Pregnancy and the Pelvic Floor

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The muscles of the Pelvic Floor are extremely important for the support of the
internal organs as well as bladder and bowel function. The muscles can
become strained and weakened during pregnancy and childbirth, leading to
Pelvic floor dysfunction and continence problems (amongst others).

Recent statistics have indicated a staggering amount of bladder weakness

during and after pregnancy.

Learn more about your pelvic floor

Pregnancy can be the most magical time in a woman's life and yet many women are still
unprepared for the changes their body will experience even before they have given birth.

While most changes are all completely normal, unlike stretch marks, an aching back and
sleepless nights, bladder weakness is something that many women have difficulty talking
about.

Conservatively it is estimated that a staggering 2 in 3 women will experience some form of

bladder weakness during pregnancy. This is because pregnancy, labour and birth place
additional strain on the pelvic floor muscles weakening them.

Stress incontinence or bladder weakness, can occur just from laughing, sneezing or coughing.
For some it can be a real problem, but for many women it only amounts to a few drops now
and then. No matter how minor the leakage, it’s still annoying and can lead to some
embarrassing moments in what should be a beautiful time.

Tips for a healthy bladder

For many women bladder weakness can be cured and in almost every case there is something
that can be done to manage and improve the situation.

There are several things you can do to ensure you have a healthy bladder:

• Drink plenty of fluids

• Don’t go to the toilet just in case or every time you get the urge, try to hold on
 • Cut down on bladder irritants such as coffee, tea, cola drinks and alcohol

• Maintain a healthy weight

• Learn to do pelvic floor exercises

Strengthening pelvic floor muscles

Like any muscles, pelvic floor muscles need a regular workout to stay strong. Pelvic floor
muscles need particular attention during pregnancy and post birth.

The floor of your pelvis is made up of layers of muscle and other tissues. These layers of
muscle stretch from the tail bone at the back to the pubic bone at the front, like a trampoline.
The urethra, vagina and the rectum pass through the pelvic floor muscles which support the
uterus and bowel. By strengthening your pelvic floor muscles through as a series of simple
exercises you will be able to improve control of your bladder.

Practice Every Day

• Squeeze, lift and hold as though you are trying not to pass wind

• Squeeze and lift 3 times quickly

• Squeeze the pelvic floor muscles and hold for 3 seconds and slowly release for 3 seconds

• Repeat 3 times

• Do these 3 times a day

If you find the exercises getting easier, hold for longer and increase repetitions

It may take 6 to 12 weeks before you notice any improvement.

Remembering to do your pelvic floor exercises can sometimes be difficult. A good way to
remember is to choose a trigger – such as every time you stop at a red light when driving.

More information
The following web links provide additional information and pelvic floor exercises

• Continence Foundation of Australia

 • The Royal Women's Hospital, Victoria

The Bub Hub Directory's Pregnancy Exercise Classes and Post-Natal Exercise pages provide
information on classes in your local area that can assist with pelvic floor development.

Why do we beat ourselves up, insist that we must be perfect, 'the best
mum', 'the best partner', "I shouldn't have said that", "I should have worn
something else" and on and on?

Now is the time to let go of some of the rules you have for yourself, the
ones you would hate if someone else tried to impose them on you. Now is
the time to nurture yourself as lovingly, gently and kindly as you do your
children.

1. Begin on a good day.

2. Decide on a time during the day when you are going to be 'mindful' of the things
you say to yourself in your head. An hour is plenty to begin with.

3. Every time you become aware that you are being unkind, critical or hard on
yourself notice it, maybe even write it down somewhere.

4. Then, think about or write down an alternative way of talking to yourself. Think
about how you would speak to your partner or child or a relative or close friend who
had been having a hard time lately. What would you say to them in the same
situation? Try saying this to yourself. Does it feel different? What does it do to your
mood?

If you become aware at any time in the future that you are saying the
unkind thing to yourself again, remember back to the alternative
message and offer it to yourself instead. With time and practice you
might notice that the little voice inside your head is much more useful
than it used to be.

Other useful things to try to help maintain good mental health during
pregnancy and parenthood:

• establish or re-establish a close friendship outside of your home so you have someone to
talk intimately with
 • join a group that provides you with a social network of some kind (eg. mother's group,
women's group or playgroup)

• take care of yourself, including nutrition, exercise, physical health, get regular haircuts or
waxing or whatever helps you feel 'well maintained'

• learn and practice breathing and relaxation techniques (such as the rapid relaxation
technique outlined below)

• try different therapies, hypnotherapy, massage, homeopathics. If one doesn't suit, try a
couple more until you find what works for you

• avoid hangovers and low blood sugar levels (ie. don't binge drink and eat regularly)

• do something nice for yourself everyday (suggestions: take a bath, buy yourself some
fresh fruit juice or say something nice to yourself eg "gee I did a really great job of dinner
tonight, I'm quite a good cook")

• practice knowing when and how to ask for help

• practice loving kindness towards yourself as well as others

The Rapid Relaxation Technique is a do-anywhere technique for achieving

deep relaxation fast.

Practice at work, as a passenger in the car, during TV commercial breaks

- anytime you would like to feel the benefits of being fully relaxed,
quickly.

The technique will be especially useful:

• Getting back to sleep after feeding or settling baby at night

• During your child's toddler years

• During breast or bottle feeding times

• After any annoyance or irritation

• In other words, generally as a parent.

Technique:

Imagine your body sectioned into 5 zones, as outlined in the following

picture.

