You don’t have to wet your pants after having a baby… with Tori from Peninsula Women’s Physio
When I was younger I remember my mother and her friends often laughing too hard or jumping on a trampoline and wetting their pants. They took this reality light-heartedly and acted like it was just a given for women who have had babies. Their generation may not have had the access to the education and professionals that we are so lucky to have today so I don’t blame them. The pelvic floor is an often forgotten part of the female body until you start having issues, issues that can debilitate you and inhibit women from living the full life they want and deserve. So we asked our Saint Tori Everard the down low on the pelvic floor and where we can begin if we have neglected our old girl thus far…
Saint Majella: I’m pregnant! When is the best time to see a pelvic floor physio?
Tori: Great question! It is a great idea to touch base with a women’s health physiotherapist during pregnancy and early postpartum. Every situation is different, but early in the second trimester is an ideal time to book an appointment as this gives us plenty of time to prepare your body and pelvic floor for the best possible birth outcome. Having said that, anytime is also perfectly ok! It is better to come late than not at all. Please reach out if you are unsure.
The main goal of antenatal physiotherapy is to prevent urinary leakage and prolapse both
during pregnancy and postpartum. If we can identify issues during pregnancy, they are much less likely to be an issue for you postpartum. Research has shown that leaking in pregnancy is a strong risk factor for incontinence post birth. So, if you can implement strategies to prevent it, or get it sorted during pregnancy, your chances of leaking after birth are much lower. If you are planning a caesarean section, it is still important to get an assessment as the 9 months of pregnancy has a significant effect on your pelvic floor as well. A women’s health physio can also help prepare your body for birth and help you implement strategies to prevent abdominal separation from sticking around after delivery. We can also address lots of other things such as pelvic girdle pain.
SM: Prolapse? How common is prolapse and what can we do to avoid prolapse following birth?
T: People who have prolapse often report symptoms of vaginal heaviness, bulging, like something is out of place (tampon), difficulty emptying bowel or bladder or low back pain. These symptoms of prolapse arise due to the descent of your pelvic organs down towards your vaginal opening. It is a highly irritating and frustrating condition for many women. Prolapse is more common than you might think. Prolapse affects 1 in 2 women who have ever had a baby, however only 1 in 5 will have symptoms early on. This means there are a group of women who have risk factors and are likely to develop a prolapse as the years go on. If we can identify these women early postpartum through screening (hopefully one day a Medicare funded 6 weeks check with the physio for ALL birthing mums!!) We can potentially prevent prolapse and fix any deficiencies which may increase your personal risk for developing one. Some general tips for early postpartum are:
Prioritise horizontal rest to allow for recoil of your stretched tissues.
Avoid lifting anything heavier than your baby until your 6-week check with the physio. This especially applies to repetitive heavy lifting (such as carrying a capsule on one arm instead of hooking it up to the pram)
Start some gentle pelvic floor exercises early postpartum are recommended. My general rule is you should be able to hold your squeeze for as many seconds as your babies age in weeks (eg – 3 weeks old, 3-sec hold)
The best way to reduce risk of prolapse is:
Do pelvic floor exercises. If you are not sure if you are doing them correctly, come and see me! You need to do them correctly for them to be of any benefit.
Maintain a healthy weight.
Avoid straining on the toilet.
Control any allergies or chronic cough.
See a Women’s Health Physio to make sure your lift technique is correct if you wish to do repetitive lifting.
Although prolapse and other pelvic floor disorders are starting to be spoken about more freely in recent times, it is still a condition that many women suffer with in silence. Prolapse is not a condition that will shorten your life expectancy, but it is a condition which affects every facet of your life. Prevention is the best option we have for prolapse currently.
“Prioritise horizontal rest to allow for recoil of your stretched tissues.”
SM: Exercise postpartum? When is a suitable time to get back into exercise following birth? Can you overdo it?
T: This is such a great question and one I get asked a LOT! Unfortunately, there is no set time for this, everyone’s situation is different. The first few weeks I recommend nothing but rest and very gentle pelvic floor squeezes. Usually around the 6 week mark your tissues have healed to the point where you can start something. At the 6-week check, I always get my patients to do some screening exercises (like crunches, leg raises, bridges etc) to check that their pelvic floor is working well enough to start low-impact exercise (think Pilates, yoga, walking etc).
It isn’t until after the 3-month mark that your tissue healing has got to a point where you might be able to attempt more vigorous exercise. This also applies to caesarean mums. There are so many factors that may make it safer to wait longer than 3 months to return to exercise. Some of these are your level of sleep, breastfeeding, weight gain or loss, pelvic floor function and the closing of the birthing hiatus (gap in the pelvic floor). What is probably more common is a return to running or high impact at 4-6 months if you had a straightforward uncomplicated delivery. If you had forceps or other interventions your time frames may be a bit longer and that is ok. No one ever looks back on this time and says I wish I did more during early postpartum, unfortunately, the opposite is often said.
We have guidelines on the safe return to running and high im-pact exercise after birth. If you are unsure about any aspect of your recovery, reach out to your local women’s health physio!
“No one ever looks back on this time and says I wish I did more during early postpartum, unfortunately, the opposite is often said.”
SM: What does a standard PF appointment look like?
T: A pelvic floor physio appointment is different and individualised for everyone. It really depends on your needs and wishes as to what we include. If you see us during pregnancy, we commonly address the following:
Discussion about birth wishes and previous births.
Screening for bladder, bowel, pelvic floor dysfunction and pelvic girdle pain, and addressing these as required.
A physical assessment including your abdominals and pelvic floor (via a vaginal examination or ultrasound, whichever you feel more comfortable with).
Assessment of pushing technique if vaginal birth desired
Preparing the body and pelvic floor for birth
Lot of education around planning for postpartum
Seeing us after birth will be similar but we usually also address the following:
Birth debriefs (a fav part of the job but also very important to recognise and identify trauma early.
Individualised rehab program to maximise recovery from birth and work towards your personal goals. For some it is running or 100kgs dead lifts, others may wish to be strong enough for mum-life (which is strong!)
We can take measurements to determine risk of prolapse the in the future.
Treatment of abdominal separation
Identifying and treating any deficiencies in the pelvic floor or the core post birth.
A vaginal examination is the gold standard for assessment of the pelvic floor. It gives us valuable information about your pelvic floor so we can tailor a treatment plan for you. If you don’t feel comfortable with this there are plenty of other ways we can assess you. When looking for a womens health physio, it is important to find one with postgraduate qualifications in assessment and management of the pelvic floor. A musculoskeletal physio will not have the skill set to do this.
SM: How can we break the myth of urinary incontinence following birth being normal?
T: It. Is. Not. Normal. Common yes, but not normal !!
If you are leaking urine, it is a clear indication that there is a deficiency somewhere in your continence system. There could be several reasons why you leak following birth and that is why an individual assessment is important. We need to educate and empower women to learn more about their own anatomy. We have some excellent treatments available to help cure or significantly reduce urinary incontinence post-birth and we need to continue to spread the word that there are options if you find this to be a problem for you. You do not have to suffer with incontinence. The script is so often the same – thought it was just me, I had no idea, I wasn’t prepared, I wish I focused more on postpartum than the birth, too embarrassed, thought it was normal… when in fact it can often be an easy fix. 75% of women will report complete cue of their incontinence following a physiotherapy program. So, it is worth a go!
If you think you need some specific or individual guidance about anything related to your pelvic floor, pregnancy or birth, please reach out to Tori at Peninsula Womens Physio. You can find Saint Tori on the Motherhood Rolodex and on socials @peninsulawomensphysio.
