To Kegel or not to Kegel?

woman who needs to pee
You’ve likely noticed some changes in your body since becoming pregnant, and you can expect many more throughout your pregnancy, birth and postpartum journey. One change you may have experienced is going to the bathroom to empty your bladder (pee) more often than usual. This is due to shifting hormones and pressure on your bladder from your growing baby and uterus. It might surprise you to learn that you could also find yourself with a leaky bladder during pregnancy or after you’ve had your baby. 

We realize this is a topic that could make you a bit uncomfortable and one you probably aren’t happy about. We bring it up because we want you to know that urinary leaking (incontinence) and the urge to go RIGHT NOW are common but you don’t just have to live with it!

Keep reading to learn more about your pelvic floor and how you can prevent or treat bladder problems caused by pelvic floor dysfunction.

What exactly is the pelvic floor?

Your pelvic floor (video) is made up of muscles that line the bottom of your pelvis like a trampoline; stretching from the tailbone at the back to the pubic bone at the front, and from one side of the pelvis to the other. These muscles hold the uterus, bladder and bowel up in the pelvis where they’re supposed to be; control the release of urine, feces (poop) and gas; and are important for sexual function in women. They also work with the abdominal and back muscles to stabilize and support the spine.  Although bladder troubles are the most common pelvic floor problem, weak or tight pelvic floor muscles can also affect bowel and sexual function, and contribute to pelvic and back pain. 

Read more about the signs of a pelvic floor problem at Pelvic Floor First.      

Why does pregnancy affect the pelvic floor? 

Your body releases a hormone called relaxin during pregnancy. Relaxin lets your pelvic floor and other tissues stretch so you can grow with your baby and give birth when the time comes. Coupled with a growing baby sitting, pushing and bouncing on the stretchy pelvic floor ‘trampoline’, your pelvic floor can weaken. Having a large baby (greater than 4 kilograms or 9 pounds), third- or fourth-degree vaginal tear, forceps or vacuum-assisted birth or long pushing stage increases the possibility of injury to the pelvic floor muscles. Also, the more babies you have, the higher your chance of having pelvic floor muscle weakness. 

Sometimes pelvic floor muscles can be too tight instead. This can be for a number of reasons, but tears caused during birth is one of them. As tears heal they create scar tissue and the scar tissue may cause tightness. In some cases, people may have tightness in some areas of the pelvic floor and weakness in others at the same time. A healthcare professional with training in pelvic floor health will be able to tell if tightness, weakness or both are causing the problem.    

Other things can contribute to pelvic floor problems. For more information, see:

What can you do?

This is where we really need your attention!  There ARE things you can to do to reduce your chance of pelvic floor problems. Whenever possible, PREVENT, PREVENT, PREVENT! This means taking care of your bowel health, being active and doing pelvic floor exercises (you may know them as Kegel exercises) before a problem starts. Yes, you heard it right, Kegel exercises ARE important during and after pregnancy!
women going for a walk with strollers

After birth, remember not to overdo it. Find time for rest (settle in for some snuggle time with your wee one) and keep physical activity to low-impact walking and pelvic floor exercises at least until you see your healthcare provider six weeks postpartum. Running or other high impact activities too soon after birth can weaken pelvic floor muscles further.
Pro pregnancy tip: As you get further along in your pregnancy it may be difficult to feel your pelvic floor muscles working during pelvic floor exercises. Try lying on your side or move to the hands-and-knees position. This will take the weight of the baby off your pelvic floor, so you can feel it contract and relax. 
Pro postpartum tip: Engage your pelvic floor muscles by squeezing up while you cough, sneeze or lift your baby. This helps protect your weakened muscles.
For the full scoop about pelvic floor, bladder and bowel health during and after pregnancy, check out the Pregnancy Guide (PDF) by the Continence Foundation of Australia.


When should you get professional help?

Learning to do pelvic floor exercises properly isn’t always as easy as it sounds. They are unlikely to help (or help as much as they could) if they aren’t done properly, and they can even make a problem worse if tight pelvic floor muscles are the problem instead of weak ones.

It may be helpful to see a physiotherapist with special training in pelvic floor health during pregnancy and again at six to eight weeks postpartum. The therapist will assess your pelvic floor muscles, identify any concerns and provide treatment recommendations if needed (including how to do pelvic floor exercises properly).
health professional

If you have any symptoms of pelvic floor dysfunction, then you should talk to your healthcare provider or see a pelvic health physiotherapist. Pelvic floor physiotherapy is considered first-line therapy (before surgery or other medical intervention) for bladder incontinence and pelvic pain.  
Pro tip: Be prepared that an assessment by a pelvic floor physiotherapist involves an internal pelvic exam. This may seem awkward at first (and for some people it may be a deal breaker), but it’s a necessary part of the assessment process.  
We understand that it can be hard to talk to a healthcare provider about bladder, bowel and/or sexual problems. But silently accepting pelvic floor dysfunction can have a negative effect on your physical health, self-esteem and intimacy. We encourage you to do what you can to prevent pelvic floor problems and speak up about problems if they do occur.

A special thank you to Meredith Fairbairn, MSc (PT), BSc Hon (Kin) for her expert content review of this month’s e-newsletter. Meredith is a Registered Physiotherapist with additional training in Pelvic Health (levels 1 and 2), Spinal Manual Therapy and the Pelvic Floor, Pelvic Girdle Pain, and Pregnancy and the Pelvic Floor.

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