How Do I Protect My Pelvic Floor During Pregnancy?

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Transcription

INTRO

If you are pregnant or you've recently had a baby, this podcast is for you. I am your host Kath Baquie, a Physiotherapist working in women's health and mum of three. Join me each week as we dive into all things pregnancy care, childbirth, and postnatal recovery, helping you have a wonderful pregnancy and after birth experience, and don't forget to hit subscribe so you don't miss any episodes.

Well, hi there and welcome back to another episode of FitNest Mama podcast. I'm your host Kath Baquie. I am a mum of three young girls, a physiotherapist for women with 15 years experience and I have an online community FitNest Mama which helps to provide pregnant and new mothers with the exercises support and resources they need to move from the overwhelm the physical aches and pains of pregnancy, the weakness felt after birth. And instead we replace that with the comfort and confidence they need to get their bodies and minds strong again, so they can get back to doing what they love with a bubba by their side (whether or not that's running around with the kids at the park, or running the next marathon).

PROTECTING YOUR PELVIC FLOOR DURING PREGNANCY

• How do I protect my pelvic floor during pregnancy?
• Should I do pelvic floor exercises during pregnancy?
• Or should I just wait until after I've had my baby?

These are two really common questions I get asked as a pelvic floor physio, which is fabulous because at the end of the day, I think everyone listening to me today wants to help set themselves up to be dry, to not leak urine and to be able to hold in wind and feces. I sat down today to record this episode to answer these questions. And my initial intention was to do a whole episode on pelvic floor during pregnancy. But to be honest, after jotting down a million notes, I thought you know what, this is all too complicated. I had written down too much information. And I felt that by delving into everything about pelvic floor during pregnancy, it can be overwhelming.

So I'm going to split it up into little bite sized pieces because I know there's nothing worse than listening to a podcast episode which seems to ramble on and on. And that's not what this podcast is all about. So everything today is hopefully going to be super simple and easily digestible.

So ladies answer to this important question. How do we help protect our ever important pelvic floor during pregnancy?

5 DAYS, 5 WAYS TO PREPARE FOR LABOUR

But first before diving in there is something super exciting that is happening in the next few weeks. Five days five ways to prepare for labor is a free five day event Saturday on Monday the 30th of November 2020. These five days will leave you feeling more confident and empowered about your upcoming childbirth experience.

So in these five days, you will learn about:

• Active birth positions. What are some positions you can use during labor?
• Perineal massage.  You will learn what perineal massage is, and how it may help to reduce your risk of perinatal tears and episiotomy and also how to do it.
• TENS machine which can be used for pain relief
• Pelvic floor essentials to help with your pregnancy, birth and after birth recovery.

So as a women's health, physio, everything I will be sharing in this free five day event are things I believe every woman needs to know when pregnant to really help with her childbirth and after birth experience.

And to register for this free event, head to www.fitnestmama.com/challenge.

HOW DO I PROTECT MY PELVIC FLOOR DURING PREGNANCY?

Hopefully after listening to this, you will have a few take home messages that you can action today. So firstly, let's get onto the same page about our pelvic floor muscles.

The pelvic floor does sound like one muscle but here I am actually referring to a group of muscles and connective tissues that form the base of the pelvis. And these tissues help to support our internal organs such as the bowel, the uterus, the bladder, and they also surround all the openings. They can help with the closure of these openings, which is why they do play a large role in helping to prevent prolapse which you might feel as vaginal bulge lump or perhaps a dragging sensation inside your pelvis. But also they have a role with continence.  In simple terms, for keeping you dry when you cough, sneeze, laugh or move.

So back to our question, how can we protect our pelvic floor?  So in this situation, we have what I call 'controllables', and 'uncontrollables'. So there are things that we have control over. And there are things that we don't have control over. I'm not going to dive into all the things that we don't have control over today. So this includes what sort of labor you have, whether or not you need an instrumental delivery, such as forceps, your genetics and your hormone levels, just to mention a few.

At the end of the day, it is good to keep in mind that if you are experiencing issues with prolapse, or incontinence of any sort, it isn't your fault, because there are so many factors at play that we potentially don't have any control over. And it's not a simple matter of getting your pelvic floor muscles stronger. But having said that, I really do implore anyone who does have any of these concerns to go and see a pelvic floor physio and to trust the doctor because it's certainly something that we may be able to manage or seek treatment for.

COUGHING AND PELVIC FLOOR

So what are some of the factors that we do potentially have control over when it comes to protecting the pelvic floor during pregnancy? The first thing that comes to mind is the impact that coughing and sneezing can have on the pelvic floor.  When we cough, there is a lot of downward, extra downward pressure that goes through the pelvic floor. And you can imagine when you're pregnant, you've also got the added weight from your baby, and all that extra fluid and everything else. So all of that is resting on your pelvic floor. And a lot of women do say to me "Oh, I don't have any issues with incontinence. But I just do leak a little bit when I cough". So ladies, this is super common, but I don't think it's something we should put up with. And if you do experience some light leaking with coughing, it is definitely worth seeing a pelvic floor physio. 

