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Opinion: Your pelvic floor might have suffered in pregnancy but you can get help

Chartered Physiotherapist Aoife Ni Eochaidh says pregnancy often causes incontinence but help is at hand.

Aoife Ni Eochaidh

Updated Aug 26th 2021, 11:10 AM

WE ALL KNOW the dreadful feeling of needing the bathroom suddenly. When you need to empty the bladder while having coffee with friends or while out shopping – it’s humiliating and embarrassing when you’re caught short and sometimes even leak urine.

Imagine the awful feeling with an overwhelming urge to empty your bladder and not making it to the bathroom on time. Worse still is the fear of not being able to control stool or gas.

New moms (and some not-so-new moms) up and down the country are dealing with these awful problems. However, help is available to give yourself back your freedom.

You can get to the point where you can live without fear of bladder and bowel leaks, with normal sexual function (to be able to orgasm or climax correctly), and to ensure optimal bowel and bladder emptying and solve constipation.

Pelvic floor

Pelvic Floor Therapy is specialised pelvic physiotherapy to train the pelvic floor muscles and ensure they are working normally, and it is vital for post-natal women.

Progressive pelvic floor muscle training is recommended as a first-line treatment for incontinence. Two-thirds of women with any type of incontinence who have pelvic floor muscle training see improvements or cure with 75% of women reporting resolution of symptoms such as episodes of incontinence. That’s two out of three women will be cured of incontinence with pelvic floor muscle training and the third woman will be improved.

Pelvic floor physiotherapists use modern non-invasive, evidence-based technologies such as electrical stimulation and biofeedback, sometimes in addition to pelvic floor muscle training. They are skilled and highly experienced in the use of a large toolbox of treatments to treat the root cause and ensure optimal results.

One in three women can have urinary incontinence. Pregnancy and childbirth are leading causes of incontinence for women. Many hide the problem and are too embarrassed to deal with the issues. Women wear incontinence pads, they reduce their sexual activity, their exercise levels, and their social lives too.

In some cases, it can affect a woman’s decision to return to work after having a baby or to apply for a promotion. Women fear that there may be an odour from the leakage, or that there will be wet patches on clothing or after sitting down on furniture too.

Causes of incontinence

There are several reasons why women get incontinence after having a baby. Changes to the pelvic floor muscles begin in pregnancy.

As early as 10 weeks, hormonal changes will take place to soften the pelvic ligaments and fascia (the things that support our pelvic organs, the bladder, the bowel, and the vaginal walls), these changes along with the increasing bump, puts pressure on the pelvic floor muscles and they become weak.

Some women can have incontinence in pregnancy too, especially if it’s a woman’s second or third pregnancy.

There are a few birth-related reasons why women will have issues with incontinence after having their babies. The type of delivery that a woman has will impact the pelvic floor muscles. These include is long labour and especially a long second stage, (the pushing part) if the baby has a large head and a forceps was needed or if a muscle tear occurred, especially one which is called a 3rd-degree tear.

What matters most is that the baby and the mother are safe and well during and after the birth. The incontinence and other problems can be treated, but the new moms should get the help they need. It’s best to be prepared that incontinence can happen, so many of my patients tell me they are shocked and didn’t realise beforehand about it.

Anatomy

It’s important to know where the pelvic floor muscles are in the body. Firstly, think of the area of your body between your waist and the top of your legs. This is where your Pelvis is located, think of it as a basin-shaped region.

Screen Shot 2021-08-25 at 16.38.44 Source: Shutterstock

Your tummy area is where your core muscles are located. The pelvic floor muscles form the base of the pelvic basin and are really the underneath part of your core. The pelvic floor muscles hold up or support your organs correctly in the pelvic cavity. These organs are your bladder and your bowel and in ladies your vaginal walls and your womb too.

We need to train our muscles to be in the normal range or function. This involves a series of exercises. In my clinic and with my online patients using my online pelvic training videos and e-booklets I give about 12 different exercises and training routines. It can take three to six-month periods to get the bulk, endurance, fitness, movement, and automatic function working in the normal range.

The bladder and the bowel muscle themselves need to be trained too with lifestyle changes and some other exercises. The exercises need to be targeted to the different muscle fibres, and you need to progress them and keep doing them for life (at a maintenance dose but much more frequently in the beginning). It is not a quick fix, but it works, and it is so worth it!

Exercises

A good starting pelvic floor muscle exercise is the Knack Exercise. In beginning to train the muscles, it’s a good idea to start with the back passage part of the muscles, this will also train the front section of the muscles as they are connected.

To do the Knack exercise tighten the muscles of the back passage as if you are trying to hold in wind (imagine that you are in a lift or at a party and that you don’t want to pass it!) don’t worry if you hold your breath or tighten your tummy or your buttocks.

Do this before and while lifting anything heavier than a jug kettle of water and before and while coughing and sneezing. Aim for about 10 per day. If you are lifting groceries from the boot of the car into the kitchen, squeeze the back passage muscles as if you are trying to hold in wind or gas before you lift the item and try to keep the squeeze on until you put the item down.

It can be difficult to hold on to the squeeze in the beginning but give it a go. This is a good first step, it is training an automatic pelvic floor bracing reflex, it’s good to guard against prolapse (the organs mainly the bladder, bowel, and womb, coming down in the pelvis giving uncomfortable feeling and often obstructing the normal emptying of the bladder and bowel).

Great help is available from pelvic physiotherapists in all maternity hospitals in Ireland, but you must start your pelvic floor training on day one after giving birth, of course you may not feel like doing it, but it is so important.

Once you are home talk to your GP or practice nurse at your six weeks check-up or sooner if your problems are severe and you will be referred to a pelvic physiotherapist.

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You can also enquire directly with a pelvic physiotherapist yourself. Most health insurance covers physiotherapy and Revenue also gives some tax relief on fees. Get your confidence and quality of life back, without fear of incontinence with pelvic floor muscle training!

Aoife Ni Eochaidh is a Chartered Physiotherapist, Clinical Specialist in Women’s & Men’s Health & Continence at the Bon Secours Consultant Clinic in Renmore, Galway.

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