Pelvic Health Consideration during Pregnancy

Asmita Shah

Pelvic Floor Muscles

A **** broad ‘sheet’ of muscle rather than a sphincter. It is divided into superficial and deep layers. The superficial layer is found around the opening of the vagina, while the deep layer fans out under the pelvic organs and makes up the vaginal walls. The bladder, uterus (womb), and intestines are all supported by the pelvic floor, which is made up of muscles and ligaments. The urethra, which comes from the bladder, the vagina, which comes from the uterus, and the anus, which comes from the intestine, all pass through the pelvic floor. The pelvic floor muscles join to the front of the pubic bone and the rear of the tail bone to form the foundation of your pelvis.

Pelvic Floor Functions

• Maintain continence

The urethra and anus are controlled by the pelvic floor muscles, which govern the flow of urine and feces. The urethra and anus are surrounded by sphincters. When the pelvic floor muscle contracts, the sphincters at the openings tighten, preventing urine, feces, and wind from leaking out. The sphincters open when the pelvic floor muscles relax, allowing urine and feces to pass.

• Support for the pelvic organs

The pelvic floor muscles, as well as the ligaments and fascia that surround them, support the pelvic organs and keep them from prolapsing out.

• Core Stability

The deep muscles of the abdominal region include the pelvic floor muscles. They stabilize the spine and pelvis by working in conjunction with the deep abdominals (transverse abdominus) and back muscles.

What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction (PFD) is caused by when the pelvic floor muscles fail to contract adequately, resulting in urine incontinence, pelvic organ prolapse, fecal incontinence, lower back pain, and sexual dysfunction. Women experiencing lumbopelvic discomfort (that originates in both the low back and the pelvis) have a significant prevalence of pelvic floor muscle dysfunction.

• Bladder or Bowel Incontinence

Leakage of urine on exertion. The most common reason is due to a lack of support around the bottom of the bladder and the top of the urethra. It affects approximately one in three women.

• Pelvic Organ Prolapse

The descent of one or more of the pelvic organs into the vagina. When the pelvic floor muscles and fascia around them become too lax, the pelvic organs descend, resulting in a descent of the bladder, uterus, or rectum.

The risk factors of POP are repetitive increases in intra-abdominal pressure, direct damage to the area, hormonal changes, etc. A lack of support of the pelvic organs - connective tissue and muscles. Approximately 1 in 3 women have a prolapse that descends to the opening of the vagina. Approximately 1 in 9 women will require surgery for prolapse.33% of women who have surgery will require repeat surgery. (Wu et al 2013)

• Sexual Dysfunction

Individuals may experience pain during or after intercourse when muscles are excessively tight.

Causes Of Pelvic Floor Dysfunction

• Pregnancy/childbirth
• Age
• Hormonal changes
• Obesity
• Lower UTI
• Pelvic surgery ****

What happens to the pelvic floor during pregnancy and birth?

Pregnancy is a time of life where multiple risk factors for pelvic floor dysfunction occur. Pregnancy-related risk factors are increased weight, injuries during vaginal birth, and effects of pregnancy hormones like relaxin and estrogen.

Lots of evidence has shown that pelvic floor muscle exercises should be done throughout pregnancy. There is no one size that fits all with regards to pelvic floor exercise programs. Pregnant women who experience symptoms of urinary leakage or prolapse should seek help from a Physiotherapist. A pre-emptive pelvic floor assessment from a Women’s Health Physio could decrease a woman’s risk of developing issues.

Pelvic Floor Considerations for the Pregnant Women

• Pelvic Floor Muscle Training

It is recommended as a first-line treatment in the literature (Dumoulin & Hay-Smith 2014), but not recommended to be prescribed without individual assessment (Thomson & O’Sullivan 2003). Pelvic floor exercises are beneficial to women at all stages.

How to do it?

Exercise 1: Slow exercise

Position: This can be done in standing, lying, and sitting positions.

• Sit in a comfortable position with knees slightly apart.
• Imagine the muscles one would contract to hold on to pee. Tighten the pelvic floor muscles surrounding your front passage, vagina, and back passage as firmly as possible. Hold for three to five seconds and slowly relax. Do three sets per day in different positions.
• Remember that the squeezing must be firm and that you should feel a definite 'let go. Avoid holding the breath or tensing the hip muscles.

Exercise 2: Fast exercise

• Squeeze and lift the pelvic floor muscles as firmly and quickly as you can. Simply squeeze and let go of the contraction rather than trying to hold it.
• After each squeeze, take a few seconds to relax.
• Rep 10–20 times, or until the pelvic floor muscles become fatigued.
• Do this exercise three times a day.

Other Activities

• When walking, climbing stairs, or doing other activities, contract the pelvic floor to 50% of its maximal strength. This will enhance endurance.
• Before coughing, sneezing, getting up from a chair, lifting, and so on, tighten the pelvic floor firmly and rapidly. This will aid in the prevention of leaking.
• Before exiting the toilet, tighten the pelvic floor squeeze out' the remaining few drips after peeing.
• Tighten the pelvic floor after defecating to 'push back' any poo matter remaining in the anal canal into the intestine.
• Tighten the pelvic floor during sexual activity to aid in sexual intercourse.

References:

• Rogers, R.G., 2013. Sexual function in women with pelvic floor disorders. Canadian Urological Association Journal, 7 (9-10 Suppl 4), p.S199.
• ASHTON‐MILLER, J.A. and DeLANCEY, J.O., 2007. Functional anatomy of the female pelvic floor. Annals of the New York Academy of Sciences, 1101 (1), pp.266-296.
• Jundt, K., Peschers, U. and Kentenich, H., 2015. The investigation and treatment of female pelvic floor dysfunction. Deutsches Ärzteblatt International, 112 (33-34), p.564.