Pelvic floor muscle training, when done in a structured way, helps to prevent certain complications during pregnancy and labour. These changes occur due to hormonal and anatomical changes. The complications that usually occur are incontinence, perineal tears, pelvic organ prolapse, less active pushing required during second stage of labour.

Why is pelvic muscle training important?

Pelvic Floor Muscles

The pelvic floor is a set of muscles attached to the spine at the back and to the pubic bone at the front.  Importantly, these muscles are the key supporter for the uterus, bladder and bowel. Some activities of daily living help women maintain their pelvic floor strength to functional level. Unfortunately, pregnancy and childbirth lead to the potential injury and weakening of these muscles. As a result, pelvic floor dysfunction is common after childbirth. This includes urinary incontinence, pelvic organ prolapses, dyspareunia and perineal tears. Significantly, this reduces the quality of life in women and cause them to withdraw from fitness.

Structured pelvic floor training help to prevent or reduce these complications. First, it helps to elevate pelvic organs and the resting position of bladder to improve incontinence and prolapse.  Also, training during the antenatal phase reduces the active pushing required during the second stage of labour. Additionally, it improves incontinence by improving co-contraction of the pelvic floor muscles as the abdominal pressure increases. Overall, correct pelvic floor muscle contraction is the key factor to achieving the benefits of pelvic floor muscle training.

What happens to the pelvic floor during pregnancy and childbirth?

First, pregnancy usually leads to the decrease in levator ani strength (one of the major pelvic floor muscles) and anatomical changes occur such as downward movement of the bladder neck, increase in bladder neck mobility, downward movement of pelvic organs, and decrease in urethral resistance due to increased pressure from the growing uterus. As the gestational age increases, so too does the weight of the uterus leading to the pelvic floor being oppressed. As a result, there can be damage to the muscles and nerves.

Secondly, during pregnancy a large amount of progesterone is secreted to maintain pregnancy. Notably, progesterone is a smooth muscle relaxant. The pelvic floor has high amounts of smooth muscle, meaning progesterone may decrease pelvic floor support and urethra tension.  In conclusion, the mechanical and hormonal changes of pregnancy may have an irreversible effect on the pelvic floor. They need to be addressed at the right time through pelvic floor muscle training which is achieved through pelvic health physiotherapy.

Also, during labor, when there is vaginal surgical delivery (episiotomy), a large fetal head or a long second stage of labour, it will lead to damage in the pelvic floor muscles if they are too tight or the perineal area has less flexibility. Vaginal surgical delivery, large fetal head circumference and a prolonged expulsive stage are risk factors for a labour-associated pelvic floor injury.

Effect of pelvic floor muscle training during pregnancy and after childbirth

1. Firstly, training during pregnancy helps to prevent developing urinary incontinence and can significantly improve the strength of pelvic floor muscles.
2.  Secondly, exercises with a perineometer in the post-partum period are helpful in restoring the function and tone of the muscles. Importantly, this aids in preventing early cystocele and rectocele by limiting the movement downwards and improving the vaginal muscles for the retention of contraceptive diaphragm. The “Perineometer,” is an instrument that provides a visual guide to the patient during her exercises.
   

   Perineometer for pelvic muscle training

3. Next, training improves the neuromuscular activity of the pelvic floor in many motor tasks after a partial denervation of nerves in after the first pregnancy.
4.  Furthermore, training helps to treat nonspecific low back pain and pelvic girdle pain during pregnancy as pelvic floor muscles provide stability to the spine.
5. Additionally, training helps to shorten the second stage of labour and reduce perineal tears by improving the flexibility, strength and motor control. Overall, this may reduce the need of assisted delivery through forceps and episiotomy.
6. Lastly, female sexual dysfunction after delivery can be treated by pelvic floor muscle training as it increases the flexibility of the pelvic floor to help the vagina feel looser and relax.

Considering all the positive effects of pelvic floor muscle training during and after pregnancy, it is highly recommended to see a trained pelvic floor physiotherapist. They will guide and train the pregnant women at the right time to prevent or treat any of the pelvic floor disorders.

If you are experiencing pelvic pain or are interested in pelvic floor muscle training, PhysioNow has experienced pelvic health physiotherapists that would love to assist you. Book with PhysioNow today for your first assessment and treatment!