Take 2 or 3 deep breaths emphasising the breath out, like a sigh. Count
backwards to yourself from 5 down to 1, and as you do, allow the
muscles in each zone to relax respectively. Feel the tension slip away as
the relaxation melts down through your body, each number taking you
deeper.

To enhance the experience, try counting each number as you exhale, still
using the sigh type breaths if you can. You can do this standing up, lying
down and with eyes open or closed. It is also a great relaxation technique
to teach children and many dads have told me how useful it is at work.

Practice as often as you like, the more you practice the easier and faster
and more deeply relaxed you will become.

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Postnatal Exercise
Posted in: labour & birth, baby, toddler, postnatal health
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You may have noticed your body has changed since the birth of your
baby.

• Weight gain

• Abdominal muscle separation and/or weakness

• Pelvic floor weakness

• Lower back pain from constant lifting

• Upper back and neck pain from breastfeeding

Early motherhood is a demanding time both physically and emotionally.

Finding time to exercise can be just as challenging. However, making
time for exercise is of vital importance. Research has proven exercise to
assist with weight loss, improved sense of wellbeing, decreased
symptoms of depression, decreased pain and increased energy.

So, what type of exercise is best?

There are a number of considerations that need addressing before you
should commence a postnatal exercise program.

The Pelvic Floor

All women should perform pelvic floor exercise postnatally regardless of
the type of delivery they have experienced. The pelvic floor is a group of
muscles that form a hammock, supporting your bladder, uterus and
bowel. Although you may not have experienced any symptoms of pelvic
floor dysfunction (leakage, heaviness, urgency to urinate) they have had
to work very hard to support the extra weight of the uterus for the past 9
months of pregnancy and need strengthening. You should start pelvic
floor exercises as soon as possible after delivering your baby.

How do I do my pelvic floor exercises?

• Sit or lie in a relaxed position.

• Squeeze your pelvic floor muscles as though you are trying to stop yourself from peeing.

• You should feel a lift upwards and tightening sensation around your bladder and vaginal
opening.

• Hold for 3-5 seconds and continue to breathe naturally.

• As you get better, aim to hold for longer until you can hold for 10 seconds.

Abdominal Muscle Separation & Strengthening

Before you launch into doing abdominal crunches or sit ups, have you had
your abdominal muscles checked by a physio for any abdominal
separation?
Our abdominal muscles provide an internal corset protecting our vital
organs and providing support to our spine and pelvis. The abdominal
muscles are made up of different layers of muscle. These are the rectus
abdominis, internal and external obliques and transversus abdominis.

During pregnancy the rectus abdominis (or six pack muscle) needs to
stretch to accommodate for your growing baby. Each side of the rectus
abdominis muscle meets in the midline of your body to form a fibrous
structure called the linea alba. This is the weakest point of the abdominal
corset. Normally, the muscles stretch to accommodate for the growth of
your baby. In some cases when the linea alba is placed under too much
pressure, rather than the rectus abdominis muscles stretching, the linea
alba overstretches or in some cases tears. This is known as a diastasis (or
separation) of the rectus abdominis. The rectus
diastasis will look like a vertical bulge in the midline of your body. You will
notice this bulge when you do certain movements that increase the
pressure within your abdomen and stress this area.

How to test for a rectus diastasis?

• Lie flat on your back with your knees bent.

• Place your fingers across the midline of your tummy just above the b
button.

• Perform a sit up and feel for a vertical gap between your fingers.

If you think you have a rectus diastasis see your physiotherapist for a
specific abdominal muscle exercise program. Your physiotherapist will
also ensure you are bracing and using your deep abdominal muscles
(transversus abdominis) correctly and avoiding movements that are likely
to increase the diastasis. Remember, a poorly managed rectus diastasis
can lead to an abdominal hernia.

Start your abdominal muscle training by learning how to brace your

transverses.
  Start on your hands and knees
 Your hands should be directly under your shoulders, and your
knees should be under your hips. Keep your back straight(see
photo).
 Relax your abdominal muscles forward.
 Slowly and gently draw your abdominal muscles inwards towards
your spine.
 Continue to breathe normally.
 Practice holding for 5 seconds and repeat 5 times.

Once you have mastered the bracing technique you can progress onto
some harder abdominal exercises. Try the following abdominal exercise.
Heel Taps

Lie flat on your back with your legs at table top position (both knees
up off the floor). Inhale and brace your pelvic floor, exhale and as
you lower one leg towards the mat. Stop if you feel your lower back
lift off the mat or if you release the pelvic floor. Return to the
starting position. Repeat 10 times on each leg.

Weight Loss
It is important to commence some form of aerobic exercise to regain
general fitness and lose any excess body fat gained from pregnancy. You
can commence a gentle aerobic exercise program from 6 weeks after
delivery of your baby. If you are breast feeding it is important to choose
a form of exercise that is low impact and of moderate intensity. Research
has concluded that exercise of low to moderate intensity will not affect
production of breast milk or lactic acid build up. Ensure you are wearing a
good fitting supportive bra. Aim for 45-60 minutes of aerobic exercise 3-5
days per week. Try walking, swimming, low impact aerobics, cycling etc.
Remember the following simple formula: Energy Input (from food) must
be less that Energy Output (from exercise) for weight loss. Don’t forget to
stay hydrated by drinking an extra litre of water during your exercise
session. Speak to a dietitian if you are concerned about your diet whilst
breastfeeding.

Resistance training is another important form of exercise postnatally.

