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5 Things a Physiotherapist Wants to Tell You About Your Pelvic Floor

If you haven't  given much thought about your pelvic floor, chances are you’ll benefit from these top tips by Lyz Evans, a Women’s Health and Continence Physiotherapist and Director of Women In Focus Physiotherapy and Health.

1. Your pelvic floor is just like any muscle – use it or lose it

The pelvic floor supports the bladder, bowel and uterus, as well as aids bowel and bladder control. “It’s an incredible structure of muscles, fascia ligaments and nerves that work in harmony to ensure we stay continent, supported and pain-free,” says Evans. “The huge hormonal and physical changes that occur in pregnancy often disturbs the normal function of the pelvic floor, meaning that 50-60% of women will report having one or more of symptoms of pelvic floor weakness during pregnancy.” So, if you don’t work these muscles, you’re more than likely to experience leaking, lower back or pelvis pain, or a feeling of heaviness in the vagina. “The pelvic floor is just like any other muscle, so the use it or lose it principal applies,” says Evans.

2. If you’re pregnant, pelvic exercises are so important

Pelvic floor exercises in pregnancy are important, for a variety of reasons. Firstly, any muscle in the body needs to be challenged to ensure that muscle strength is maintained. “We know from research that women who follow a structured physiotherapy lead pelvic floor in pregnancy are 30- 35% less likely to experience urinary leaking during the second and third trimester, and 40% less likely after the baby is born,” says Evans. Another important reason to exercise the pelvic floor in pregnancy has to do with connection: the pelvic floor only activates when a nerve “talks” to it and the more a nerve talks to a muscle, the stronger and faster this muscle responds. “It’s a bit like having a muscle on speed dial as opposed to having to look through your phone contacts to find a number and then make a call. So, if a woman has been exercising her pelvic floor during pregnancy, then following the birth of the baby this “well-rehearsed” nerve pathway is likely to result in a quicker and faster recovery of the pelvic floor,” says Evans.

If a woman has been exercising her pelvic floor during pregnancy, then following the birth of the baby this “well-rehearsed” nerve pathway is likely to result in a quicker and faster recovery of the pelvic floor.”

3. Strengthening is overrated

Most of us think hear about strengthening our pelvic floor, but it’s not just about that. “The majority of women and health care providers fail to understand that in pregnancy the role of pelvic floor engagement is to not only ensure the muscle can tighten, but can also open and relax completely,” says Evans. “We know that during birth the pelvic floor needs to be able to open and lengthen between 2 - 3.5 times its normal length during crowning phase, so learning how to relax and open the pelvic floor really should be a priority for all women planning a vaginal birth.”

4. Don’t do your exercises in the toilet

Despite many magazines recommending women doing pelvic floor exercises on the toilet, it can play havoc with bladder function. Evans recommends it only as a way to help women connect to her pelvic floor. “As a one off, a woman can try to slow or stop the flow of urine by tightening up in the vagina, holding for 2-3 seconds then releasing. This is the sensation she needs to remember when she does pelvic floor exercises at other times such as sitting in a chair, lying on a mat or in bed,” she explains. “I would also highly encourage every woman to see a women’s health physiotherapist where possible to teach correct pelvic floor activation and to check “what type’’ of pelvic floor she has. We know from research that if women do pelvic floor exercises through written instructions, then 50% will do it incorrectly, of which 25% will actually push the pelvic floor down, not up and this is absolutely not what we want.”

Despite many magazines recommending women doing pelvic floor exercises on the toilet, it can play havoc with bladder function.

5. You might want to continue working on your pelvic floor after pregnancy

“In my opinion doing pelvic floor exercises following having a baby is the most important time in woman’s life to do pelvic floor exercises.” Says Evans. “It’s like having surgery on your knee, and totally skipping the post-operative rehab program set by the surgeon. You wouldn’t do that would you? Or if you were silly enough to not do your rehab program, then you wouldn’t be surprised 6 months down the track if you have poor outcomes form your knee surgery such as ongoing knee weakness, stiffness, pain and an inability to do the exercise you love such as running. This is exactly what birth is to the pelvic floor.”


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