Pregnancy and Pelvic Floor Health: Why Physiotherapy is Essential!

 

Pregnancy is a time of major change in someone’s life. Arguably some of the most incredible and fascinating changes during this life stage, are those that occur to a woman’s body. From the moment of conception, right up to and beyond delivery, a woman’s body undergoes major physical, hormonal and physiological changes. One part of the body that is crucial in supporting these changes is the group of muscles known as the pelvic floor. 

What is the pelvic floor and what does it do?

The pelvic floor muscles are a group of muscles found at the base of the pelvis. Formed by several layers of muscle and other important tissues like ligaments; the pelvic floor acts as a “hammock” or “sling” with roles both pre-pregnancy and during pregnancy, including:

• supporting the organs within the pelvis (bladder, bowel, uterus, vagina) 
• helping to maintain continence of the bladder (wee) and bowel (poo and wind)
• support normal sexual function
• help maintain and control pressures within our abdomen and pelvis along with the rest of our “core” (deep abdominal, lower back and diaphragm muscles) during breathing, daily movement and the higher demands of physical activity or exercise
• ability to relax and stretch during childbirth (vaginal delivery)

The pelvic floor muscles are controlled and “switched on” both consciously and unconsciously. Primarily, they work behind the scenes in an unconscious way, performing all these roles without our awareness. However, during times of increased demand such as coughing, sneezing, laughing or even exercising, we are able to actively contract or squeeze these muscles ourselves when we need to. Equally as important, we are also able to consciously relax these muscles to ensure they aren’t always “on” or being over-worked. A healthy pelvic floor is able to move through its full range of movement to contract when needed but also to relax and “let go” when required. Our pelvic floor is supported by a complex web of connective tissue and ligaments, which provide the passive support to everything in the pelvis. 

How does pregnancy impact the pelvic floor?

During pregnancy, the demands on the pelvic floor increase immensely due to the rapid growth and change a woman’s body undergoes. Furthermore, pregnancy hormones work to soften ligaments and soft tissues to accommodate this growth and to prepare for childbirth. Pre-pregnancy, the uterus is about the size of a closed adult fist, but expands up to 1000 times this to the size of a watermelon. This increases the weight of the uterus alone to about 1 kilogram. The growing baby, as well as amniotic fluid, increased blood volume and breast tissue weight adds a total of 11-16 kilograms over the course of the pregnancy. This weight is distributed primarily to the front of the body, significantly changing posture, biomechanics and even breathing patterns. Further to this, the pelvic organs are also pushed out of the way to make room, with the bladder and urethra (tube through which urine passes out of the body) proven to sit lower towards the end of pregnancy. Thus the pelvic floor is now having to perform all its usual roles, but under a lot more load and with far less support. 

So why should I see a physiotherapist, and how can they help?

Given the immense changes that occur during pregnancy, a women’s pelvic health trained physiotherapist is well-positioned to help women during this time. Every woman and pregnancy are different from the next, so it is important to ensure high-level individualised assessment and management during this time. Your physiotherapist can help you during and after pregnancy with the following:

• Prevent, treat and manage any musculoskeletal pain or symptoms associated with pregnancy, birth and infant care
• Prevent (where possible), assess and treat any pelvic floor dysfunction during pregnancy and after childbirth (including the appropriate prescription of pelvic floor exercise and/or stretches)
• To provide advice regarding birthing preferences and alternate pain relief options for labour and delivery, such as birthing positions, breathing techniques, partner massage
• Provide post c-section rehabilitation
• Manage pre and postnatal care such as exercise and ergonomics
• Work with high-risk pregnancies, providing advice on bed rest and restrictions in consultation with the medical care team
• Working with special population groups such as those with disability, sporting populations and with specific cultural or sensitive needs.  

 

If you are pregnant or have any questions as to how a physiotherapist could work with you during this special time, contact your local clinic to find out more. 

References:

Elenskaia, K., Thakar, R., Sultan, A.H., et al. (2011). The effect of pregnancy and childbirth on pelvic floor muscle function. International Urogynecological Journal, 22, 1421-1427.

Geelen, H.V., Ostergard, D., & Sand, P. (2018). A review of the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques. International Urogynecology Journal, 29, 327-338.

Herschorn, S. (2004). Female pelvic floor anatomy: The pelvic floor, supporting structures and pelvic organs. Reviews in Urology, 6 (5), S2-S10.

International Organisation of Physical Therapists in Women’s Health 2013 Scope of Practice (PDF), IOPTPWH, Available online at http://www.wcpt.org/sites/wcpt.org/files/files/IOPTWHscopeofpractice.pdf

Kahyaoglu, S.H. and Balkani, K.P. (2016). Effect of pelvic floor muscle exercise on pelvic floor muscle activity during pregnancy and the postpartum period. Neurology and Urodynamics. 35 (3), 417-422. 

LoMauro, A., Aliverti, A., Frykholm, P., et al. (2019). Adaptation of lung chest wall and respiratory muscles during pregnancy: Preparing for birth. Journal of Applied Physiology. 127 (6), 1640-1650. 

Parente, M.P.L., Jorge, R.M., mascarenhas, T., et al. (2008). Deformation of the pelvic floor during a vaginal delivery. International Urogynecology Journal. 19, 65-71.

Resende, A.P., Petricelli, C.D., Bernardes, B.T., et al. (2012). EMG evaluation of pelvic floor muscle in pregnant and non-pregnant women. International Urogynecological Journal. 23 (8), 1041 – 1045. 

Von Veelen, G.A., Schweitzer, K.J., and Van der vaart, C.H. (2014). Ultrasound imaging of the pelvic floor: Changes in anatomy during and after the first pregnancy. Ultrasound In Obstetrics and Gynecology. 44 (4), 476 – 480.