The pelvic floor during and after pregnancy  

The pelvic floor is a group of muscles that hangs like a hammock in the lowest part of your belly between your pubic bone and your sacrum. It not only supports the organs in the belly but can regulate urinating and defecating. The pelvic floor muscles are also very important during sex.

The strain on the pelvic floor increases rapidly during pregnancy because of the growing baby and uterus. Also, because of the hormone relaxine, the muscles in the pelvic floor relax. 

Because of the growing uterus the bladder can contain less urine than normal. There is no room for the bladder to expand properly. Because of that, you will urinate more frequent with smaller amounts. There's also the possibility u can get involuntary loss of urine.

Problems with defecating also occur more regularly during pregnancy. Because of higher elasticity the intestines work slower. This can lead to constipation. Important advice is eating a high fiber diet, drinking enough fluids (2 liters a day) and excersising regularly. Do not rush your visit to the bathroom. When you feel the urge, go immediately. Sit down with a slight convex back and try not to push during defecating.

At the end of the delivery your baby has to pass the pelvic floor and the muscles there are stretched. We will try to prevent tearing of the muscles by letting you pant when the head of the baby is passing. If you do have a tear, the midwife can, most of the time, repair it herself. We can also do that at home.

Tips and advice:

- Be aware of your pelvic floor.
- Always turn sideways first if you want to get up from a lying position.
- Tighten your pelvic floor before you lift someting and hold it close to your body. Keep breathing normally.
- Follow a pregnancy course. They also pay attention to the pelvic floor.   
- After 34 weeks of pregnancy the advice is to lie down every day for 30 minutes to lift the weight of the pelvic floor. 
- This is how you practice your pelvic floor muscles: Tighten your muscles like you try to hold your urine and release slowly. Repeat this a few times. 

If you're having a hard time to feel your pelvic floor muscles or to practice them, please talk to your midwife.

Right after birth the feeling in your pelvic floor is reduced. You will notice this by not feeling properly when you have to urinate or when you release gas unwanted. Shortly after birth this is normal. The muscles are overstretched and nerves can be damaged. Those complaints should decrease quickly. By starting pelvic floor excercise you can diminish the complaints. Women who had an instrumental delivery have a higher risk of having damage to their pelvic floor.

Every woman who just gave birth has benefits from pelvic floor excercise. The advice is to start as soon as possible. The first 7 to 10 days after birth you just need to try to feel your pelvic floor muscles again. Later on you can exercise to strenghten the muscles.  

The first days after birth your pelvis and pelvic floor need rest to recover. Try alternating lying down a lot and walking small distances and sitting. Don't stand too long. Do not excert too much effort. Don't lift anything heavier than your baby and do'nt vaccuum. If you do need to lift someting, first tighten your pelvic floor. Every woman who gave birth should excercise a couple of times daily.
Excercising regularly can prevent problems later in life, like incontinence and/or prolapse. If you know how to do it, it will cost you no time or effort and you will automatically tighten your muscles during lifting or getting up out of bed.

Every woman experiences damage to the pelvic floor muscles after birth. Not everybody has the same complaints. A lot of women have no complaints at all. But research says that 30% of all women who delivered less than a year ago have unwanted loss of urine.

When you visit us 6 weeks after birth, we will ask you if you have good control over urinating and defecating. If you want to we can do an internal examination to check if you don't have a prolapse and if you can tighten your pelvic floor muscles. If you have any complaints please talk to us so we can refer you to a pelvic floor specialist. 

See www.defysiotherapeut.com to find a pelvic floor specialist in your neighborhood.