Women’s health care is gaining steam in recognizing the unique needs of pregnant and postpartum women. Over the past 20 years, there has been an increase in understanding of how the pelvic diaphragm works and its important role in healthy bladder, bowel and reproductive habits. Most importantly, women and health care providers are bringing different forms of pelvic floor dysfunction into the conversation so that treatment is possible and successful. Each woman has individual needs to care for this area, however, here are some general tips towards a healthy pelvic diaphragm during pregnancy, childbirth and post-partum.
Stress Incontinence-leaks: During pregnancy, women may experience stress incontinence-leaks with coughing, sneezing, laughing or high impact exercise. This can be transient and resolve after the baby is born. It is important to keep track of this and, if it persists, let your OB/GYN or nurse midwife know at your 6 week post-partum follow up. Pregnancy is often when women begin to think about Kegel exercises. Kegel exercises include gently squeezing the muscles around the vaginal, urethral and/or rectal opening. Keep in mind, that the baby needs to pass through the vaginal opening, so it is important not to overwork these muscles. A basic guideline would be to do 10 quick Kegels (done in about 10 seconds), 2-3x per day in a comfortable position such a lying down with standing being the most challenging. The goal is to keep these muscles active and coordinated, not necessarily to build strength. You should feel the muscles working as well as relaxing between each Kegel.
Perineal Massage: Another topic that comes up during pregnancy is whether or not to do perineal massage. This is a technique where the pregnant woman massages and stretches the soft tissues around the vaginal opening. The theory is that it will decrease pain and the risk of tearing during childbirth. However, perineal massage has not been proven to be effective with this and is very uncomfortable. There are options to reduce the risk of tears! First, finding a position that allows the baby to crown and present slowly which allows time for the perineum to stretch. Often, your healthcare provider will stretch the perineum during delivery to avoid tearing. While the baby is delivering, providers also can apply a warm compress with consistent firm pressure to support the perineum to avoid tears. Finally, avoiding episiotomy, unless medically necessary, is also important. Often, episiotomies result in greater tearing. For example, imagine you are wanting to tear a sheet - if you make a cut in the fabric first, it makes tearing it easier.
Pelvic Floor Recovery: Post-partum is a time of pelvic floor recovery from pregnancy and delivery, whether vaginal or via c-section. With a vaginal delivery, sitz baths in Epsom salts can be very effective to ease pain and swelling. This is a time to check in on your pelvic floor and make sure each week is better than the last in terms of swelling, pain, or incontinence. Each woman will heal at a different rate, so it is important to go slow with activity and prioritize self-care. Walking is one of the best ways to gently exercise the pelvic diaphragm. After a few days to a few weeks, most women are ready to start with gentle pelvic floor exercises such a Kegels. Again, doing 5-10 quick Kegels, paying attention to feeling the muscles work is a good place to start. As the muscles feel stronger, holding the Kegel for 5-10 seconds, 5 times a day is a great way to begin working on endurance. If Kegels are seemingly going well, but you still experience incontinence or pain, you should check in with your doctor.
Awareness: A good thing to keep in mind is that not all women need the same things for pelvic floor health. When experiencing an issue, sometimes doing Kegels for strengthening or endurance is not going to help. For example, when pelvic floor muscles are strong and already working too hard. It is also not uncommon for pelvic floor issues to be related to an imbalance outside the pelvis, such as the low back, hips or abdomen. This is where a pelvic floor therapist can focus pelvic floor function as it relates to the rest of your body.
Lastly, it is important to remember that fecal or urinary incontinence, pelvic pain, prolapse or pain with intercourse are very treatable. Providers are having these conversations with women of all ages, stages of childbearing and walks of life every day. If you are experiencing any of these issues it is important to let your doctor, midwife or physical therapist know!
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