The Pelvic Floor - by Physiotherapist, Simon Murphy

Published : November 13, 2015

Urinary incontinence is a common and embarrassing problem widely experienced in the postnatal population.
I am often asked why is this happening? What is causing this problem? Can it be fixed? The answer is Yes!

by Simon Murphy

ROLE OF THE PELVIC FLOOR

To understand why urinary and faecal incontinence occurs when individuals run, jump cough or laugh, the anatomy of the pelvic floor needs to be considered and the affect that child birth has on the PF. The pelvic floor forms the bottom of your pelvic cavity that is shaped like a hammock. It is made up of numerous muscles and elastic material. The purpose of its structure is to support the abdominal contents and maintain continence of urine and faeces during times of raised intrabdominal pressure. Activities that causes this increase in abdominal pressure includes jumping, laughing, coughing and running. The pelvic floor allows you to excrete waste products and allows sexual intercourse to take place. In recent times studies have also proven that pelvic floor exercises¯ helps to improve sexual function in men, and not just women.

Imagine the pelvic floor muscles being an elastic band. The harder and longer you keep stretching it the looser and looser it will become. Over time the elastic band will never return to its normal position. During child birth the pelvic floor muscles are continually placed on tension and stretch. This leads to the fascia and muscles of the pelvic floor becoming stretched and weakened. Therefore just like the elastic band the pelvic floor is not as “tight” as it used to be and this results in the poor control of urine, faeces and a decreased sexual performance.

Just like any muscle in the body if we train it correctly through exercises it can get stronger. The PF is no exception, it is a muscle and therefore can be trained to prevent those unwanted symptoms that can accompany child birth.

Often in gym settings I witness new mothers performing hundreds of sit-ups, or running on the treadmill for 5 minutes then rushing off to the bathroom. Their main complaint is that they find it hard to ‘hold on’. This can be rather discouraging leading to avoidance behaviors often ceasing exercise which leads to further health related issues in the future.

The reason why this is occurring is that common exercises performed in gyms such as sit-ups, lifting weights and running produces large abdominal pressures that place further strain on the already weakened PF. Therefore when greater pressure is placed on the PF it increases the risk of incontinence. It is important that before these exercises are performed the mother needs to learn how to activate her PF and hold this contraction. This will help maintain the pressure inside the abdominal cavity and prevent symptoms of incontinence occurring. The more and more these exercises are performed the stronger the pelvic floor muscle becomes and a gradual reduction of symptoms will be noticed.

The best advice I can give is that: “postnatal exercises are required to regain full strength, otherwise symptoms such as incontinence and prolapse may result and continue.”

When teaching PF contractions the best way is to imagine you are busting to go to the toilet and you need to hold on as hard as you can so you don’t wet your pants. Therefore you contract your PF muscles and squeeze them up inside you. There are many ways to teach however this method is realistic and most clients can relate to this. What I suggest is for women to strengthen their pelvic floor muscles they should be encouraged to squeeze as strongly and quickly as possible and hold this contraction for 3 breathes or approximately 5 seconds. After each squeeze you should rest for 10-15 seconds which aids in reducing fatigue of the muscle. I encourage that 30-50 contractions are performed per day during pregnancy and post natally increasing this as required.

A way of testing whether or not your PF is improving is by performing the ‘mid-urine stop stream test.’ Go to the toilet and try and stop urinating by contracting your PF. If you stop the flow your pelvic floor is working. If the flow is still present or the flow is dribbling then you still can improve. Never use this technique as a treatment technique as it poses the risk of developing UTI’s. Use this as an objective measure of your pelvic floor function.

So for those suffering from such issues there are ways to treat and prevent ongoing symptoms. It’s a matter of being consistent with your exercise and performing the correct exercises. If you still have issues consult your gyno or physiotherapist with a post graduate degree in Women’s Health.