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Info Centre - Looking after your pelvic floor

Looking after your pelvic floor

Your Pelvic Floor

Contents

How to excercise
Massage
Birth
Sex
Who can help?

What is it/what does it do?

Your pelvic floor is a group of muscles and ligaments which go across the base of your pelvis in two joined halves with gaps for the urethra, vagina and anus to pass through.

What it does:

  • Supports your internal organs (bladder, intestines, uterus etc.)
  • Maintains bladder and bowel control (including when you sneeze, cough, lift heavy objects etc.)
  • Plays a vital role in supporting the spine
  • Helps you enjoy sex more

During pregnancy and birth:

  • Helps rotate the baby's head into the correct birth position
  • Helps prevent constipation and piles
  • Supports the weight of the baby and fluid

It is made up of two kinds of muscle fibre: slow twitch for stamina and fast twitch for quick contractions and for best effect, you need to exercise both kinds.

How to find your Pelvic Floor:

There are a number of ways to do this:

Try “squeezing” your partner during penetrative sex or insert one or two fingers into your vagina and try squeezing them.

You can also try using your pelvic floor muscles to stop your urine mid-flow or stop wind from your back passage, but don't do this as an exercise as it can lead to your bladder not emptying properly.

Slow Exercise #1

Sit or lie comfortably with your knees slightly apart. Pull up the muscles surrounding your back passage, then pull up towards the front. Hold and count to four, remembering to breathe normally.

Double check you aren't pulling in buttock muscles by placing your hand on your bottom as you do the exercises. It's OK if you're tensing your lower abdominal muscles slightly.

When you find this exercise easy, try holding for a longer count, up to a maximum of ten.

With these exercises, quality is better than quantity: it's much better to do a few good ones at a time.

Slow Exercise #2

Imagine your pelvic floor is like a lift. Tighten the muscles around the anus and vagina, as if closing doors in a lift. Now tighten a little more as if you're going up to the first floor, then the second, then gently come back down to the ground again, making sure you keep breathing normally throughout.

Try coughing or blowing into your fist. You will feel the muscles of your pelvic floor being pushed down. This will also happen when your baby' head starts to move down the birth canal during the second stage of labour. Knowing how to relax these muscles will help you give birth to your baby.

Fast Exercise

Try tightening and then relaxing your pelvic floor muscles as quickly as you can, 5-6 times in a row. These are the muscles which contract instantly when you cough, sneeze etc. to resist the rise in abdominal pressure. Before you cough, sneeze, lift or laugh, try to take a moment to pull these muscles up.

When?

Try and work up to doing about 50 exercises per day. Try and fit them into your daily routine like doing them while you are stuck in traffic, watching TV or on the loo. Some women have found it helpful to put little stickers round the house and do a few exercises each time you see one.

Perineal Massage

Massaging the area between the vagina and anus in the last weeks of pregnancy has been shown to reduce the likelihood of tearing during birth, stitches or needing an episiotomy.Either on your own with a mirror or with your partner, massage oil (preferably vegetable based) into the skin of the perineum using your fingers or thumbs.Then place your fingers around 5cm (2”) inside your vagina and press downwards towards the anus, then move to each side in a U-shaped stretching movement. This may give a tingling/burning sensation.Hold the stretch for 30-60 seconds then release. The feeling is similar to what you will feel when your baby's head is crowning.

Caring for Stitches

If you need stitches after birth there are a few tricks that can help you recover afterwards:

  • Walking will prevent stiffness and help reduce swelling
  • Once you are home, where there is less risk of infection, bathing in warm water may help soothe any pain.
  • A Valley cushion is a specially designed inflatable cushion for women with a painful pelvic floor, piles, stitches or a sore coccyx, and makes sitting down much more comfortable. Local vendors can be found through the NCT Enquiries Line (0300 33 00 770)

After Your Birth

Resuming pelvic floor exercises as soon as possible after giving birth will help reduce swelling and speed up the healing process. If you have had stitches you may wish to start the exercises lying down and work your way up to doing them whilst sitting.

Continuing with your pelvic floor exercises until you feel they are completely back to normal is a good idea. Doing them for the rest of your life will help prevent problems in later life such as a prolapsed uterus or bladder.

Exercise

You can start low impact exercises such as walking, cycling and swimming when you feel ready. Although no matter how fit you were before your pregnancy, you shouldn’t attempt high impact exercise until at least three months after the birth of your child, as if done too soon it can place a great deal of stress on the pelvic floor and potentially slow down recovery and damage bowel and bladder control. If you find that you are having incontinence problems, ask your GP for a referral to an Obstetric Physiotherapist.

Organisations such as the Guild of Postnatal Exercise and the YMCA can help you find organised exercise classes in your area

Sex

You don’t need to wait until your six week check-up to make love providing you both feel ready. But remember that breastfeeding alone is not an adequate form of contraception. If you feel apprehensive about intercourse, using a lubricant like KY Jelly or trying different positions may make it more comfortable. Many women wait several months before making love with penetration.

People who can help

A small but significant number of women find they lose some bladder or bowel control (leaking urine and or faeces) after birth. It may be embarrassing to discuss with your doctor or midwife, but they can help. Also look at the Continence Foundation website www.continence-foundation.org.uk.

For information on postnatal exercise classes visit the Guild of Postnatal Exercise at www.postnatalexercise.co.uk, or contact your local YMCA at www.ymca.org.uk.

The NCT runs helplines whose numbers can be found on the side of the page.