10 Facts About Your Pelvic FloorCeridwen Morris
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1: Your pelvic floor is important
The pelvic floor is like a hammock slung from front to back with muscles crossing over and interlacing around the urethra, vagina and anus. These muscles are used in sex, birth and going to the bathroom; they are strong elastic, unless they have been weakened due to aging, being overweight, having an hysterectomy, and multiple, difficult births. A slack pelvic floor can lead to incontinence, sexual dysfunction or sometimes prolapsed pelvic organs. There are things you can do before, during and after birth to maintain a healthy pelvic floor.
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2: The vagina was meant to stretch
Most women understandably wince at the thought of a large baby coming out of a very small space. But the body is a lot more elastic than it may seem — this means the birth canal (the vagina) can stretch out and stretch back. A good doctor or midwife will help during the pushing phase to reduce the risk of tearing or weakening the pelvic floor. It can be reassuring for first-time mothers to know that the pelvic floor is only directly involved briefly, at the very end of labor.
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3: Kegels work
This is the best way to actively strengthen the pelvic floor. Doing kegels — an exercise named for the guy who invented them — involves contracting and releasing the muscles around your vagina in sets of 10 or so. You can also try the elevator technique, tightening the muscles progressively as if your pelvic floor were an elevator going up to the first, second, third and fourth floor, and gradually releasing as you lower the elevator down. Do these sitting, standing or while lying down.
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4: Routine episiotomy is not recommended
An episiotomy is a 1-2 inch incision made in the perineum to increase the size of the vaginal opening during the pushing stage of labor. Episiotomies used to be routine as they were considered less damaging to the pelvic floor than a tear, but now ACOG practice guidelines state that episiotomy should be done only when medically necessary. Your odds of tearing or having an episiotomy have a lot to do with your care-provider; ask for his or her rates of episiotomy and what will be done to prevent one.
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5: Changing positions can reduce pelvic floor problems
Most women deliver on their backs, but pushing in a gravity-friendly position — such as supported squat or on hands and knees — can reduce pressure on the lower half of the perineum. Being more or less upright means the babys head presents with equal pressure all around the perineum (the area between the anus and the vagina). Medications limit the possibility for changing positions in labor, and some doctors prefer women stay on their backs, but if you want to and you can, try moving into pelvis-opening, gravity-friendly positions.
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6: Massaging the perineum can help
Some studies suggest that massaging the perineum with warm olive oil towards the end of the third trimester can greatly reduce the chances of tearing or episiotomy (especially for first time mothers). Others say its useless. I say, maybe its worth a try. Whats probably more helpful is to have a skilled caregiver who massages and gives you good instructions during the pushing to help prevent tearing.
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7: Elective C-section doesnt offer protection
Women with vaginal births sometimes have more immediate incontinence, but over time, C-section and vaginal birth moms have equal rates of pelvic floor problems because its what happens during the birth rather than the actual birth method — some practices increase the risk of damage to the perenium. Also, pregnancy alone can cause pelvic floor problems.
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8: Hemorrhoids happen
Hemorrhoids are varicose veins of the anus. Like other veins in a pregnant womans body, they can swell up. During the end of pregnancy, due to the increased pressure and weight or during labor they can "pop" out, forming a ring of lumps around the anus. Theyre not dangerous, but they can bleed a little during bowel movements. Eventually they tighten up and pop back in. When making a bowel movement, push only when you feel the urge to push; place your feet on a foot stool while sitting to increase your squat; eat a high fiber diet; drink lots of water and and try witch-hazel compresses.
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9: You can take care of your pelvic floor in pregnancy
Mary ODwyer, pelvic floor physiotherapist and author of Hold It Sister, suggests that pregnant women get in the water for the benefits of weightlessness but avoid bouncing activities which can strain the muscles. Women can also support the pelvis with abdominal binders, sacro iliac supports or pregnancy shorts. Most women have some incontinence towards the end of pregnancy but if you experience a lot of bladder leaking, talk to a womens health physical therapist about prevention and treatment.
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10: You can take care of your pelvic floor postpartum
Give yourself several months to heal before returning to full-on workouts, like running. Try lifting your pelvic floor (as you would with a kegel exercise) before and during coughing, sneezing, shouting, lifting, and intercourse. Focus on your core muscles to help support good posture when sitting and standing. Other things that reduce damage include not smoking, maintaining a good weight, avoiding hysterectomy (when possible), minimizing repeated urinary tract infections and doing lots of kegels. If all else fails, there are many useful forms of physical therapy for women with pelvic floor problems.
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