Increasing your general strength will help decrease symptoms of back
pain by increasing your strength, making lifting your baby easier. Weights
 training will also assist with weight loss by increasing your metabolism. A
simple weights training program can be performed at home such as wall
squats, lunges and pushups. Try the following exercise at home.

Wall Squats
Lean back into a wall (or place your fitball
against the wall and lean back into the ball so
your lower back is supported by the ball). Lower
into a squat by bending your knees, keep your
knees in line with your toes, push through your
heels and return to the starting position.

Talk to your physio about prescribing a resistance training program that

you can perform at home.

Skip to menus

Physiotherapy
• Pre and Postnatal Physiotherapy
• Mother and Baby Wellbeing
• Paediatric Services
• Pelvic Floor Disorders
• Osteoporosis Self-management Program
• Building Better Bones
• Adult Musculoskeletal Physiotherapy

Pre and Postnatal Physiotherapy

Experienced physiotherapists with a special interest in Women's Health assist with various
musculoskeletal changes that occur in the child-bearing year. Basic antenatal or postnatal exercise
programs are designed for each patient. In addition, further strategies are used to effectively treat:

• Antenatally
o Low and mid back pain
o Sacro-Iliac Joint pain (+/- sciatica), Pubic Symphysis pain
o Piriformis muscle spasm
o Difficulty/pain with movement
o Rectus diastasis (abdominal bulging)
o Bladder control problems or constipation/straining
o Carpal tunnel symptoms
• Postnatally
 o Back, shoulder and neck pain
o SIJ, pubic symphysis or piriformis pain
o Rectus Diastasis
o Abdominal bulging during movement
o Post caesarean pain (after healing)
o Perineal pain and discomfort
o Bladder/bowel control difficulties and constipation/straining

These conditions are often greatly relieved with various strategies including pain relieving modalities,
deep massage and other manual therapies, core-stability muscle strengthening, postural stretches,
specific muscle balancing and co-ordination techniques (including retraining, positioning and
patterning) and sometimes external supports and splints.

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Mother and Baby Wellbeing

Experienced Physiotherapists assist parents in:

• Understanding and promoting baby development and learning through play (ideas for play,
toys, appropriate equipment)
• Settling an unsettled baby (including massage and relaxation bathing — especially with colic
or reflux babies)
• Managing minor postural variations (eg. In utero compression, postural talipes or mild
plagiocephaly)

Back to top

Paediatric Services
Physiotherapists experienced in the management of soft tissue trauma and sports injuries offer
children and adolescents appropriate acute and longer term management of musculoskeletal and
sports-related injuries, taking into account the special requirements of the musculoskeletal system
before maturation and completion of growth.

Nocturnal Enuresis (Bedwetting)

Nocturnal enuresis (bedwetting) is a common condition in children and many parents/carers manage
the condition within the family. Nocturnal enuresis can be hereditary. Physiotherapy can optimise
recovery through the use of bedwetting alarms, pelvic floor muscle function, bladder retraining, fluid
intake and education for both children and parents.

Childhood Constipation and Daytime Urinary Symptoms

Children with bladder dysfunction often present with bowel symptoms. Constipation is more common in
children than reported to family practitioners. This problem can be managed conservatively by pelvic
floor physiotherapists using bowel charts, defaecation dynamics, monitoring fluid/fibre intake and
pelvic floor muscle retraining.

Daytime urinary symptoms include urinary frequency (voiding > 7 times/day), incomplete emptying of
the bladder, recurrent urinary tract infections and leaking of urine during the day. Pelvic floor
physiotherapy treats these symptoms through bladder emptying techniques, pelvic floor muscle
retraining, bladder retraining and relaxed voiding.
 Back to top

Pelvic Floor Disorders

Experienced physiotherapists provide assessment and conservative management for a range of pelvic
floor disorders in women, men and children. Conditions treated include stress and urge urinary
incontinence, faecal incontinence and obstructed defecation, perineal descent and prolapse, various
pain syndromes and nocturnal enuresis (bedwetting).

Therapy can include relaxation of overactive muscles, correct activation and strengthening of weak
muscles (pelvic floor and deep abdominals), bladder retraining and specific muscle co-ordination
techniques, retraining, positioning and “patterning”.

These simple techniques have been shown to be extremely effective in helping many problems
associated with pelvic floor dysfunction and is recommended as the first option before any surgery is
considered.

Incontinence
Pelvic floor dysfunction can result in urinary and/or faecal incontinence. Loss of urine with coughing
and sneezing (stress urinary incontinence), is the most common symptom of pelvic floor dysfunction
and many women may be affected by this condition. Pelvic Floor physiotherapists can assist in the
assessment and treatment of incontinence by an individualised pelvic floor muscle rehabilitation
programme. Imaging of the pelvic floor muscles by Real-time ultrasound is available as a biofeedback
tool. This is useful for those clients who have difficulty isolating and identifying these muscles that
needs to be strengthened and co-ordinated. Further treatment in the form of bladder/bowel retraining,
dietary advice as well as lifestyle and general exercise advice may be given.

Prolapse
Pelvic organ prolapse is the downward movement of a pelvic organ such as the bladder, bowel or
uterus, into the vagina. Long-term strain on the pelvic floor muscles and pelvic organs through heavy
lifting, chronic coughing, straining due to constipation and increased weight can lead to prolapse.
Weakness of the pelvic floor muscles following childbirth put women at risk of developing prolapse.
Symptoms can be managed by tailored lifestyle advice from a Pelvic Floor physiotherapist following
assessment. Treatment will include an individualised pelvic floor rehabilitation programme and the
option of biofeedback for clients who have difficulty isolating and identifying the pelvic floor muscles.

