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Pelvic Floor

The Pelvic Floor – A Vital Little Muscle For All New Mums And Mums-To-Be

Giving Birth gives you the greatest gift imaginable but it also leaves around 43% of moms with a few gifts they’d prefer to return; and if you’re afraid to sneeze and jump in public, you know exactly what we’re talking about.


Incontinence issues is just the tip of the iceberg, with organ prolapse, back pain and perineal tears also make life post-birth difficult for moms, especially if left untreated.


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Dr Rebekah Das, Continence and Pelvic Floor Physiotherapist at My Physio talks about why and how pelvic floor problems develop, especially during pregnancy and how you can prevent problems or treat them if they have already started.


5 Reasons to See a Pelvic Floor Physiotherapist

If you are pregnant, it will be an excellent idea to see a pelvic floor physiotherapist to learn how to exercise your pelvic floor muscles during you pregnancy and after your delivery.  This is the best way for you to prevent the development of a problem with pelvic floor function.

You should also see a pelvic flor physiotherapist if you have any concerns about the function of your pelvic floor.  The 5 most common signs of a problem are:

  • Leaking urine when you cough, sneeze or laugh.
  • Having to rush to the toilet too often during the day (and possibly leaking urine on the way to the toilet).
  • Not being able to stop the passage of gas from your bowel if you need to.
  • Having to rush to the toilet to empty your bowels because you are afraid you can’t hold on (or have actually had the occasional accident).
  • Feeling a lump or a bulge or a feeling of pressure in your vagina.

According to international standards of care, pelvic floor physiotherapy is the first line of treatment for these problems and a pelvic floor training program, conducted for at least 3 months will be effective treatment for most people.


What is my pelvic floor?

The pelvic floor is the sling of muscles at the base of the pelvis.  These muscles control all of the pelvic outlets – the bladder, the bowel and the vagina.  Both men and women have pelvic floor muscles, they are just slightly differently configured. The following diagram, from the Continence Foundation of Australia shows the position of the pelvic floor muscles in women.


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Why is my pelvic floor so important?

The health of pelvic floor muscles is important for everyone, as any loss of strength or function can mean that you end up having trouble controlling your bladder or your bowel.  The most common symptom of a  pelvic floor problem is stress urinary incontinence, which means leaking urine unintentionally when there is increased pressure in the abdomen (for example when coughing, sneezing, laughing or during exercise).


Other people develop urinary urgency (needing to rush to the toilet very quickly because of fear of not making it on time).  Sometimes the muscles controlling the anal passage are more of a problem and controlling the passage of wind or stool can be difficult. People with weak anal muscles might have to rush to the toilet to empty their bowels because they can’t hold on, or they might not be able to control the passage of wind or may even leak stool or mucus unintentionally.  For women with weak pelvic floor muscles, especially after childbirth, prolapse may also be a problem.  Prolapse is a bulge or lump in the vagina indicating that one or more of the pelvic organs (uterus, bladder or bowel) may no longer be well supported and is sitting too low in the pelvis.  This can sometimes cause difficulty with completely emptying the bladder or bowel.


Sometimes pelvic floor muscles can be too overactive and cause pain.  Women with overactive pelvic floor muscles might find sex uncomfortable or even impossible. Overactive pelvic floor muscles can also cause problems with emptying the bladder or bowel.


Remember that bladder or bowel leakage is never normal and can usually be helped, no matter what a person’s age.


How does pregnancy affect my pelvic floor?

During pregnancy, the pelvic floor becomes lengthened and if not adequately exercised, will generally become weaker.  This is partly due to hormones which soften ligaments and muscles in preparation for birth, but is also due to increased weight and postural changes.  Research has demonstrated that women who exercise adequately during pregnancy and particularly exercise their pelvic floor muscles accurately, are less likely to develop symptoms of incontinence.  They are also likely to recover more quickly if they do develop incontinence during pregnancy.  Exercising the pelvic floor during pregnancy is not dangerous in any way so long as it is done properly and it is recommended that you have a pelvic floor physiotherapist check that you are doing pelvic floor muscle exercises correctly.


Pelvic floor muscles can be injured during the birthing process.  If you have learned how to accurately exercise your pelvic floor prior to giving birth, it will be much easier for you to recover from any injury afterwards.  It is difficult to try to learn how to exercise a muscle for the first time when it has just been injured.  All the more reason to see a pelvic floor physiotherapist when you are pregnant or even planning pregnancy.


How will pelvic floor exercises help me?

Pelvic floor exercises keep the pelvic floor muscles functioning optimally.  This means that they are strong enough for you to hold on whenever you need to hold on.  It also means the muscles can fully relax when not needed and also that they can react quickly to changes to abdominal pressure (such as for sudden sneezes).  A pelvic floor physiotherapist can assess your pelvic floor to determine any deficits in function and prescribe exercises specifically tailored to your needs.


You will often see pelvic floor exercises referred to as ‘Kegels’.  Dr Kegel was the first doctor to describe exercise of the pelvic floor as successful in treating incontinence and hence this type of exercise was named after him.  However, research into the most effective ways to exercise the pelvic floor has progressed rapidly over the last decade. It is not generally a good idea to try to teach yourself how to exercise your pelvic floor by reading generic information off the internet, especially if you already have bladder or bowel symptoms.  The safest approach is to an appropriately trained pelvic floor physiotherapist who can design exercises specific to your needs.

How often do I need to exercise my pelvic floor muscles?

If you have no specific pelvic floor problems, it is a good idea to include pelvic floor muscle training in your regular exercise program 3-4 days per week.


But if you are at all unsure, seek an individual assessment. It is possible to overtrain the pelvic floor or to use nearby muscles instead of the pelvic floor if you do not learn to use the muscles properly right from the start.
If you have problems with your pelvic floor muscles, you will need to exercise according to individualised advice given to you by a pelvic floor physiotherapist.  Once your muscles have recovered and are functioning well, it is a good idea to continue a maintenance exercise program 3-4 days a week for the rest of your life.  Just consider it an important part of keeping fit!


If you are looking for a pregnancy and post natal fitness classes, find more details here



By Dr Rebekah Das
Is a Pelvic Floor Physiotherapist, originally from Australia, now working as a Continence Therapist at myPhysio, GK2 in New Delhi. She completed a PhD studying bladder sensation in 2014 and continues to teach pelvic floor physiotherapists at the University of South Australia.  She is a member of the Continence Foundation of Australia and the International Continence Foundation. Rebekah has also conducted training courses for pelvic floor physiotherapists in India and can recommend where you can find help from appropriately trained pelvic floor physiotherapists in Delhi, Mumbai and Bangalore.