Nearly 1 in 3 women will develop pelvic floor muscle symptoms during their lifetime
It is especially common to develop these symptoms in the first 2 weeks postpartum. Symptoms may include urinary leakage, vaginal pain, heaviness in the vagina or rectum, loss of wind control, or decreased sensation.
Your pelvic floor muscles may feel stretched, weak and sore. You may be healing from an episiotomy, a muscle tear or a C-section. You may feel disconnected, anxious and unsure of how to contract your pelvic floor muscles. It is often hard to know when to start doing your pelvic floor exercises and which exercises to begin with. In the first 10 days postpartum, the short answer is less is more.
Let us consider the role of the pelvic floor muscles
- They have a role in maintaining continence
- They have a role in supporting our pelvic organs
- They have a role in maintaining intra-abdominal pressure when we cough, sneeze or laugh
- They have a role in sexual function
- They have a role in core stability
In order to fulfill their role, our pelvic floor muscles contract and relax in a rhythmic pattern throughout the day. Much of this will happen without us consciously being aware of these muscles working or telling them what to do. Your pelvic floor muscles will continue to perform their role after you give birth, even if they are weak or damaged- it is just going to be harder. Which is why in the first 10-14 days postpartum, you should give them as much support as you can, prioritise rest and allow proper time for them to recover.
Women should wait at least 10 days prior to starting their pelvic floor exercises, even if they have had a straightforward vaginal delivery. Your pelvic floor muscles will have stretched to nearly double their resting length and will be stretched, swollen and often painful.
For women who have had assisted deliveries (forceps or ventouse), muscle tearing or an episiotomy- these women need to wait even longer. Women with C-sections will have had a catheter in place; they may have urethral irritation or difficulty emptying their bladder after the catheter comes out – these women also need to wait. Your body has done something heroic, and these muscles will continue to work even if you are not telling them to. Instead, try and focus on the following.
Your natural sleep cycle will likely be disrupted for the better part of a year after you give birth. You need to maximise your sleep and rest as much as you can in the first early days. Rest when your baby rests. Take the help that is offered to you and ask for more if you need it.
The more time you spend on your feet, the harder your pelvic floor muscles need to work. Allow yourself to rest – laying down with a soft cushion under your hips to take the pressure off these muscles.
You will have lost blood and bodily fluids during your birth. You need adequate hydration to optimise healing and replenish your body. If you decide to breastfeed, your body will require even more water to stay balanced. Aim for at least 2.0L of filtered water a day if not more.
Focus on eating nourishing foods that make you feel satiated and full. Try and limit sugar and caffeine.
Consider using an abdominal wrap or compression pants with pelvic floor and abdominal support. Supporting these muscles with gentle compression can facilitate healing and improve recovery time. It can also help bring your abdominal muscles back together.
Many women are nervous to have their first poo after giving birth. This makes sense. Constipation is often an issue as well which makes that first poo even more difficult. When you are ready to have your first poo, take a dry clean towel and wrap it around your hand. Apply gentle pressure on your perineum, angling slightly up towards your back passage to provide extra support. Try not to bear down and exhale as you push out.
Good nutrition and lots of water will help keep that first poo smooth and easy to pass. If you are concerned or have had a history of constipation, you can request a stool softener from your GP or mid-wife.
When to start pelvic floor exercises
You can begin gentle pelvic floor exercises either in sitting or side-lying after 10 days if you are feeling comfortable, pain free, and having little to no trouble emptying your bladder and bowel. For those who are still having pain and swelling, it is ok to wait beyond the 10 days until you feel you are ready to begin.
Try and focus on taking nice, deep belly breaths. It is important not to breath hold or bear down on these muscles as it can make your symptoms worse. If you continue to have symptoms after the first 2 weeks or you are concerned that things just don’t feel right – it is important to contact a postnatal physiotherapy specialist who can provide support and advice and exercise to get you started.