This is a guest blog post by Physiotherapist Amy Gilbert based in Perfect Balance Rehabilitation LLC Abu Dhabi.
Amy specialises in the following:
- Sports Injury treatment and prevention
- Women’s health physiotherapy of pelvic pain, incontinence, pain management
- Dry Needling (Certified Dry Needling Practitioner)
- Rehabilitation Pilates (STOTT Rehabilitation Pilates Matwork and reformer)
- Kinesiology Taping
- Exercise Therapy and Instructing
With professional memberships both National and International:
- Health Authority Abu Dhabi (HAAD)
- Healthcare Professions Council UK (HCPC)
- Chartered Society of Physiotherapy UK (CSP)
- Pelvic, Obstetric and Gynaecological Physiotherapy UK (POGP)
Amy will discuss pelvic floor health during pregnancy and post partum. From experience the pelvic floor muscles come under pressure both during pregnancy and child birth. It is essential that woman receive education about pelvic floor exercises during pregnancy and pelvic floor restoration post partum.
Q&A with Amy Gilbert, Physiotherapist
1. What are your pelvic floor muscles?
The pelvic floor muscles are a group of muscles that sit on the under side of the pelvis. They have attachments to your pubic bone, tail bone and pelvis. They work all day long in many ways.
Their main roles are as follows:
– SPHINCTERIC: the muscles of the pelvic floor wrap around and control the opening of the bladder and rectum. When there is increased abdominal pressure (for example when you cough or sneeze, laugh or jump) these muscles contract around the urethra and anus to prevent leakage. Equally as important is the relaxation of these muscles to allow us to urinate and have bowel movements easily.
– SUPPORT: The pelvic floor acts as a basket to support our pelvic organs (bladder, rectum and uterus)against gravity and increases in abdominal pressure. With excess strain on the pelvic floor (especially during pregnancy) or with weakening of the pelvic floor (with age or hormonal changes) the pelvic organs can start to protrude near the vaginal opening. This is referred to as a prolapse.
– SEXUAL: during intercourse the pelvic floor muscles help to achieve and sustain an erection and allow for penetration. Sufficient strength of the pelvic floor muscles is necessary for orgasm, and excessive tension or sensitivity of the pelvic floor can contribute to pain during or after intercourse.
– SUMP-PUMP: just like the calf muscles in your leg act to pump blood and lymphatic fluid back up towards your heart, the pelvic floor muscles act as a blood/lymph pump for the pelvis. A loss of this sump-pump action can contribute to swelling or pelvic congestion.
2. What are common problems during and post pregnancy impacting pelvic floor health? (Prenatal pelvic floor health, post natal pelvic floor health)
During pregnancy the pelvic floor under goes a large amount of strain. Good news though it is designed for this. Exercising the pelvic floor is a great way to keep it strong. Complications can arise during delivery or even just the prolonged strain during pregnancy. Common problems that affect the pelvic floor are weakness, tightness, decreased supportive ability and all of these can lead to pain, incontinence and prolapse.
3. What is Pelvic Floor Physiotherapy?
Pelvic floor physiotherapy is provided by a women’s health specialist physiotherapist. It involved the detailed assessment of the pelvic floor and the surrounding pelvis anatomy. Once the pelvic floor has been assessed for strength and stamina, function, muscle integrity (tightness and trigger points), and pain a treatment plan is then formulated. The treatment plan addresses the problem list, and is therefore very much individually tailored physiotherapy. The treatment is aimed at rehabilitating the pelvic floor back to its optimum function.
4. What can you do to protect your pelvic floor?
Be aware of your pelvic floor. Have a specialist Women’s Health physiotherapist assess the function of your pelvic floor to ensure it is working effectively. Just doing general ‘kegels exercises’ is not enough, it is vital to know that you are exercising the pelvic floor correctly.
5. Why is exercise important during pregnancy? What exercises should you avoid? What exercises are recommended?
Exercise is vital during pregnancy to keep your cardiovascular fitness up. Most exercise is safe, with obvious exceptions that put your abdomen at risk. The main rule of thumb is don’t try to start a new form of exercise during pregnancy, for example if you are not normally a runner, we don’t advise you take this up during pregnancy. Exercise that targets a full body workout is recommended. Strengthening those muscles that you will need to work well during pregnancy is great, for example your postural muscles, leg muscles.
6. What is the recommended protocol to protect the pelvic floor muscles during pregnancy and what is the recommended protocol for restoring the pelvic floor muscles post partum?
To protect the pelvic floor, make sure it is working effectively, have a specialist women’s health physiotherapist assess. To prepare the perineum for delivery, perineal massage (especially for the first pregnancy) can be a beneficial process 6 weeks before the due date. This helps to increase blood flow to the perineal tissue and prepare for the increased strain during delivery.
Post partum we recommend a post-natal assessment to establish the pelvic floor’s function, and we then guide the safe return to exercise.