Coughing is one of those things that we might not have control over. But let's say for example, you're finding that you're coughing a lot or more than usual, in this situation, seeing your doctor to help work out what the issue is, or managing perhaps your medications, all these things might definitely help.  The other tip is if you do feel you need to cough or sneeze to do a little pelvic floor lift beforehand, before coughing and sneezing. And this little lift can help to support your organs before you cough.  I know this might be impossible if you sneeze suddenly with no warning, but this is called 'the Knack'.  The Knack is a term used to described exactly what I've just said. So if you can feel a cough or sneeze is about to come on, do a little pelvic muscle lift, pre-cough or pre-sneeze. And you might find that is really helpful in protecting your pelvic floor against those extra downward pressures.

CONSTIPATION AND PELVIC FLOOR

So the next thing to be aware of when pregnant and wanting to protect your pelvic floor is avoiding constipation, looking after your bowels and avoiding that downward strain. So this is probably a whole topic that we could talk about for an hour. So I'm just going to summarize a few things. When we are pregnant, we have pregnancy hormones circulating our body that can make the bowels sluggish. And when you combine that with postural changes that might happen as your belly is growing.

Constipation can be a big issue during pregnancy. And it's really common. So again, this has some of those elements we talked about before, we can't control our hormone levels, and we can't control certain postural changes and mechanical aspects as well. However, there are a few aspects we can control. So let's dig into these.

When it comes to looking after our bowels, our diet and how much we're drinking immediately comes to mind. So being aware of what you're eating, how much fiber you're having, how hydrated you are, can play a big role. And this isn't my area of expertise, but we are getting a dietitian onto the podcast soon we will dive into all things pregnancy and diet then.

And then another two things which we can potentially control when it comes to managing constipation and perhaps things that are less commonly discussed. So being aware of our posture and positioning on the toilet can be really helpful. So the way the bowel is positioned means that if we can get our knees above our hips, this can help to improve potentially the position of our bowels and make it easier to pass a bowel motion. If you think about the fact that humans used to be under than gatherers, and we used to squat on the ground to open up bowels, and then think about the height of a lot of modern toilets, I've had clients who have had chronic constipation, who have then gone on holidays to countries with squat toilets. And they have found this has made the world difference to how easy it is to pass a bowel motion.

So we can't all have squat toilets in our home. But what we can do is check to see if your knees are above your hips. So if you're short and you've got a high toilet at home, get a little stool to pop your feet on and see if that makes a difference. So don't just lift up your heels to lift up your knees, actually try putting your feet on something to get your knees above the hips.

The other trick is putting your elbows on your knees, and taking a few deep breaths. This helps to relax the pelvic floor, which can help with the opening of the bowels. And I like to tell my members "Moo to Poo" which totally sounds weird, but the thought process is if you're mooing, then you're not holding your breath. And if you're not holding your breath, then you're not straining down, you're hopefully relaxing your pelvic floor.

Another point to mention in terms of getting your knees above the hips, this position might not work for everyone. So if you have an issue with prolapse, you might find a different position more effective in opening your bowels depending on what sort of prolapse you have. So again, if there's any issues with prolapse, please go and see pelvic floor physio to get properly assessed. And I also haven't mentioned heading to the doctor and checking over medications. So when it comes to constipation, there's a lot of things on the market whether or not that stool softeners, or perhaps bulking agents like Metamucil. But what works on one person might not work on another. So always check your doctor or pharmacist before taking these just to make sure that you've got something that works for you.

HEAVY LIFTING AND PELVIC FLOOR

Right so the last two things that might help with protecting your pelvic floor during pregnancy are avoiding things such as super heavy lifting, and avoiding high impact exercise. I'm not going to talk about this in huge detail today, as it is an area where research is a little gray. And this could again be a whole episode unto itself. But in terms of lifting my recommendation is similar to that of the constipation during pregnancy, try not to lift anything that requires that grunt or cause that downward force through the pelvic floor. If you need to hold your breath, you could potentially be straining downwards and putting that extra pressure downwards.

So what super heavy lifting means for one person might be totally different for the next person, depending on your level of strength. And this is something that I discuss with a lot with my members during our live workouts together. So our workouts are done from home with very little equipment. If an exercise uses weights, one person might be holding a tin of baked beans from the pantry, which incidently can offer great workout. But then another member might have a set of four kilogram or six kilogram or larger dumbbells. So no matter what weight someone is lifting, I talk through the principles of how to lift, how to manage their breath,
and how to become aware of any excess pressure straining downwards through the pelvic floor, because I'm not the sort of person to give a blanket rule for everyone. But instead, I like to adapt each workout based on individual levels of strength and capabilities. So to empower people to know what works for them is so powerful.