Constipation
Dietary advice, general exercise and use of optimum positioning on the toilet together with correct
patterns of muscle co-ordination, are all helpful in the management of constipation. Conservative
management of constipation by Pelvic Floor physiotherapists can prevent complications such as
prolapse and pelvic floor muscle weakening.

Undergoing gynaecological surgery

Assessment of pelvic floor muscle activity prior to Gynaecological surgery by a Pelvic Floor
physiotherapist can ensure optimum strength and function is achieved through correct technique of
muscle activation. Expert advice on exercise and general well-being can be given in preparation for
gynaecological surgery. Post-operative follow-up by the Pelvic Floor physiotherapist can ensure
appropriate progression of abdominal and pelvic floor muscle exercises as well as tailored lifestyle
advice can be given to aid in recovery.
Post Prostatectomy
Urinary incontinence is a common consequence in men post radical prostatectomy. Removal of the
prostate gland and associated vessels can lead to leakage of urine. Pelvic floor physiotherapists can
assist in the assessment and treatment of this problem through pelvic floor muscle retraining, bladder
retraining, maintenance of bowel function and education.

Back to top

Osteoporosis Self-management Program

Experienced physiotherapist and accredited osteoporosis educator Helen Beech assists clients to
develop a specific management program based on individual assessment and personalised, agreed
goals. Programs are aimed at improving muscle strength, flexibility, balance and postural awareness,
thereby reducing the risk of falls.

Individual consultations form one part of a self-management program which includes the options of
Osteoporosis Education and Self-Management Series, exercise classes and the clients ongoing home
exercise program.

Back to top

Building Better Bones

Are you at risk of osteoporosis? Learn about risk factors and evidence based strategies to prevent
osteoporosis and reduce your chance of a fracture. If you want to receive expert assessment and a
personalised advice the Better Bones Package is the program for you.

Back to top

Adult Musculoskeletal Physiotherapy

Mater Health and Wellness provides access to highly experienced and qualified musculoskeletal
physiotherapists, who provide hands on assessment and treatment for all musculoskeletal conditions,
including:

• low back and neck pain, and other spinal problems

• headache and jaw pain
• tendon injuries (tendonitis, tendonopathy)
• osteoarthritis
• sports injuries
• work injuries
• perioperative and post-fracture rehabilitation.

Physiotherapy staff also provide personalised management, including hands-on treatment, precision
exercises, education regarding your condition, and individualised ergonomics, fitness and lifestyle
advice.

At your request, and at no additional cost, we can also provide:

• a postural assessment
• a written, customised exercise program
 • advice for optimal functioning
• advice and options for self-management of pain
• advice to prevent pain and maximise your future wellbeing.

Mater Health and Wellness is affiliated with the Mater/Australian Catholic University Back Stability
Clinic. If further specialised care is required for a difficult or stubborn spinal pain problem (e.g. complex
and chronic conditions), the Back Stability Clinic, using ultrasound imaging, can provide expert and
knowledgeable management and treatment.

For further information about the Back Stability Clinic, please telephone 07 3163 1529, or visit their
website.

Back to top

Edited June 25, 2010 EAST by Webmaster.

Mater Health and Wellness Clinic: Quality wellness programs
designed for individuals.
Contact numbers
Call +61 7 3010 5744
Email info.wellness@mater.org.au

Physiotherapists are active in treating a range of women’s health needs, e.g. aspects of pre- and
post-natal care, complications of breast cancer, and management of osteoporosis, pelvic pain
and urinary incontinence. These conditions can significantly affect not only your health, but also
your physical and mental well-being, participation in daily activities, and can even have an impact
on your identity as a woman.

Your physiotherapist is knowledgeable of the female body and systems and will be able to
address to your specific movement impairments within the context of your overall health.

Breastfeeding and Bone Health

Breastfeeding also affects a mother’s bones. Studies have shown that women often lose 3 to
5 percent of their bone mass during breastfeeding, although they recover it rapidly after
weaning. This bone loss may be caused by the growing baby’s increased need for calcium,
which is drawn from the mother’s bones. The amount of calcium the mother needs depends
on the amount of breast milk produced and how long breastfeeding continues. Women also
may lose bone mass during breastfeeding because they’re producing less estrogen, which is
the hormone that protects bones. The good news is that, like bone lost during pregnancy,
bone lost during breastfeeding is usually recovered within 6 months after breastfeeding
ends.

Tips to Keep Bones Healthy During Pregnancy, Breastfeeding, and Beyond

Taking care of your bones is important throughout life, including before, during, and after
pregnancy and breastfeeding. A balanced diet with adequate calcium, regular exercise, and
a healthy lifestyle are good for mothers and their babies.

Calcium. Although this important mineral is important throughout your lifetime, your body’s
demand for calcium is greater during pregnancy and breastfeeding because both you and
your baby need it. The National Academy of Sciences recommends that women who are
pregnant or breastfeeding consume 1,000 mg (milligrams) of calcium each day. For pregnant
teens, the recommended intake is even higher: 1,300 mg of calcium a day.

Good sources of calcium include:

 low-fat dairy products, such as milk, yogurt, cheese, and ice cream
 dark green, leafy vegetables, such as broccoli, collard greens, and bok choy
 canned sardines and salmon with bones
 tofu, almonds, and corn tortillas
 foods fortified with calcium, such as orange juice, cereals, and breads.

In addition, your doctor probably will prescribe a vitamin and mineral supplement to take
during pregnancy and breastfeeding to ensure that you get enough of this important mineral.

