Month eight
Your pelvic floor
“WHAT WE CALL the pelvic floor is a group of muscles that work together to functionally control urine loss, the passing of wind and faecal incontinence. These muscles sit beneath the bladder, uterus and bowel, almost like a hammock. There are three passages through the pelvic floor: the urethra, the vagina and the anus. The skin and connective tissue between these three openings is called the perineum.” This wonderfully clear word-picture of our pelvic floor, painted by Johannesburg physiotherapist Carren Hughes, helps us better understand our pelvic floor. By the eighth month of pregnancy, she says, you should be feeling the heaviness of the baby bearing down on your bladder and bowel. “At this stage, frequent urination and even some stress incontinence, such as a cough, sneeze or laugh that leads to a little urine escaping, should be expected.” This is nothing to worry about, Carren adds. “It doesn’t mean your pelvic-floor muscles are damaged. They just aren’t able to close the urethra under the great pressure of your baby, as well as the increased intra-abdominal pressure that occurs when you cough or sneeze.” This stress incontinence is a temporary condition that should resolve itself.
WHAT HAPPENS TO YOUR PELVIC FLOOR DURING PREGNANCY?
“Hormones in pregnancy, especially the hormones progesterone and relaxin, affect the muscles and joints, which explains the aches and pains one feels in pregnancy, the so-called ‘pregnancy discomfort’,” says Cape Town urogynaecologist Dr Lamees Ras. “These hormones relax the ligaments and some of the muscles in the body. “At the same time, the muscles helping to support the growing uterus are placed under pressure, and the growing womb puts pressure on the bladder. Though these changes tend to be transient and normalise after delivery, there may be a lingering effect in some women.” Carren notes that changes in defecation habits during pregnancy can take their toll too. “Some women experience diarrhoea, while others complain of constipation during pregnancy,” she says. “Constipation and constant straining on the toilet may affect the ligaments and connective tissue that holds up the uterus, bladder and rectum.”
HOW CAN YOU SUPPORT YOUR PELVIC FLOOR DURING THIS TIME?
“It’s never too early to start your pelvicfloor exercises, or Kegels,” says Dr Ras. “This involves tightening or contracting the muscles that you use to stop and start urinating. Do this exercise five times, for five seconds each time, three to five times a day. You can eventually work up to 10 times, for 10 seconds a time, three to five times a day.” “Get somebody who really knows what they’re doing to teach you these exercises,” Carren advises. “You shouldn’t be holding your breath, contracting your buttocks or sucking in your stomach. The pelvic-floor muscles are functional muscles, meaning that they shouldn’t be in a state of contraction all the time; they contract only when necessary. So Kegels aren’t an exercise that you try to do all day long.”
POST DELIVERY
“If you have a normal vaginal delivery, you may experience bruising and stretching internally, as well as in the perineal region,” says Carren, adding that these muscles heal. After the birth, you may still have some stress incontinence triggered by a very heavy pregnancy or difficult delivery. “If, following your six-week checkup, you’re still peeing a bit when you cough or sneeze, you need to see a physio,” says Carren. “In almost all cases, stress incontinence is treatable and even completely fixable with physiotherapy.”