maternity
dragging/feeling of heaviness
vaginally, lower back pain, painful sex.
3. How do you go about designing
a rehab program? What would be
some typical exercises?
I prescribe pelvic floor rehab
programs based on what I find on
assessment- it is individual to each
person. An internal pelvic floor exam
assesses the position of pelvic
organs, as well as the ability of the
different muscles to both contract
and relax. I assess the strength,
endurance, speed and co-ordination
of these muscles and give an
individualised exercise program to
suit the client's ability and goals. I also
assess the joints and muscles around
the pelvis, lower back, hips and the
abdominal wall.
4. Approx how many sessions over
what period of time is sufficient to
see some recovery?
This is quite individual, depending on
the dysfunction and the goal of the
client. It depends on their starting
point, and what they want to achieve
(for example, being continent while
sneezing vs heavy weight lifting).
Many clients will see a benefit from
having one assessment and learning
the correct techniques. Like any other
muscle group in our body though,
it will take weeks of training to see
muscle adaptation.
5. Once therapeutic sessions are
done and symptoms improved, do
patients typically come back for
maintenance work?
If there is a big change, for example
subsequent pregnancy/birth or
an increase/change of activity
such as a return to high impact
activity, then clients tend to benefit
from reassessment.
6. What other issues are related to
pelvic floor weakness?
The pelvic floor forms part of our
core, so any issues with your lower
back, abdominal wall (including
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diastasis recti), and pelvis or thoracic
issues can be related to pelvic floor
problems.
7. Do you see women with
these problems who’ve never
had children?
Yes! Although pregnancy and birth
are the most common, any kind
of activity that increases intra-
abdominal pressure puts stress on
the pelvic floor. This can include
chronic respiratory issues, persistent
vomiting, or high impact exercise.
8. Even if the pelvic floor is ok now,
when might issues crop up...
hormone influences etc?
The effects of ageing and your
estrogen level can affect your pelvic
floor function. You may notice
changes if you're not having a
period, if you're exclusively breast
feeding, or when you're going
through menopause
9. Are most cases resolved
with physio?
There is very strong evidence for
pelvic floor muscle training as a
Physiotherapy intervention. Clinically I
would say that symptoms can always
be improved.
10. What guidelines should women
follow post-partum in terms of
what to do and when?
A great resource for education and
postpartum advice is the pelvic
floor first website, where you can
find a timeline to follow: www.
pelvicfloorfirst.org.au/pages/
returning-to-sport-or-exercise-
after-the-birth.html
For runners, the first clinical
guidelines have recently been
released for return to running
postpartum. This is evidence
based and advises to wait at least
3-6months before returning to
running. It can be accessed for free
here: mailchi.mp/38feb9423b2d/
returning-to-running-postnatal-
guideline
A few considerations outlined by
an OB/GYN, including when to
seek surgical intervention:
1. Any recommendations during
pregnancy to help keep the pelvic
floor in shape and avoid issues
later?
Pelvic floor weakness contributes to
urinary incontinence and even flatual
incontinence. Being pregnant and
having a vaginal delivery may lead to
its weakening.
The best way to prevent or treat
incontinence secondary to the
weakness is by strengthening the
muscles through exercise. Pelvic floor
exercises should be done throughout
and after pregnancy. A physiotherapist
is best equipped to guide you and
it is worth noting that pelvic floor
strengthening (aka Kegels) is not
appropriate for everyone and may in
some cases make symptoms worse,
especially if done incorrectly. Women
who already suffer from pelvic floor
weakness prior to pregnancy may
benefit from seeing a physiotherapist
early on to ensure adequate and
appropriate pelvic floor exercise.
2. What are the guidelines
postpartum in terms of how
best to preserve the integrity
of the pelvic floor - anything to
avoid, anything to specifically do,
timeframes for these activities?
Childbirth is different for every
woman and no delivery is the same.
That said, for most new mums the
best time to start your pelvic floor
exercises is as soon post-partum as
you feel comfortable or your OBGYN
allows. Gentle pelvic floor squeezes
in the first few days after birth can
help the healing process, reducing
swelling and improve circulation, as
well as helping with that all important
continence control.
After delivery, the best thing to
do is start doing the exercises on a
regular basis and throughout your
day alongside another regular activity,
such as eating or going to the toilet,
so that you remember to do it.