Exercise. Like muscles, bones respond to exercise by becoming stronger. Regular exercise,
especially weight-bearing exercise that forces you to work against gravity, helps build and
maintain strong bones. Examples of weight-bearing exercise include walking, climbing stairs,
dancing, and weight training. Exercising during pregnancy can benefit your health in other
ways, too. According to the American College of Obstetricians and Gynecologists, being
active during pregnancy can:

 help reduce backaches, constipation, bloating, and swelling

 help prevent or treat gestational diabetes (a type of diabetes that starts during
pregnancy)
 increase energy
 improve mood
 improve posture
 promote muscle tone, strength, and endurance
 help you sleep better
 help you get back in shape after your baby is born.

Before you begin or resume an exercise program, talk to your doctor about your plans.

Healthy lifestyle. Smoking is bad for your baby, bad for your bones, and bad for your heart
and lungs. If you smoke, talk to your doctor about quitting. He or she can suggest resources
to help you. Alcohol also is bad for pregnant and breastfeeding women and their babies, and
excess alcohol is bad for bones. Be sure to follow your doctor’s orders to avoid alcohol
during this important time.

Resources for Pregnant and Breastfeeding Women

National Women?s Health Information CenterWebsite:

http://www.womenshealth.gov/pregnancy

Designed for expectant mothers, this Web site provides resources about each
trimester of pregnancy, family planning, preparing for the new baby, childbirth,
postnatal and postpartum care, and financial assistance.
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Post- Natal Pelvic Floor Muscles and Incontinence

1 in 3 women who have had a baby wet themselves! – but it
doesn’t have to be this way, 85% of people are cured of
incontinence within a few months of doing their exercises. If
you have any symptoms, purchase Women’s Waterworks (Book
section) to find out the simple steps you can take to cure this
condition!

Pregnancy and childbirth places a great strain on the pelvic floor, so it

is important to commence these exercises straight away if you are not
already doing them. Weakness of the pelvic floor may cause stress
incontinence (wetting your pants when you sneeze, cough, lift etc).
This is very common in pregnancy due to the strain on the pelvic floor
and hormonal changes – it can get worse over time and will not fix
itself, so start your exercises now.

Why does having a baby weaken the pelvic floor?

• Complicated vaginal delivery: use of forceps or vacuum, episiotomy or tearing
can damage or stretch the muscles, nerves and connective tissue.
• High birth weight: the bigger the baby the more stretch and strain on the pelvic
floor both during the pregnancy and delivery.
• Long second stage labour – the more pushing you do, the more strain on the
pelvic floor.
• 3+ vaginal deliveries, each time you have a baby, the pelvic floor gets a little
weaker (especially if you haven’t been doing your pelvic floor exercises).
What does the pelvic floor do?

• Supports the bladder, vagina, uterus and bowel to prevent

prolapse
• Contributes to the closing pressure of the urethra, vagina and
anus
• Is important for bladder and bowel control and sexual function
• Withstands abdominal pressure which is increased during
coughing, sneezing, vomiting, lifting, laughing etc
• Works with abdominal and spinal muscles to support your spine
• Assists with pregnancy and childbirth
Signs of a weak Pelvic Floor
• Urine loss when you cough, sneeze, lift or exercise
• Frequency – passing urine more then 6-8 times a day
• Urgency –
o an urgent need to pass urine
o Unable to hold until you find a toilet
• Prolapse – you may feel a bulging, dragging or heavy sensation
• Poor control of wind
• Decreased sensation and tone in the vagina during intercourse
• Difficulty evacuating bowel motions
• Unable to completely empty when you pass urine
• Frequent urinary tract infections due to poor bladder emptying

Things you can do if you have a damaged pelvic floor from

child birth:
• Ice packs (do not apply directly to skin) 10 min every couple of hours (pain
relief section)
• Rest lying on your side or flat on your back with your head down (1 pillow) to help
with swelling for at least 30 minutes twice a day
• Lean forward as you sit to empty your bladder
• To empty your bowel, lean forward keeping your spine straight and use a wad of
toilet paper to support your perineum
• Do not lift anything heavier than your baby
• Keep up your fluid intake
• Eat a high fibre diet to keep your bowel motions soft
• Avoid heavy lifting
• Start gentle pelvic floor contractions
• Do not use ring cushions for pelvic floor damage
• Avoid high impact exercises for 12 weeks or while you are still having
incontinence or feelings of heaviness
• Watch your posture

Things you can do if you have a weak pelvic floor:

• Do your pelvic floor exercises regularly
• Cross your legs and squeeze them tightly before coughing
• Do not lift heavy loads
• Don’t strain when using your bowels
• Do not do any bouncing or jumping exercises
• Don’t go to the toilet just because you get up to your baby – only go if you have
an urge

How to do your pelvic floor exercises!

There are 2 muscle types in the pelvic floor (fast twitch and
slow twitch), so you need to do 2 different exercises.

Start exercises in a lying position, as they become easier progress to

sitting and standing.
 1. Gently draw up and in around the vagina, urethra and anus (as though you are
trying to stop weeing) – you should feel a lift and squeeze. Try to hold this
contraction strongly for 5-10 sec, relax for 10 sec then repeat up to 10 times. To
do this sequence at least three times per day. Be sure that you do not hold your
breath or clench your buttocks. You should continue this program throughout
your pregnancy and for a minimum of 4 months after your baby is born. It is a
good idea to make them part of your daily routine forever. As your muscles get
stronger you can build up the length of hold and number of repetitions. Start
doing your exercises as soon as possible after having a baby to assist with the
healing process.
2. Strongly squeeze and lift your pelvic floor muscles, then relax – there is no need
to hold this (fast twitch) exercise. Do 10 repetitions, three times a day.

