Pregnancy
Pelvic floor exercises
One set of exercises that all women - pregnant or not - should learn to do is pelvic floor exercises. The pelvic floor is the sling of muscles that forms the base to your pelvis. Exercising these muscles during pregnancy, and afterwards, will help tone them up, as well as make you more aware of them so you can relax them during the birth. Exercising the pelvic floor after the birth may also help ease perineal pain.
What is the Pelvic Floor?
The ‘floor’ of your pelvis is made up of muscles that support the bowel, bladder, urethra, and uterus. These muscles are like a hammock, or the bottom and sides of a bowl, in shape. They run from the pubic bone in the front to the end of the spinal column (or tail bone) in the back. They provide support to the pelvic organs.
It can be hard to identify the pelvic floor muscles at first
• Begin by sitting on a firm chair like a wooden kitchen chair, with your feet flat on the ground.
• Now tighten up the muscles around the vagina and then relax them. Try not to tighten the muscles of your buttocks. You will know if you are, because you will notice that your body lifts up a little.
• Again tighten the muscles around your vagina and try to imagine them pulling up inside you. Hold this for a count of four and then relax them. Try not to hold your breath, or let your shoulders lift up while you do it.
• Repeat the tightening, but this time make a point of breathing out slowly as you begin. Hold for a count of four and then relax.
If you find it hard to identify which muscles are working, you can check by trying to stop the stream of urine when passing water. Start to empty your bladder, then squeeze the muscles so the flow stops, hold it for a count of four, and then continue, making sure you completely empty the bladder. Leaning forward on the loo seat can help to squeeze the last few drops of urine out. This stop/start technique is useful if you are asked for a midstream sample of urine.
Once you can begin to identify the correct muscles try this exercise
Squeeze the pelvic muscles tight and hold the contraction for 5 seconds. Then relax for 10 seconds before starting the next contraction. Repeat this sequence of squeezing for 5 seconds and resting for 10 seconds. Do it 10 times each morning, afternoon and night. Gradually increase to:
• 15 contractions - 3x/day
• 20 contractions - 3x/day
• 20 contractions - 4x/day
• 20 contractions - 4x/day plus 20 extra whenever possible.
These exercises can be done virtually anywhere - sitting, lying or standing. Do them regularly. They will only help if done on a regular basis.
Since all the muscles you are exercising are internal you can do it while you are doing other tasks and no one need know. Establish a routine time for doing these exercises. Schedule the times you exercise with activities you do every day. This will help you to remember to do the exercises on a regular basis. For example, you could do them while:
• Washing your hands
• Brushing your teeth
• Waiting for a bus or train
• Sitting down at work
• Watching TV
Do the exercises properly - check often to be sure you are exercising the correct muscles. If you find it difficult to identify the correct muscles to exercise, your healthcare professional can help. He or she may recommend the use of the following:
Biofeedback
Biofeedback equipment helps you identify and exercise your pelvic muscles. Biofeedback uses a probe inserted into the vagina and a computer monitor. It allows you to see the effects of your muscle contractions on the monitor. This way you can more easily know if you are contracting the correct muscles and using proper exercise technique. It is a teaching
tool only.
Vaginal Cones
Vaginal cones are a set of vaginal weights which can be inserted into the vagina tohelp identify and strengthen the pelvic muscles. They are used with exercises. Once a cone is inserted, you try to hold it in place by contracting the pelvic muscles
for a short period of time before removing the cone.
Relaxing the pelvic floor is useful during the birth of your baby as it makes it easier for your body to stretch and give as the baby is born. The pelvic floor needs regular frequent exercises to increase strength and control.
After your baby is born, pelvic floor exercises will help get the blood flowing through bruised or damaged soft tissues and help with healing. Start moving your pelvic floor as soon as you can; the muscles will have stretched and they may feel much less responsive. By squeezing and relaxing the muscles as often as you can you will improve the strength and control.
If your pelvic floor is very weak after the birth talk to your midwife or ask your doctor to refer you to an obstetric physiotherapist. She can teach you more pelvic floor exercises and can offer other treatments to help tone up the pelvic floor.