Pelvic floor training is a hot topic right now, but long before becoming trendy pelvic health has been an incredibly important component of prenatal and postnatal health. The pelvic floor is a group of muscles that lies within the bony pelvis and acts as the seat for our pelvic organs (bladder, uterus, rectum). The pelvic floor muscles allow us to maintain important functions that we don’t always think about, including bowel and bladder continence, pain-free intercourse, lymphatic circulation, and core stabilization. When everything is functioning normally down there, you wouldn’t normally think twice about your pelvic floor; but when something goes wrong, these issues can severely affect your quality of life.
The way I like to describe it is that you can get by with a regular muscle strain – it sucks but you can manage – but if you have to go to the bathroom 14x/day, you pee yourself every time you laugh, and sex isn’t very enjoyable, many aspects of your life will be impacted. This is especially important to consider during pregnancy – the abdominal muscles need to lengthen and the uterus needs to expand to make room for the growing baby. As a result, there is often greater pressure on your core and pelvic floor. You may find yourself breathing differently, experiencing weakness in your core, and potentially feeling heaviness and pressure in your pelvic floor. If you start to adopt dysfunctional movement patterns or fail to modify your movement where it’s needed, your core and pelvic floor are susceptible to dysfunction. But Pelvic Floor Physiotherapy can help.
Yes, it’s true, your perineum (the region directly below vagina where all of your pelvic floor muscles connect) is vulnerable to tearing during birth as these tissues need to expand to accommodate for the baby’s very large head. But don’t worry, research has shown us that perineal massage – a technique used by pelvic floor physiotherapists to practice stretching and desensitizing the perineum – is effective at reducing the incidence of tearing for a first-time birth.
While dismissed by many as “just another part of pregnancy”, the peeze is common but it’s not normal and it can be treated through pelvic floor physiotherapy. It is especially important to treat this early as it can worsen and it is a signal that your pelvic floor isn’t functioning well which can lead to other forms of pelvic floor dysfunction (urinary frequency, urinary urgency, pelvic organ prolapse, pelvic pain, and more). It also isn’t something that you want to be treating after-the-fact postpartum (you will have enough on your plate!).
There is a special kind of pelvic girdle pain that only occurs during pregnancy and that is what we call pregnancy-related pelvic girdle pain (PPGP for short). This pain can be experienced at the sacroiliac joints (SI joints), at the pubic symphysis, and can refer across the hip and thighs. PPGP symptoms can range from mild to severe, with some individuals experiencing disabling pain affecting their ability to walk. Treating PPGP early is important as it takes time to build muscular support around the joints of the pelvic girdle and alleviate ligamentous strain. In some cases, pain can immediately resolve after birth, but in other cases it can linger long after. The best approach is to stay active during pregnancy and see a Pelvic Floor Physiotherapist for direction on which exercises are safe and which exercises can worsen your condition.
A common misconception is that the pelvic floor muscles need to be strengthened during pregnancy – while training these muscles can be helpful, understanding how to relax your pelvic floor is just as important. Pelvic floor muscle contractions or “kegels” are often performed wrong and over-training can lead to excessive tension in the pelvic floor. During active labour and delivery, tight pelvic floor muscles can create resistance to the baby descending through the pelvis – this added resistance can prolong labour and lead to greater strain on the pelvic floor muscles and surrounding nerves, risking further injury. Learning how to connect with your pelvic floor muscles, how to perform a proper pelvic floor contraction, as well as how to contract and relax these muscles in coordination with your breath is the best form of training for your pelvic floor in preparation for birth.
Similar to the pelvic floor, the bony pelvis can create resistance to the baby descending through the pelvis. The shape of the pelvic outlet is affected by the orientation of our hips, tailbone, and sacrum. In pelvic floor physiotherapy, we can help you to open the hip joints and create better movement in the joints of your pelvic girdle through specialized exercises and manual therapy. Education is also a large component – I often teach my clients how to breathe during labour and delivery to protect their pelvic floor and which birthing positions will free their tailbone and sacrum so they can maximize the opening of their pelvic outlet.
Think of your Pelvic Floor Physiotherapist as a source of support during pregnancy and postpartum – helping you to prevent pelvic floor and core dysfunction, stay active in the safest way possible, treat any issues that arise, and ensure that you are doing everything you can for your health during pregnancy and when it comes to preparing for birth.
Pelvic Floor Physiotherapist, Certified Yoga Instructor, and Co-Founder of Preparing for BirthPelvic Goddess
Hayley O’Hara (@pelvicgoddess) is a Pelvic Health Physiotherapist and Certified Yoga Instructor. Hayley’s practice is currently based in Toronto and online. During the pandemic, Hayley launched her own online clinic and yoga studio where she sees clients and teaches weekly classes. To build onto her clinical practice, Hayley designed two specialized prenatal and postnatal programs for mothers looking to stay active during pregnancy and prepare for birth as well as recover from core and pelvic floor dysfunction in the postpartum period. Hayley’s mission is to transform the way pelvic health is practiced by giving it a role in our daily wellness rituals, on and off the mat.
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