New mums often develop pelvic floor disorders, such as urinary incontinence, bowel leakage, or even a pelvic organ prolapse. Pregnancy hormones relax all the soft tissues of the body, meaning the weight of the baby during pregnancy puts stress and strain on the pelvic floor muscles and other surrounding tissues. These tissues normally support the bladder and pelvic organs, but can struggle to do this job so well after a pregnancy. A vaginal delivery can cause further muscle and soft tissue injury, or put downward pressure on the pelvic organs. Therefore, all new mums are recommended to incorporate pelvic floor exercises into their recovery.
But what do you do if pelvic floor exercises are not helping?
In this article, Amanda Savage explains the common pelvic floor problems new mums suffer with, and what to do if you feel pelvic floor exercises are not working to resolve them.
Common Postnatal Pelvic Floor Problems
- Pain in the vaginal and/or anal area
- Painful or dissatisfying sex
- Feeling of bulging, gaping or discomfort below - which could be linked to a pelvic organ prolapse
- Leaks when you cough, sneeze, laugh or run - urinary stress incontinence
- Struggling to get to the toilet on time - urge incontinence
- Needing more than 2 wees in the night - nocturia
- Bowel leakage
Fortunately, a large percentage of women will find that their post-baby symptoms gradually improve with a programme of pelvic floor exercises. These exercises improve the strength, endurance and reaction time of the pelvic floor muscles.
If after 8-12 weeks of regular pelvic floor exercises, with or without Kegel8 assistance, you find that you are still having one or more of these problems, it is time to seek help from your GP and ideally, a specialist Pelvic Floor Physiotherapist. Please don’t delay - if the pelvic floor exercises you have tried are not helping your symptoms, you don't have to struggle alone. The next step is to get a professional assessment of the whole situation. A Physiotherapist can help with the next more advanced stages of muscle training, and provide access to further investigations and treatments.
Why Aren’t Pelvic Floor Exercises Working for Me?
There are several reasons why exercising your pelvic floor muscles by yourself may not be having the outcome you hoped for:
- The muscles could be very weak - If your starting point was very weak, your muscles may need more development to cope with activities such as running and jumping, without leaking
- You are not doing the exercises correctly - You cannot tell if you are exercising the pelvic floor muscles correctly from the outside.
- Your muscles are stuck in a spasm and overworking - This can make them appear weak and is also a common reason for vaginal pain.
- Scar tissue, from your delivery, can be interfering with the muscles - Even though your brain is sending the right signals, the muscles can’t react correctly.
- The bladder or bowel position may be distorted - This can be related to back alignment, pelvic alignment, a weak core, or a caesarean scar.
- There could be other things going on - Like hormone imbalances, haemorrhoids, an infection, a rogue stitch, or something completely new, not even necessarily connected with your delivery, like a fibroid, polyp or cyst.
What Can I Do If DIY Pelvic Floor Exercises Are Not Working for Me?
Although you may be left feeling disappointed and frustrated, you are in a better position after you have finished a full programme of traditional pelvic floor exercises. Your GP will have expected you to try this first, so you need to be confident that you have given them a really good go. Be honest with yourself, and if you need guidance, ask for it.
If the DIY traditional exercise approach is not working, it is time to have a proper assessment of the pelvic floor muscles. You can be referred to a specialist Pelvic Floor Physiotherapist to assess the pelvic floor muscles and surrounding structures that influence the muscles ability to work, as well as influence the function of the bladder or bowel. Some of these problems can be caused by issues other than pelvic floor dysfunction, and should be investigated properly if they are not getting better.
What Is Involved in a Proper Assessment of My Pelvic Floor?
A specialist Pelvic Floor Physiotherapist will internally examine your muscles to understand their condition and function. During this examination you will be shown exactly where your muscles are on the inside, which can be very enlightening. The examination will also discover if common problems are present; such as muscle spasm, scar tissue, or a change in the position of the pelvic organs.
The examination doesn’t take long, and your Physiotherapist will be gentle and informative. Providing advice and personalised tips to help get you onto the next level of your pelvic floor training. With a clear diagnosis, your Physiotherapist will help you plan a swift path to recovery.
How Can a Specialist Pelvic Floor Physiotherapist Help If Doing Exercises Myself Didn’t?
Imagine you have followed a programme you found online, building your running fitness from couch to 5km. You would be really pleased with how much you have achieved alone. But now you want to do your first half marathon. Suddenly you realise that there is quite a lot more to learn about the body, nutrition, and technique for this much more complex goal. You will start to read about experienced runners, you might have some sessions with a personal trainer and you will spend more time taking your running to a more advanced level.
Consider your Physiotherapist as your experienced personal trainer for your pelvic floor. Just like a personal trainer, Physiotherapists also have a lot of other exercises up our sleeves. We can train muscle reaction times, co-ordination with complex movements, improve endurance and work on muscle symmetry and alignment. If the muscles are very weak, we can help you use an electrical muscle stimulator like Kegel8 provide. We can also use biofeedback and other hands-on therapy techniques to wake the muscles up. We will help you correct other musculoskeletal issues; such as pelvic and spine alignment, and symmetry issues. We think holistically and will help you tackle a weak core or diastasis rectus abdominis (DRA) - poor closure of the abdominal muscles after pregnancy. We also give advice on other aspects of bladder and bowel function that could be contributing to your symptoms. Most mums leave Physiotherapy with more than just one problem sorted out!
Physiotherapists also work closely with Gynaecologists, Urologists and local maternity departments, liaising together to help your situation.
How to Organise Further Assessment and Treatment
In many places in the UK you can self-refer to a specialist NHS Physiotherapist. They are usually associated with the maternity unit where you gave birth. If this service isn’t available in your area, your GP will be able to make a referral. There are many private Physiotherapists too, you can find members of the Chartered Society of Physiotherapy (CSP) by following this link.
Look After Yourself, Mama
I believe that if your body is in a good place, you will cope better with the physical and emotional demands of motherhood. If you are concerned about your pelvis, abdominal muscles, bladder or bowels do visit my blog, www.supportedmums.com. You can also watch me and Stephanie talk about the structures of the pelvic floor in our YouTube Series: The Pelvic Floor and Pelvic Floor Exercise Techniques.