You should not return to sport until you can control your pelvic floor.

Read Women’s Waterworks (Book section) for more information

If your muscles are very weak and you are unable to do your
exercises, commence your strengthening program with
electrical stimulation or vaginal cones (see the exercise and
functional section)

If you cannot feel your pelvic floor muscles working or have any
concerns make an appointment with your women’s health
Physiotherapist.

By 12 weeks after having a baby you should be able to:

• cough without leaking
• completely stop your urine flowing (midstream) – please do this once
only as a test, doing this often could lead to urinary tract infections

***if you cannot do this please see your Women’s Health

Physiotherapist***

Episiotomy or Tearing Pain

This is when the doctor needs to cut the area between the vagina
and the anus (perineum) to assist delivery of your baby, this area
may also tear during childbirth. In both cases you will need stitches
and the area will be swollen and painful for up to a few weeks. You
will find that your pelvic floor muscles will be weak due to the pain
and trauma.

What can you do?

 • Rest
• Gentle Pelvic floor exercises will help to accelerate the healing process
• Ice Packs (SEE PAIN RELIEF SECTION)
• U shape pillows
• Cool salt baths
• Compress with disposable or cotton underwear (see functional section) and
sanitary pads
• Elevate lower limbs
• Commence scar tissue massage after a couple of weeks and before 14 weeks to
encourage tissues to become more elastic and prevent painful intercourse. Use
the tip of your thumb or middle finger and feel for lumps in the scar – hold gentle
pressure for 30 seconds and slowly release.

Healthy Habits for the Pelvic Floor

• Do pelvic floor exercises everyday as a lifelong habit
• Drink 1.5 – 2 litres of water a day, more if it is hot or you are exercising –
restricting your fluid intake will make things worse by irritating the bladder
• Avoid just in case visits to the toilet – go only when you have an urge
• Aim for normal frequency of voiding (passing urine) 4 – 6 times a day (every 2-3
hours) and perhaps once at night, you should pass between 250 – 500 ml each
time
• Always sit on the toilet seat to urinate. Hovering over the toilet can prevent the
bladder from emptying properly. The best position is to sit with a straight back,
leaning forward with your elbows resting on your thighs.
• Limit caffeine intake (coffee, tea, cola, and chocolate)
• Limit alcohol intake
• Avoid constipation or straining
• Eat lots of fruit, vegetables and fibre to stay regular
• Be a non smoker
• Do regular general low weight bearing exercise e.g.- walking
• Stay in the healthy weight range
• Avoid lifting heavy objects – never lift more than your pelvic floor can control
• Exercise – Cycling, Pilates and Fit ball are great.
• Lose weight
• Teach your daughters to commence pelvic floor training at a young age
• Tension your pelvic floor before you lift, sneeze, cough or exercise
• Tension your pelvic floor following toileting

Working with the Abdominal muscles

The deep core muscles and pelvic floor muscles work together to
support our pelvic organs and lower back, especially if there is
increased intra-abdominal pressure, e.g.-when we cough, sneeze, lift or
exercise. Learning to co-activate these muscles will help your pelvic
floor stay fit and strong.
Abdominal Drawing in exercises

1. Lie on your back with your knees bent.

2. As you breath out gently draw in your lower abdomen as if you are trying to
flatten your stomach across your spine.
3. Breathe normally – Do not suck in your upper abdomen or hold your breath.
4. Try to feel your pelvic floor muscles working at the same time.
5. Practice combining abdominal drawing in and a gentle pelvic floor exercise
together.

Aim for 10 repetitions of 10 seconds 3 times a day

Physiotherapy Pilates DVD’s will assist you with both pelvic

floor and core muscle strengthening (see the DVD section)

Urinary Incontinence

Stress incontinence (S.I.) is the loss of urine associated with

coughing, sneezing, lifting and straining. 1 in 3 women who have had a
baby suffer from incontinence.

It is caused by a lack of support to the bladder outlet; this is due to

both pelvic floor and connective tissue weakness.

Risk Factors:
• Childbirth – SI is more frequent in women who have had a number of children,
with larger birth weight increasing the risk.
• Race – Caucasian women are at a greater risk.
• Obesity
• Smoking (chronic cough)
• Chronic constipation
• Connective tissue – women who are prone to stretch marks, hernias and flexible
joints

Treatment
 • Pelvic floor strengthening (purchase women’s waterworks and exercises
DVD’s).
• Deep abdominal strengthening
• Learning the knack – this is when you contract your pelvic floor and deep
abdominal muscles prior to coughing (or whatever triggers your incontinence)
• Lifestyle changes
o posture
o adjusting activities e.g.- avoid jumping until your symptoms improve
o avoid heavy lifting
• Weight loss if necessary
• Dietary changes to prevent constipation

Studies show 85% of women with S.I. are cured with Physiotherapy
treatment

Urge incontinence is when you suddenly and urgently need to

urinate and are unable to get to the toilet in time. This urgent need to
urinate may occur frequently during the day and often at night as well.
It is worse in pregnancy due to hormonal changes and the pressure of
the growing baby on the bladder.

