Why You Should Get Your Pelvic Floor Assessed in Pregnancy!

Pregnany pelvic floor 2

You’ve probably thought about where you’ll give birth, possible names for the baby, and maybe even which pram you’ll choose. But amidst all these preparations and body changes, have you started thinking about your pelvic floor? 

Ensuring that your pelvic floor muscles are in optimal condition can significantly impact your pregnancy and postpartum experience. In this blog post, we’ll explore the importance of pelvic floor exercises, but also crucially, the importance of a pelvic floor assessment during pregnancy and how this can benefit you.

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    Why are Pelvic Floor Exercises so Essential in Pregnancy?

    Pelvic floor exercises, also known as Kegel exercises, involve the repeated contraction and relaxation of the pelvic floor muscles. These are the muscles that make up the vaginal walls, and support the bladder, uterus, and bowels. 

    During pregnancy, the added weight and pressure from the growing baby can weaken these muscles, leading to issues such as incontinence and pelvic organ prolapse.

    But also - the ability of the pelvic floor muscles to move through full range, and relax fully, plays an important role in the ease of vaginal birth and outcomes after a vaginal birth. 

    Regular pelvic floor exercises can help:

    1. Prevent Incontinence: Strengthening these muscles reduces the risk of urinary incontinence during and after pregnancy.

    2. Support Vaginal Delivery: A pelvic floor that can relax fully can make vaginal delivery easier (shorter pushing stage and less likelihood of needing assistance from forceps and vacuum) and can reduce the likelihood of tearing.

    3. Enhance Recovery: Postpartum recovery is likely to be faster with well-conditioned pelvic floor muscles, aiding in the healing process.

    Why You Might Be Getting Your Pelvic Floor Exercises Wrong - and How to Fix This!

    It’s common for women to simply be given a brochure, or to be verbally encouraged by a health care provider to ‘do their pelvic floor exercises’. This makes the assumption that you’re doing pelvic floor exercises correctly, but many women inadvertently make mistakes. Here are some common errors and tips to correct them:

    1. Not Engaging the Right Muscles: Many women mistakenly contract their abdominal or gluteal muscles instead of the pelvic floor. The result? Potentially just a waste of time!

    2. Overdoing It or Incomplete Relaxation: Excessive squeezing, and/or not relaxing completely between contractions, can lead to muscle fatigue or too much muscle tension. The result? Possibly being counterproductive and causing more problems with birthing vaginally. It’s very important to know if you have an ‘overactive pelvic floor’ and adjust your exercises accordingly.

    3. Incorrect Technique: It’s not uncommon to find that women are breath holding or pushing downwards when trying to do a pelvic floor contraction. The result? Unnecessarily adding repetitive strain to this muscle during pregnancy. 

    A pelvic health physiotherapist can guide you through the correct technique, correcting any mistakes and putting in place an individualised exercise program to ensure that you reap the full benefits of your exercises.

    How can a Pelvic Health Physiotherapist assess your Pelvic Floor?

    There are two main ways that a physiotherapist can assess your pelvic floor - either with a digital vaginal examination, or with a real time ultrasound machine through your lower abdomen (looking at your bladder). 

    While the vaginal examination is the gold standard, it is acknowledged that some women may not consent to this, and it’s important to know the different benefits to both options. 

    Pros and cons of the two methods are as follows:

    1. Invasiveness - as mentioned, some women will prefer the non-invasive nature of having an ultrasound on your lower tummy instead of a digital vaginal examination.

    2. Visual feedback - some women will gain a lot of benefit from seeing the lift and lower of the bladder base on the ultrasound screen when doing a pelvic floor contract and relax.

    3. Tactile feedback - some women will gain a lot of benefit from having the therapist’s fingers directly on the muscles and being given tactile feedback as to where they need to contract and how to relax.

    4. Limitations of real time ultrasound - a vaginal examination is the gold standard in pelvic floor assessment due to the ability to assess strength, tone/tension, effectiveness of ‘bearing down’, measurements of the perineal length and internal vaginal width, presence or likelihood of prolapse, and presence of pain. None of these things can be assessed via trans-abdominal real time ultrasound, and these things can all impact the way your pelvic floor exercises are prescribed, and decision-making around vaginal birth. 

    When Should You See a Pelvic Health Physiotherapist for an Assessment?

    It is highly recommended to see a pelvic health physiotherapist at three specific points in your pregnancy - and potentially other check in times too if the therapist determines that you have specific aspects of pelvic floor training to work on. 

    1. Approx 12-20 weeks - getting a pelvic floor assessment done in your second trimester - the earlier the better - allows you to make an early start on pelvic floor training, safe in the knowledge that you are performing them correctly. This also allows for early detection of issues like increased tension, and inability to ‘bear down’ and pelvic floor weakness, all of which can then be worked on during pregnancy.

    2. Approx 34 weeks - this is when perineal massage can be taught and demonstrated, so that you can confidently start doing this at home regularly with the aim of decreasing the chance of perineal tearing during vaginal birth.
    3. Approx 37-38 weeks - this is when a pelvic health physiotherapist can do a final pelvic floor check for readiness for vaginal birth, plus a TENS machine can also be demonstrated and hired to use for pain distraction during labour. 

    Regular check-ups throughout your pregnancy can ensure your pelvic floor remains strong and functional. A check in would be warranted for management of any symptoms to do with bladder or bowel incontinence, vaginal bulging or heaviness, or pain in the pelvic or vaginal area.

    What Else Can a Physiotherapist Help You with During Pregnancy?

    Pelvic health and Musculoskeletal Health physiotherapists offer a wide range of services beyond just pelvic floor assessments. As well as the perineal massage and TENS services mentioned above, physiotherapists who work with pregnant women can also assist with:

    1. Pain Management: Addressing pregnancy-related pains in the back, hips, and pelvis (this would warrant booking a ‘Musculoskeletal Assessment’ rather than a ‘Women’s Health Physiotherapy Assessment’).

    2. Exercise education and prescription: Giving individual advice on exercise modification and prescription to stay safe, but also to achieve the recommended physical activity levels during pregnancy.

    3. Breathing Techniques: Teaching breathing exercises that aid in relaxation and labor.

    4. Postpartum Recovery: Developing a plan for postpartum recovery, including safe return to exercise and activities.

    Investing in your pelvic health during pregnancy can lead to a more comfortable pregnancy, smoother delivery, and faster postpartum recovery. Don’t wait until issues arise; schedule a pelvic floor assessment with one of the FitRight physiotherapists and take proactive steps towards a healthier, happier pregnancy journey.

    Book a Women’s Health GP appointment here

    FitRight

    Perth’s Leading Centre for Women’s Health and Exercise

    Physiotherapy, GP services and physio-led exercise classes specifically for women

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