CeeCee2010
Mummy to Jessica xxx
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Oh my gosh - sod the doughnut that drink looks heavenly!!!
Is anyone doing there pelvic floor exercise? I keep forgetting and think I really need to! Sometime I have no control when I sneeze or laugh really hard![]()
What is my pelvic floor?
Your pelvic floor is a broad sling of muscles, ligaments and sheet-like tissues. It stretches from your pubic bone at the front of your body to the base of your spine at the back.
The pelvic floor is sometimes compared to a trampoline, as it can stretch in response to weight and bounce up again!
Unlike a trampoline, however, if it bears weight for a long time (as it does during pregnancy), the muscles or tissues can become over-stretched and weak.
Why is my pelvic floor so important?
Your pelvic floor supports your bladder, bowel and uterus (womb). So your pelvic floor gives you control over when you empty your bladder and your bowels.
Having a weak pelvic floor makes it harder for you to squeeze the muscles (sphincters) at the bottom of your bladder to stop wee escaping. You may find you accidentally leak a little wee when you cough, sneeze or exercise. This is called stress incontinence (Morkved et al 2004). You may find this continues after you've had your baby. Postnatal stress incontinence affects up to a third of all new mums (Morkved and Bo 2000).
Your pelvic floor affects your vaginal muscles too. You may find sex less satisfying if you have weak pelvic floor (Roughan and Kunst 1981).
It's not just during pregnancy and childbirth that your pelvic floor is important. You'll need to keep it strong for the rest of your life to guard against problems later, especially after the menopause.
Later in life, if your vaginal muscles are weak, it's possible for your uterus to sag down and push against the walls of your vagina (Jelovsek et al 2007, Swift et al 2003). This is called prolapse. It's thought that four out of 10 women over the age of 50 have some degree of prolapse (Hendrix et al 2002, Swift et al 2003).
If all this sounds alarming, the good news is that you can do something about it. If you do your pelvic floor exercises (see below) every day, you'll be guarding against problems later.
How does pregnancy affect my pelvic floor?
Being pregnant can place a lot of stress on your pelvic floor muscles. Your pelvic floor can become weak and stretched from as early as 12 weeks into your pregnancy. Constipation, which is common in pregnant women, can put even more strain on your pelvic floor.
How do pelvic floor exercises help me?
Pelvic floor exercises, if done properly and often, can help to protect you from leaking urine while you're pregnant and after your baby is born (Morkved and Bo 2000 and 2003, Reilly et al 2002, Hay-Smith and Dumoulin 2006).
The National Institute for Health and Clinical Excellence (NICE) says that all women should be told how to do the exercises during their first pregnancy (NICE 2006). If you haven't been shown how to do pelvic floor exercises during your antenatal classes, ask your midwife about them at your next visit.
Good pelvic floor muscles may help to:
support the extra weight of pregnancy
shorten the second stage of labour, when you push your baby out (Salvesen and Morkved 2007)
heal the area between your anus and vagina (perineum) after birth, by increasing the circulation of blood to it
Another benefit is that women with stronger pelvic floor muscles may be more likely to have orgasms during sex. So doing pelvic floor exercises could help you to have a more satisfying sex life (Roughan and Kunst, 1981)!
How do I find my pelvic floor muscles?
Imagine that you are trying to stop yourself from passing wind and trying to stop your flow of urine mid-stream at the same time. The feeling is one of squeeze and lift, pulling up and in around your front and back passages. When you have practised the exercises for a while, you could try this during love-making, asking your partner whether he can feel the effect.
Some women will feel more happening at the front and some will feel more happening around their bottom. Don't worry too much about this. As long as you can feel a tightening in at least one of these areas, you will be exercising your pelvic floor.
Of course, that sounds easy enough. But the catch is that you have to squeeze and lift without:
pulling in your tummy
squeezing your legs together
tightening your buttocks
holding your breath
When you first try pelvic floor exercises, it is best to start in a comfortable position, for example, lying down (Bo and Finchenhagen 2003) in a quiet place. It may help you get a feel for where your muscles are. Once you know how to do the exercises in this position, try doing them when you are sitting down.
How can I perfect the exercise technique?
When you start out exercising your pelvic floor muscles, you may find that you hold your breath as you squeeze. You'll need to learn to breathe normally as you do the exercises. This is because when you cough or sneeze, you breathe out forcefully. If you can only tighten your muscles when you hold your breath, they will relax as you cough and won't stop urine leaks.
To help you get the technique right, try the following exercise:
Place one hand at the top of your bump and the other on one of your shoulders. Breathe normally for four or five breaths.
If your breathing is relaxed, you should find that the hand on your tummy moves up and down more than the hand on your shoulder. If this is not happening, try to stop your shoulders moving and let your tummy rise and fall naturally.
Gently pull up and in "down below" as you breathe out. When you are learning, don't try to pull up so hard that you have to hold your breath. Start with a gentle contraction until you have managed to co-ordinate your contraction with a breath out.
Try then to hold a contraction for a few seconds while you continue to breathe in and out as normal.
You may feel your lower tummy muscles tightening, and that's fine (Sapsford et al 2000). If you are tightening your upper tummy muscles (above your belly button) then you are trying too hard! Go back to the breathing exercise and start again.
You should aim to be able to hold a pelvic floor contraction for 10 seconds while breathing normally. If you lose your breathing control, stop and start again.
There is a way to help you check if you're doing the exercise properly. Only do this check if you have not been told to avoid sex during pregnancy and do not have any bleeding or infections in your bladder or vagina. Gently insert one or two fingers in your vagina when you are having a bath. Start doing the exercises. You should feel a squeeze and lift inside your vagina if you are exercising your pelvic floor muscles.
Once you have got the basic exercise down to fine art, you can add in fast pull-ups. Begin by making sure you are breathing in a relaxed way and then as you breathe out, pull up your pelvic floor muscles and let go quickly. Then try to pull up and let go quickly up to 10 times in a row without holding your breath.
This exercise helps your pelvic floor muscles to react quickly when you cough, sneeze or laugh. It only works if your pelvic floor muscles are strong enough to support all of your pelvic floor, which is why it is important to start with the slow contractions.
It is much harder to learn how to do these exercises after your baby is born, so practise as much as you can while you're pregnant.
How often do I need to exercise my pelvic floor muscles?
NICE recommends you should exercise eight times, three times a day (2006). If you are having problems with leaking urine you may need to do them more often. In fact, it's a good idea to do as many as you can as you go about your daily routine. You should aim to make pelvic floor exercises a part of your life for ever.
What else do I need to know?
It is just as important to learn how to relax your pelvic floor as it is to tighten it. When your baby's head "crowns" during the second stage of labour, your muscles need to relax. Some midwives believe that a relaxed pelvic floor at this stage can help prevent tearing or episiotomy. Also, if your muscles can't relax properly, they will tire more quickly.
After you have tightened your pelvic floor muscles, make sure you relax them fully before tightening them again. For some women, a gentle push out at the end of each pelvic floor contraction will help. Getting your breathing right will make this easier.
Other things that will help you to protect your pelvic floor:
Drink normally and only go when you feel that your bladder is full. It is normal to go to the toilet more often when you are pregnant but this should stop a week or so after your baby is born.
If you're trying to get fit after the birth of your baby, don't do straight-leg sit-ups and double-leg lifts. These put severe pressure on your pelvic floor and your back. See our article about safe postnatal exercises.
If you find that pelvic floor exercises do not help you control your bladder, ask your GP, obstetrician or midwife to refer you to a specialist women's health physiotherapist or continence nurse.