: Women can wear these weighted probes while doing other things. You increase the weight and the duration while your training progresses. They rely solely on the automatic contraction of the pelvic floor muscle. This is a protective reflex, which is reduced after delivery and normally works efficiently again after 6 to 8 weeks. If the muscle is too weak the reflex will not return and this method is not suitable.
- the electronic probes. They are for very weak muscles, women who have no control of the pelvic floor. If there is no neurological cause, you can use the ones available in the market. The latest versions are very simple to use, often with one or two programs. I like the wireless option, more expensive, but it allows more freedom of movement. Three things to remember with any of them: they work in combination with lubricant, they work well only if you can achieve an efficient muscle contraction (you shouldn’t stop increasing at the first contraction felt) and, although not the nicest sensation to have, they should be completely PAIN-FREE. Stop using them immediately if there is pain and get a checkup!
What about apps that are useful for pelvic floor training?
Informative and including reminder functions, several apps can help you to stay on track with your training. ‘Squeezy’ from the English public healthcare system NHS is an app that received a lot of praise. ‘B.wom’ is another useful one.
There are also devices that can be paired with apps and connected to your phone, so you can keep track of your training and progress, like the recently released ‘Elvie’ (www.elvie.com).
Is there anything else you can do to prepare your pelvic floor for birth and labour?
During a natural delivery, the perineum is stretched to let the birth happen. It is possible to help this process with perineum massage and stretches.
How soon after labour should you start to train your pelvic floor again?
I often advise to start a few gentle Kegel exercise movements one day after the delivery. This can help the perineum to recover by improving the blood supply locally, and reducing the local swelling. There is absolutely no risk in doing pelvic floor muscle contractions, even if there is a tear or an episiotomy. Between the delivery and 6 weeks, your pelvic floor muscle is healing and recovering. Not doing any pelvic floor movement during that period is a mistake, as it will delay this process. After 4 weeks to 6 weeks, the exercise should intensify. This is the best time to start seeing a physiotherapist.
On average, how weakened is a woman’s pelvic floor muscles after delivery and to what extent does it usually recover by itself versus needing extra help?
Your perineum is not the same after having a child, whether born naturally or by C-section. It really depends on a lot of factors: Genetics, weight gain, size of the baby, natural healing process, type of damage, etc. All of this will determine if you are one of the lucky few, having a normal natural recovery of 80 to 90 per cent, or only recover 30 to 50 per cent, or not having any recovery at all without help.
It is wrong to think that child birth is the only moment where the pelvic floor muscles are at risk. The weight gain and pressure applied during pregnancy and some sports that increase pressure and impact can be as damaging as the delivery. It is also wrong to think that we only need to strengthen the pelvic floor. Sometimes the pelvic floor muscle recovers nicely, but the abdominal muscles don’t.
Are there any home exercises or devices that can help you gauge how weakened your pelvic floor is?
Sadly at the moment there is no device in the market that is reliable. Manual testing even in the professional word is still the test of reference.
When should you consider seeing a physio regarding your pelvic floor?
In general seeing a physio will help to prevent problems that can develop down the road. But you definitely should see one if you feel something is wrong, want to assess the strength of your pelvic floor, make sure you are doing your exercises right or face difficulties when returning to sports. You also need to see a physio if you can’t get rid of your Mummy Tummy, as you might have Diastasis Recti, a condition that will get worse with standard exercise.
What does an average treatment course usually consist of before the pelvic floor is back to how it was before pregnancy?
It depends. I usually have a more holistic approach. I take in consideration not only the pelvic floor but also the abdominal muscles, the back and posture post-delivery. It takes between four to 15 sessions, depending of the women.
Each session with Kuur Rehabilitation is Dh400 and they are covered by most insurances, if you have a doctor’s referral and your policy doesn’t exclude maternity coverage, kuur-rehab.com.