You go through pregnancy, you go through childbirth, you have the wondrous ability to create life and bring a baby into this world. But then, you are left trying to understand what has happened to your body and to figure out how to deal with the aftereffects of the great adventure. Many have to cope with medical or functional problems after childbirth, mostly caused by the impact on our pelvic floor, but there is far more to be done about it than is told, and I would like to share some useful tips to help you.
In order to understand the impact of childbirth on your pelvic floor, we must first understand what it is. The pelvic floor is a group of tissues, ligaments and muscles, which create a strong layer, shaped like a hammock, covering the whole pelvic area from below, and supporting all the pelvic and abdominal organs from underneath. Through this layer, three very important vessels emerge: the urethra directing urine from the bladder, the vagina leading to the uterus, and the anus coming from the rectum. Each of these has a sphincter muscle of its own, which works in synchronization with the pelvic floor muscles.
These muscles are semi-independent; that is, they contract or relax automatically when needed but can also be contracted voluntarily by you during exercise or function.
The pelvic floor muscles are also part of the main central stabilization system of the torso, consisting of the diaphragm from above, the deep spinal muscles from the back, the deep abdominal muscles from all around, and the pelvic floor muscles from below. These muscles are responsible for balance and posture and for supplying support to all organs and muscles during strenuous movement or in any situation with elevated abdominal pressure.
So now we know that our pelvic floor muscles have double significance. They not only play a role in maintaining our bowel and urinary continence, sexual function, and keeping our organs in place, but they also play a part in controlling support for the whole pelvic and abdominal region.
During pregnancy, there are many changes in practically every system in the female body, including an immense stretch of all abdominal muscles and tissues, changes in spine position and strength of joints, and high pressure on pelvic organs and muscles. Finally during vaginal childbirth, the vagina and pelvic floor muscles are stretched to almost 3 times their normal length, leaving deep and superficial tissues damaged on the way.
Consequently, many women after childbirth experience symptoms such as urinary incontinence, pelvic girdle pain, pelvic organ prolapse, sexual dysfunction, or separation of abdominal muscles named diastasis recti. Most of these symptoms are temporary and will be resolved naturally, or with simple exercises or treatment.
Here are some simple exercises you can start with on your own:
- Exercise your pelvic floor muscles: simply contract your pelvic floor muscles, bringing them up towards your stomach, and relax, letting them go back down. Repeat the exercise, holding the muscles for up to 10 seconds, making sure you are breathing normally and the rest of your body is relaxed.
- Perform this exercise 3-4 times throughout the day, trying different positions each time - lying on your back, on your side, sitting up, standing up.
- Pelvic floor exercises are recommended from the very first day after childbirth. Many women are afraid of any movement in that area because of the pain, but on the contrary, small gentle exercises improve blood flow and speed up recovery.
- If you are experiencing a small leakage every time you cough or sneeze, contract your pelvic floor muscles just before the cough/sneeze, as you are inhaling, and hold them until the end of the cough/sneeze. This takes some training so practice by coughing voluntarily while holding your muscles, and it will eventually become easy and natural.
- Sometimes our muscles are exceptionally tight due to pain in the vaginal area or in the pelvic region. Tight muscles can cause pain and can also add difficulty during bowel movement. If you feel this is the case, you should learn some stretches, practice relaxing your muscles, and make sure your position and breathing technique in the bathroom is assisting the process, rather than hindering it.
- Returning to intimacy after childbirth is always challenging and not only because of the changes in your pelvic floor. No need to rush things, the more relaxed your body is, the easier it is to function. Get to know your body again, gently and patiently, and let it lead you in its own new natural pace.
- Your body is magnificent! It has the ability to create life, and to recover mostly on its own, but you must help by providing the time and conditions for this. Especially if you are breastfeeding, your body needs plenty of energy to recover. Make sure the first 6 weeks after childbirth are restful, no strenuous exercises, no weight lifting (including baby strollers), laundries and house chores can wait. If you'd like to return to regular exercising, do it gradually and only after you have had the approval from your gynecologist.
In some countries, it is mandatory for a woman after childbirth to have her pelvic floor evaluated and treated by a professional physiotherapist. In Israel, however, it is not standard procedure but it is a service that is included and provided in all medical insurances.
Most important, if these symptoms are not treated, they may intensify with time or with more pregnancies and births, so do not delay and take care of yourself now!
Raheli Kuperman is a women's health physiotherapist, specializing in prenatal and postnatal therapy, pelvic floor health. She is also a qualified sexology counselor.Raheli receives patients in a private clinic in Mazkeret Batya, and also delivers lectures and organizes workshops in women's health physiotherapy around the country. "As a woman, I feel a strong responsibility to spread awareness of simple and efficient methods to women of all ages, and to provide them with the ability to regain control over their own bodies, improving their quality of life and well-being.” Contact Raheli at 054-4410379; email@example.com; Facebook PelvicFloorRaheli רחלי קופרמן פיזיותרפיה לרצפת האגן