Your Pelvic Floor After Birth

Your pelvic floor after birth
What is my pelvic floor?

It's a broad sling of muscles, ligaments and sheet-like tissues that stretch from your pubic bone at the front of your body, to the base of your spine at the back. Think of your pelvic floor as being similar to a trampoline, as it can stretch when something presses down on it, and bounce back up again.

Unlike a trampoline, however, if it bears weight for a long time, as it does in pregnancy, the muscles and tissues can become overstretched and weak.

Why is my pelvic floor so important?

Your pelvic floor supports your bladder, bowel and uterus (womb), and gives you control over when you empty your bladder or bowel. Having a weak pelvic floor makes it harder for you to squeeze the muscles and sphincters at the bottom of your bladder. You may find that you accidentally leak a little wee when you cough, sneeze or exercise.

You are far from alone if you have stress incontinence. It affects up to a third of all new mums.

Your pelvic floor affects your vaginal muscles, too. You may find sex less satisfying, and feel less sensitivity in your vagina, if you have a weak pelvic floor.

You'll need to keep your pelvic floor strong for the rest of your life, as hormonal changes after the menopause can make pelvic floor problems more likely. If your vaginal muscles are weak, it's possible for your uterus, bowel or bladder to sag down and push against the walls of your vagina (prolapse).

Doing just a few pelvic floor exercises every day will help to treat bladder weakness or prolapse symptoms, and will help to prevent problems later on.

How will birth have affected my pelvic floor?

Just being pregnant can weaken your pelvic floor, even if you don’t go on to have a vaginal birth. During labour and birth, your pelvic floor stretches to allow your baby's head to pass out of your womb, and through your vagina. This may have left you with bruising, swelling and soreness.

The nerves that connect to your pelvic floor muscles will have also stretched. This can make the area between your vagina and anus (perineum) feel numb or sore, which can make it more difficult for you to work your pelvic floor muscles.

Your pelvic floor may have been overstretched during labour if you:

  • pushed your baby out for a long time
  • had a big baby
  • had a severe tear
  • had a forceps birth

If you try to do too much too soon after your baby's birth, your pelvic floor may feel heavy, or as if you have something bulging between your legs. This is a sign that you need to slow down, so try to get some rest, and don't stay on your feet for too long. If you can, spend time lying down, rather than sitting. This will help to take some of the pressure off your perineum.

When can I start to do my pelvic floor exercises again?

Start doing pelvic floor exercises as soon as you can. It may sometimes feel like the last thing you want to do, but it will really benefit you.

Doing your exercises will:

  • Help your perineum and vagina to heal more quickly.
  • Prevent and treat accidental leaks of wee
  • Improve the circulation of blood to your perineum, which will help to reduce swelling and bruising.

If you had a catheter inserted into your bladder after giving birth, wait for this to be taken out before starting your exercises.

You may find that you can’t feel your pelvic floor muscles working for the first few days, or that nothing is happening. This is completely normal, and happens because the nerves in your pelvic floor will have been stretched during the birth.

Your exercises will be working, even if you can't feel the effects. Keep trying, as the feeling in your pelvic floor will gradually come back.

Start exercising your pelvic floor muscles when you're lying on your back, or on your side. You may find it easier to do your exercises while you're relaxing in the bath, to begin with.

How should I do pelvic floor exercises?

Here's how to do your pelvic floor exercises:

  • Breathe in, and as you breathe out, gently squeeze your pelvic floor muscles. Pull your muscles up and in, as if you’re trying not to wee or pass wind.
  • Hold the squeeze for about four seconds or five seconds, while you continue to breathe in and out as normal.
  • You may feel your lower tummy muscles tightening, and that's fine. If you are tightening your upper tummy muscles (above your belly button) or your buttocks, you’re trying too hard!

Build up to holding a pelvic floor squeeze for between eight seconds and 10 seconds, while breathing normally. This can take between six weeks and 12 weeks, depending on how strong your muscles were before you began to exercise them.

If you lose control of your breathing, stop and then start again, while breathing normally. Once you have mastered this, try to do five fast contractions in a row, gradually building to up to 10. This helps you to tighten the muscles when you cough, sneeze or move suddenly.

Aim to do a couple of exercises every hour in the first day or so, and then slowly build up to eight to 10 exercises, three times a day. Try to tighten the muscles as hard as you can, as this helps to make them stronger. You can also try to do one or two really long holds of between 15 seconds and 20 seconds, two or three times a day, to build up your endurance.

It’s also important to remember to tighten your pelvic floor muscles just before you cough, sneeze, laugh or lift anything. This will help to prevent accidental leaks.

It can take a while for these muscles to strengthen, so persevere. It may take three months or more before you feel that you have control over your pelvic floor again.

Do I still need to do my exercises if I've had a caesarean?

Yes. Being pregnant can overload your pelvic floor, however you have your baby. Pregnancy hormones loosen your pelvic floor, and the weight of your baby stretches it further.

The good news is that you should find it easier to do your exercises than someone who had a vaginal birth, as your pelvic floor will not feel as sore, and your muscles are likely to be stronger. Your nerves will not have been affected, so your muscles will be firing on all cylinders.

How will stitches affect my pelvic floor?

You should still be able to do your pelvic floor exercises if you had stitches. However, stiches that have been sewn quite tightly can lead you to tense your pelvic floor muscles, without realising it. If your stitches are sore after the first few weeks, you may also squeeze in your pelvic floor muscles, in response to the pain.

If your muscles are held tight for too long, it can make having sex painful, and you may accidentally leak wee. You can help to prevent this by focusing on the relaxation part of your pelvic floor exercises. After you have tightened your pelvic floor, make sure that you let go completely and count to 10 before starting another exercise.

A gentle push out at the end of the squeeze can help with this. Wait for 10 seconds before starting again. Don't rush your exercises, and breathe normally throughout.

When should I get help with my pelvic floor?

Make an appointment with your GP if, after your postnatal check at about six weeks:

  • you can't tighten your muscles well
  • you still feel pain
  • you’re still leaking wee
  • your perineum feels painful

Ask your doctor or midwife to refer you to a women's health physiotherapist or a continence nurse. A physiotherapist will be able to assess your pelvic floor, show you how to do the exercises properly, and treat any problems.

However, it's worth asking to see a physiotherapist before you have your postnatal check if you had:

  • an assisted birth with forceps
  • a severe tear
  • problems with leaking wee in the first six months of pregnancy, or before pregnancy

This is because you may be more likely to develop long-standing problems, such as incontinence or prolapse. Seeking help early on will help to prevent these problems.
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