We, the Pelvic Floor Patrol, are a team of 5 women who are all passionate about empowering women with health and wellbeing postnatally. We are starting a campaign to improve postnatal care and make sure that all women have access to the right information, and are given the option to have physiotherapy to heal fully and effectively after birth. Birth injuries can otherwise last a lifetime, if not dealt with fully. But there is so much that you can do to empower your own recovery.
Your pelvic floor is at the centre of what Joe Pilates called your “powerhouse”, or “girdle of strength” – a strong core offers you the freedom of graceful fluid movement, without tension and impingement. Your pelvic floor is the base of this “core”. Think of your core as the space from your ribcage to your pelvis. The diaphragm is the “ceiling”, the deep abdominals (the Transversus Abdominis and obliques) are at the front, the deep muscles of the spine (the multifidus) are at the back and the pelvic floor is the foundation.
The pelvic floor isn’t just one muscle, but a layer of muscles supporting the pelvic organs, spanning the pelvic cavity. Imagine it as a round mini-trampoline made of firm muscle, attaching at the tailbone at the back and the pubic bone at the front. These muscles are interlinked, overlapping and webbed together in a figure-of-eight shape around your vagina, anus and urethra to support the uterus, bowel and bladder. Men also have a pelvic floor (perhaps a little known fact, as we always associate the pelvic floor with women) but they don’t have the baby exit route to consider. The pelvic floor muscles provide you with strength, spring and support through your daily movement, plus they’re your rapid response team to make sure you don’t leak urine when you cough or sneeze. They’re also important for sexual function – the contraction of the pelvic floor contributes to sensation and arousal.
It’s so important as a woman to lay the foundations for your pelvic floor health in the long term, for a life where you are able to go for a run, or jump up and down without fear of letting some wee escape.
What is the fuss about the pelvic floor? Why should I bother?
Your pelvic floor is a shock absorber through the daily pressure of movement – the pressure is particularly increased with pregnancy and childbirth. Remember that the pelvic floor forms the base of the core: your structural support system. Imagine what would happen if you built a loft extension on a house where a load-bearing wall had been knocked down? It would all collapse. This is why pelvic floor exercise matters.
Weakened pelvic floor muscles will mean your internal organs are not fully supported. This can lead to incontinence and pelvic organ prolapse.
Pelvic floor health declines as we age, particularly if we do nothing to maintain awareness and strength – this is one of those inevitable facts of life. Staggeringly, only 25 per cent of women aged 18–83 have ‘normal’ pelvic floor support (Swift et al. 2003). So when you add pregnancy and childbirth into this picture – there is a huge potential for pelvic floor malaise.
But we laugh about stress incontinence as mums – we normalise it (“me too! A tidal wave after 4 kids! LOL!”) and accept it as “just a part of being a mum”.
IT IS NOT NORMAL and women, we are doing ourselves a huge disservice by accepting this. There are things you can, and should, be doing to take the power back for your pelvic floor health and make sure you will be able to run after your kids without fear of weeing. Plus, your pelvic floor health and your mental health are inextricably intwined. Fear of weeing yourself in public will lead to feelings of shame, inadequacy, failure, and avoidance behaviours such as stopping exercise, which will mean you might start to feel physically weaker and more under par, which brings you down further..it’s a vicious cycle that begins with THE FLOOR.
Pelvic floor awareness
We need to be aware of the balance of the pelvic floor muscles rather than simply make them ‘strong’. Think about your arm muscles – they allow you to bend your arm in towards your shoulder, but they also straighten and extend your arm out and away from you. You’d be a bit stuck for functionality if you could only hold your arm in a slightly bent position in mid-range of movement, with neither of the two ends of the movement spectrum available to you. This flexible strength is what we need to aim for with our pelvic floor.
We need to balance strength with release.
Stand upright, in front of a mirror if you can, to check your alignment. Your feet are hip-width apart. Find your neutral pelvis by tilting the pelvis through full range and stopping at the midway point. You don’t want it sticking too far out but you don’t want it completely tucked, either. Make sure that your ribcage is stacked directly over your pelvis. Create length through the spine as if someone is drawing the crown of your head to the ceiling, keeping the chin softly tucked parallel with the ground. Soften your shoulders into your back. Take a wide breath in, imagine the ribcage opening out to all sides, like an umbrella.
- As you breathe out, lift your back passage, as if you’re trying to stop breaking wind. Continue this lifting energy up and forward. Engage from back to front, up and in. We want to locate the full breadth of the muscles from the back to the front, and from the sides in: imagine flower petals folding up and into a bud, evenly from all sides. Some sides might feel easier to you than others. You will feel your lower belly lifting gently as well. Maintain this lift for a few seconds, as long as you can remain relaxed and soft everywhere else.
- Breathe in, and let the engagement go, fully release it like dropping a marble into a glass of water. Try to do 10 of repetitions of these slow contractions.
We also need to train the pelvic floor with fast contractions, lifting up and in quickly to train the emergency rapid response element of your floor, for when you cough, sneeze, jump.
- On an out breath, quickly lift the pelvic floor to full engagement, keeping your surrounding muscles – the bum, inner thighs, upper abdominals, and your jaw, soft and relaxed.
- Then slowly relax the whole of the pelvic floor. Try to do 10 of repetitions of these fast contractions followed by a slow release. Breathe in a way that’s comfortable for you throughout these exercises, remembering not to hold your breath at any point.
Remember, when practising pelvic floor exercises:
- Scan your body for tension and try to release it: jaw, neck, inner thighs, buttocks.
- If you lose your connection, don’t feel frustrated. Take a breath and start again. With practice, it will become more natural.
- Make sure that you can still breathe, and your torso isn’t rigid.
- Please don’t practise this while sitting on the loo and stop mid-flow while actually having a pee. You might introduce the chance of a UTI.
Help! I can’t feel it!
If you really can’t find your pelvic floor at all: try sucking your thumb, pressing your hands down on your desk in front of you, or coughing. These actions all trigger your natural functional pelvic floor lift.
Persevere with gentle pelvic floor awareness exercises every day, often.
If you really struggle with lack of sensation, or pain, I’d advise going to a women’s health physiotherapist to see if a hands-on practitioner can give you some pointers.
To protect your pelvic floor health, always consider exhaling, and consciously drawing up in your centre as you lift heavy objects or your children.
The breath and your core strength are inseparable. If there is a missing link in the natural momentum: if your alignment is slightly off, for example your ribcage is tilted forward or back, or your pelvis tucked underneath you, this directs the natural momentum off course and pushes pressure to areas where it shouldn’t be. Pelvic floor exercises therefore are linked inextricably to good alignment and mindful posture.
Watch this space for updates about the PELVIC FLOOR PATROL. What are your experiences of postnatal care? Please share by commenting, or sharing this post with your friends. We need to build awareness and get the message out there that it is not ok to put up long-term with effects of birth which could otherwise be prevented and improved.