PELVIC FLOOR MUSCLE STRENGTHENING AND RELAXATION

So we have just talked through quite a few different ways of helping to protect the pelvic floor without even discussing pelvic floor strengthening. So that is definitely next on the list. Let's get strengthening the pelvic floor muscles! Ladies, there is some research pointing to the potential benefits of doing pelvic floor muscle training during pregnancy to help reduce the risk of developing incontinence and prolapse issues. So my top tips is to firstly go and see a pelvic floor physio for personalized assessment and treatment program. Not everyone will have the same issues some women may need to strengthen other women may need to learn how to relax their muscles. And some women may need to learn how to do both. So if you're already confident you're doing your pelvic floor correctly, and you just need a bit of extra motivation. Or perhaps you're unable to go and see a physio face to face. So you might live regionally or rurally. Or perhaps it's just not the right time for you at the moment (I totally get it!). The next best thing is to try to fit in regular pelvic floor exercises.

It's not all about strengthening. We've got quick lifts, we've got long holds, we've got relaxation exercises. And this is something I teach in detail in a module inside FitNest Mama, my online membership for pregnant and new mums.

Relaxation exercises are great to do during pregnancy, teaching a pelvic floor how to relax as well as strengthen is super important. So a few tips when I think of relaxing my pelvic floor, I like to think of 'drop & flop', letting the tension go, it can help to relax your tummy muscles. Too often, you might find if you're used to sucking in your tummy muscles, your pelvic floor might also have some tension in them.  We just talked about relaxing the pelvic floor muscles when you're on the toilet, passing a bowel motion. And it's the same sort of thing. When you're doing a poo, you don't want to be holding in tension in your pelvic floor. And when you're pushing out a baby, you also don't want to be holding in tension. And it's really interesting to note that there are so many different forms of relaxation strategies that are taught during pregnancy. But whatever form of relaxation works for you.... visualization, deep breathing, body scanning... it doesn't need to be anything fancy. This relaxation helps with all over body relaxation. But it also helps with pelvic floor relaxation. So a combination of relaxation and strengthening exercises, be it strengthening quick lifts, long endurance holds. This is something we do at the end of every single workout inside FitNest Mama.

It is simply not a matter of doing a few quick lifts here and there. You often hear people saying, do some pelvic floor every time you have a red light or do them when you're on the phone. But this is often not enough to work your pelvic floor in a way that's going to be beneficial. I find it's like cleaning your teeth, it's a relatively boring activity, I totally admit it. And it's a bit of a chore. But cleaning your teeth only takes a couple of minutes. And we're all in the habit of doing it two times a day. And this is really where we want to be with our pelvic floor. So rather than 10 seconds here and there at a traffic light, it would be great to be able to get into a bit of a routine with your pelvic floor so it can become a lifelong habit.

If you'd like help learning about the different aspects of pelvic floor strengthening and relaxation, or perhaps you just need that extra motivation. Then come and join us for free seven days and dive into the module all about pelvic floor and core. So just head to www.fitnestmama.com/free.

Okay, so ladies, we have talked about coughing and 'The Knack' so that pre cough pelvic floor lift we have talked about managing constipation, including positioning on the toilet, and relaxing your pelvic floor and 'mooing to poo'.

We've talked about the benefits of pelvic floor strengthening and pelvic floor relaxation. One thing we haven't talked about today is perineal massage. So perineal massage is the message of the perineum. And the perineum is that area between the vagina and the anus, which becomes stretched during pregnancy. And this is sometimes where perineal tears or an episiotomy might occur. There has been a bit of research demonstrating that perineum massage done from 35 or 36 weeks onwards in pregnancy may help to reduce your risk of a large perennial tear or an episiotomy.  I will do a future episode all about perineal massage because it is too much to cover now, but if you would like to find out more do come and join me for our free five day event which is happening on the 30th of November. So really soon!

'5 DAYS, 5 WAYS to prepare for labor'.  Day two is all about perineal massage. So ladies, this list or what I've talked about today is by no means exhaustive, but I hope it has been helpful for you to think of a few things that you can start to do today to help protect your pelvic floor during pregnancy whether or not it's booking the appointment for your GP to discuss your constipation or coughing. Whether or not it's booking an appointment with your pelvic floor physio to discuss any concerns with leaking or prolapse. Or perhaps you're going to delegate 2 minutes at the end of the day, when you're lying in bed about to fall asleep to do your pelvic floor exercises. And trust me, you'll be sleepy afterwards! And remember if you do want to learn about perineal massage, TENS for labor, active birth techniques and more then sign up for my free five day event five days five ways to prepare for labor.

If you found this episode all useful, I would love for you to send me a DM on Instagram at FitNest Mama. It would be amazing to hear from you. So that's it ladies, my team and I will be putting together the Show Notes for this episode with all the links at www.fitnestmama.com/podcast. Have a fabulous day everyone and I look forward to you joining me next week for another episode of the FitNest Mama podcast.

Thanks for listening to the FitNest Mama podcast brought to you by the FitNest Mama freebies found at www.fitnestmama.com/free. So please take a few seconds to leave a review subscribe so you don't miss an episode. And be sure to take a screenshot of this podcast, upload it to your social media and tag me at FitNest Mama so I can give you a shout out too.  Until next time remember, an active pregnancy confident childbirth, and strong postnatal recovery is something that you deserve. Remember, our disclaimer, materials and contents in this podcast are intended as general information only and shouldn't substitute any medical advice, diagnosis or treatment. I'll see you soon.