maternity
Note that many women will
experience incontinence in the
first few days after birth. However
if this is continuing longer than a
couple of weeks, it is recommended
you consult your OBGYN or GP
and ask to be referred to a pelvic
floor physiotherapist. A pelvic floor
physiotherapist can advise how to
safely perform or modify activities that
may impact pelvic floor healing.
You may need to avoid the
following to prevent further weakening
of the pelvic floor:
• lifting heavy objects or exercise
that involves this
• constipation or straining
• excessive weight gain
• certain abdominal exercises
3. If your patients have issues such
as incontinence, at what stage
would they require intervention?
What is the first line of therapy?
Patients should seek treatment as
soon as symptoms arise and the
first line of therapy is physiotherapy
with a pelvic floor physiotherapist.
There is strong evidence that pelvic
floor strengthening is effective in the
treatment and management of urinary
incontinence and prolapse.
It’s important to understand the
initial severity as a baseline for future
comparison so an evaluation will
be performed. Many women find it
embarrassing to talk about and may
not seek help until the symptoms
start affecting their daily activities.
In some countries every woman
who gives birth gets a full post-natal
pelvic floor and abdominal check-up/
rehabilitation program. This helps to
identify those at risk of developing
pelvic floor issues before they happen.
4. At what point is surgery
recommended?
Surgery becomes a point of
discussion when therapeutic
exercises fail to address the
incontinence and it progressively
worsens. Surgery is definitely
considered a last option. Women
usually opt for surgery if the
symptoms are severe or if they have
other associated conditions related
to pelvic floor weakness, such as
uterine prolapse.
5. Are all of the above commonly
discussed with your patients or
only when a problem arises?
We usually delve into the details
when symptoms start to arise. Not
all women will suffer from urinary
incontinence in their pregnancy, but
weakness will occur for all women
during pregnancy. We recommend
all women to do pelvic floor exercise
in pregnancy and work closely with
midwives and physiotherapists.
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Bio feedback sessions
One method of getting help with the
pelvic floor, which is not dissimilar
to physio, is with manual or electro-
stimulation and bio feedback with a
vaginal probe. Muscle activity can
be monitored and directed under the
guidance of a midwife. The aim is to
relieve leaking or prolapse as well as
generally rehabilitate the pelvic floor and
abdominal muscles. This work is best
done five to six weeks postpartum and
before returning to normal exercise.
With 10 sessions post-partum, the
ability to gain control over your pelvic floor
muscle function is restored. In the case of
C-Section, five sessions would suffice.
With thanks to Dr Lucy Lord, Dr
Christina Hui and Hazel
Walpole at Central Health
and Dr Zara Chan of
OT&P
Winter 2019
27