Bladder retraining is the technique used to try to increase the capacity

of the bladder and decrease the sensitivity of the bladder. By teaching
your bladder how to store more urine without leaking or giving
uncomfortable spasms, you will have more time between voids, less
discomfort and more freedom to go out. This is a disciplined program
to suppress an overactive bladder. Expect the program to take at least
3 months to have a positive effect.

How to retrain your bladder

The first step is to fill in a frequency / volume chart (or bladder
chart) – this gives you an indication of how your bladder is
functioning. Your physiotherapist will give you these charts.

Once you start your bladder retraining program you must:

1. Avoid just in case visits to the toilet. Only go when you have a full bladder,
not out of convenience. You may need to void to a timetable. Start with a minimum of
1 hour and increase by 15 – 30 min each week.
2. When you get the urge to go to the toilet – defer your visit. Start by holding for
10 seconds and slowly build up. Often the urge will disappear as it was a false alarm.
If the bladder fullness feeling persists then allow yourself to go after this waiting
period. This is a game of mind play as well as sheer physical strength and
determination. YOU MUST LEARN TO ONLY GO TO THE TOILET WHEN THE
BLEADDER IS FULL!!
 3. Become aware of your triggers e.g. - running water, key in the door and use the
techniques below to defer, do not give in to known triggers e.g. - urinating in the
shower.

Urge control techniques

1.
• Stay still, rushing to the toilet only makes it more likely that you will leak
• Firm perineal hand pressure
• Sit pressure – by sitting on the edge of a chair or corner of a desk, you can
substitute hand pressure
• Sit on a rolled up towel - this is especially good if you get urgency first
thing in the morning, as your feet hit the floor
• Toe pressure – press firmly with your toes into the floor
• Cross your thighs
• Squeeze your buttocks
• Walking
• Strong sustained pelvic floor or deep abdominal drawing in until the urge
subsides

Once the urge has passed make a decision – is the bladder full? If not,
defer going to the toilet. If the bladder is full use the following
techniques to get to the toilet dry:
• Stand carefully
• Breathe easily
• Walk quietly and calmly to the toilet, do not rush
• Count your steps and use distraction techniques e.g. – counting backwards in
threes, making up a shopping list, reciting a recipe remembering all the details of your
favourite holiday or?

Other advice
• Maintain a normal fluid intake – this is VERY important. We need to fully extend
the bladder to retrain it properly.
• Reduce your caffeine intake (coffee, tea, cola, chocolate and sports drinks)

* You are bound to have some accidents while you retrain your
bladder. Hang in there, it will be worth it. If you are diligent
with the program you should see some improvement by week
3*

* see your women’s health Physiotherapist for assessment and

treatment specific to your condition*
 Painful Intercourse (Dyspareunia)
What causes it?
• Spasm in the pelvic floor muscles
• scar tissue following tearing or episiotomy from childbirth
• anxiety

What can you do?

• Pelvic floor exercises
• Massage to the pelvic floor - you can gently massage the tight area with your
finger using a vegetable oil as a lubricant or make an appointment with a
Women’s health Physiotherapist.
• As a self management technique, while you are attempting intercourse, instruct
your partner to stop penetration if there is burning pain, but not pull out. He
should maintain constant steady pressure with the head of his penis as you do
several lengthening pelvic floor contractions. This will reverse your protective
guarding response and desensitize the tissues by direct stress loading. This can
also be accomplished with a dilator or your own finger.
*** see your women’s health Physiotherapist for assessment and treatment specific to your
condition***

Faecal incontinence after childbirth

Can be caused by: third-degree perineal tears associated with delivery, or nerve damage of the pelvic
floor and external anal sphincter associated with childbirth or excessive straining with defecation.

What can you do?

• strengthening of the pelvic floor muscles (See the books section for women’s waterworks)

• Use of barrier creams to protect skin

• Appropriate absorptive pads.

• Surgery for severe cases

*** see your women’s health Physiotherapist for assessment and treatment specific to your
condition***

Prolapse
What causes prolapse?

• connective tissue laxity due to hormonal changes and stretching during delivery

• weight gain during pregnancy

• multiple pregnancies

• complicated delivery

• obesity

• smoking
• Chronic cough

• Chronic constipation

• Lifestyle activities such as frequent or heavy lifting

What can you do?

• Avoid activities that will further weaken the pelvic floor

1. Straining to move your bowels

2. Heavy lifting, pushing or pulling
3. Smoking (as it causes chronic coughing)
4. Sneezing (you may need to seek allergy treatment)
• Learn to use your pelvic floor and deep abdominal muscles for support.
Avoid straining to move your bowel as this will stretch and weaken the pelvic
support structures and worsen your prolapse

• Improve your general fitness with

• Maintain your weight within a healthy range

• Wear supportive underwear

*** see your women’s health Physiotherapist for assessment and treatment specific to your
condition***

Disclaimer

Tummies, Mummies and Bubbies have provided these articles for general
information only and they should in no way be considered as a substitute for
the advice and information your physiotherapist and or doctor will supply
about your particular condition. It is recommended that you always seek
professional advice.

While every effort has been made to ensure that the information is accurate,
Tummies, Mummies and Bubbies accept no responsibility and cannot
guarantee the consequences if you choose to rely upon these contents as
your sole source of information.

All prices are in AUD. Copyright 2010 Tummies, Mummies & Bubbies. Sitemap

Pregnancy belt, Pregnancy pillow, Pregnancy exercise dvd, exercise during pregnancy, Back pain in pregnancy

Post Natal Exercise

Post Natal exercises are performed to:

• Increase or maintain the fitness levels of the participants

• Posture and body alignment

• Body awareness

• Strength training

• Cardio endurance

• Stretching and Relaxation

Post Natal exercise can be divided into following segments:

 • Warm-up: The warm-up exercise involves joint preparation, large muscle activity and static stretching.

• Cardio: The cardio aerobic includes low impact mild-to-moderate intensity movement. Participants are encouraged to adjust their intensity based on
their perceived exertion.
• Muscle strength and endurance: This segment includes upper & lower body strength training and abdominal work, lower back strength work,
progressive abdominal exercises and arm and leg strength work are incorporated.
• Cool-Down: The cool-down includes stretching and relaxation.

Electro Therapeutic Modalities

We sometime use electrical devices to stimulate healing and produce pain relief. At Punarnava, we make use of following electro-therapeutic modalities:

• Shortwave Diathermy

• TENS

• IFT

• Ultrasound

• Paraffin Wax Bath

• Traction

• Infrared

• Hot Packs

• Electrical Stimulation

• Exercise

• Weight Loss Basics

• Strength and Cardio Workouts

• Exercises By Muscle Group

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Postpartum Fitness
Exercise After Baby

By Paige Waehner, About.com Guide

Updated October 08, 2007

About.com Health's Disease and Condition content is reviewed by our Medical Review Board

See More About:

• pregnancy

• postpartum weight loss

• how to lose weight

• toning the abs

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Having a baby means a lot of things: losing sleep, learning how to hold a tiny person correctly and dealing with the weight you gained during
your pregnancy. As you try to get your new routine down, exercise may seem like that last thing you feel like doing. But, being active now is
more important than ever because it helps raise metabolism, shed extra weight, provides much-needed energy and helps reduce stress and
tension.

Studies show that most women gain an average of about 30 pounds during pregnancy, although many of us end up gaining a lot more than
that. On average, 18 to 20 pounds are usually lost within a month of having a baby, but it's those extra pounds that can be tough to get rid
of. Your body may be different after having a baby. But, with a little patience and consistent exercise, you can get back into shape.

How Much and When?

You already know that getting back to exercise should be a gradual process. Your body has gone through a tremendous change and it takes
time for it to bounce back. Your doctor will give you the go-ahead for when you can exercise and may give you simple exercises you can do
the first couple of weeks after the birth. Some of those suggestions may include:

• Kegel exercises: Kegel exercises involve making small contractions of the muscles at the vaginal wall. These exercises can help
strengthen weak pelvic muscles, which can cause bladder control issues, which are common in women postpartum.
• Walking. With your doctor's OK, short, slow walks can help prepare your body for more vigorous exercise, as well as get you fresh
air. If you exercised before pregnancy, you may need about six weeks before you can return to what you were doing before.
• Yoga: Gentle yoga poses can be a great way to get your blood flowing while reducing stress. You may need to avoid some poses
(like inversions), but basic moves like supported bridge, warrior I and pelvic tilts, are a great place to start. You may also be able to find a
postpartum yoga class at a local gym or health club.
• Pilates: With some modifications, you may also be able to do basic Pilates exercises to strengthen the core and increase your
flexibility.

What About Your Abs?

You may be anxious to get back to ab exercises as soon as you can. But again, you may need some time before you can safely do traditional
ab work, especially if you have a separation in the abs or diastasis.

If you don't have diastasis, you may be able to start with simple exercises like pelvic tilts and isometric contractions.

• Pelvic tilts: Lie down on the floor with your legs bent, feet resting on the floor. Slowly tighten your abdominals and roll your
pelvis towards you. Breathe evenly and try to initiate the movement with your abs instead of squeezing the glutes too much. Don't forget
to tighten the pelvic floor when doing pelvic tilts, since they may place pressure on it and stretch it further.
• Isometric contractions: This is a move you can do with your baby, if you like. Lie down with knees bent and feet flat on the
floor, placing the baby on your belly. Inhale and, as you do so, squeeze the abs, pulling them in like a sponge and lift the baby up. Exhale
and lower the baby back down. Repeat for 10 to 16 reps.

As you get stronger, you can progress to more difficult exercises. Keep in mind that if you've had a c-section, you'll need more time to allow
your body to heal before trying abdominal exercises. Before you do anything, check with your doctor and work with him or her to develop a
starting exercise program.

Postnatal Workouts

Once you've gotten the go-ahead from your doctor and are feeling sufficiently ready for exercise, you might need some ideas on exactly what
to do. If you exercised before, you may be able to ease back into modified versions of what you were doing. If you haven't exercised before,
you'll want to start with a beginner program to allow your body time to get used to exercise. These resources will help you figure out where to
start:
 • Robin Weiss, About.com's Pregnancy Guide, has the perfect postpartum workout for you, taking you through four days of
exercises designed to help strengthen your body.
• Postpartum exercise videos. These Pilates and yoga videos offer gentle ways to get in shape after you've had a baby.

• Postnatal Workouts. This comprehensive list of exercises and workouts offer safe ways to get in shape postpartum.

The important thing to remember is to be gentle with yourself and follow doctor's orders. Make sure you're eating a healthy diet,
particularly if you're breastfeeding (which may require up to 500 extra calories a day). Stay well-hydrated and don't give up. Fitting in
exercise may be hit or miss as you adjust to your new life and baby. So do the best you can and focus your energy on taking care of
yourself and your baby.

Suggested Reading

• Exercise During Pregnancy

• Exercise

From Other Guides

• Pregnancy

• Postpartum Fitness

• 9 Months of Fitness

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• Health Pointers for Fitness

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Paige Waehner
Exercise Guide

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