Post-Natal Pelvic Floor Muscle Retraining

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Each birth experience is different.

Jenni Davies from Jenni Davies and Beaches Pelvic Physio details her post-birth pelvic floor rehab programme below.  This programme is designed to suit the majority of women, however, a few of you will birth your baby with no pelvic floor trauma at all and find that you can progress quickly through the stages. Alternatively, a few of you will experience more significant pelvic floor trauma possibly due to a perineal tear or episiotomy, or due to the use of forceps/ventouse to assist the healthy delivery of your baby and will progress slowly. The majority of you will fall somewhere between the two. It doesn’t matter how quickly you progress, work through it at your own pace.

Remember that the perineum is made up of skin, tendon and muscle. If you have a tear, episiotomy or are just bruised and swollen, treat this in a similar fashion to a sports injury as explained below. The following programme will take you through the stages needed to regain good, basic function of your pelvic floor muscles.

Stage 1

Ice it – get some surgical gloves (thin, vinyl ones from the chemist) and fill 2 or 3 with water. Tie a knot in the top of the glove and place them in your freezer. (Whilst in hospital, they should provide you with ice as needed). Every 2 hours, break off a finger of ice, wrap it in a square of gauze and pop it lengthwise along your perineum. You will be wearing a pad anyway for your post-natal bleed so this will collect the melting water. Once it has melted, change your pad and gently dry the area.

Rest it – completely rest your pelvic floor muscles for 24-48 hours (as you would do a sports injury). Don’t try to do any pelvic floor muscle contractions in this time.

Elevate it – Lay down flat at least 2-3 times during the first few days. If you can tolerate it, lay on your stomach as this completely off-loads the pelvic floor muscles. This position will also help your uterus to shrink down. If your breasts are too uncomfortable, lay over a pillow that stops just below your breasts. Alternatively, you can lay on your side or back. N.B. sitting does not rest your pelvic floor muscles as they are still under load from gravity and your internal organs.

Stage 2

Work it – reconnect to your pelvic floor muscles.

  1. Try to gently squeeze and lift them then relax. Don’t try to hold them at this point and keep it basically pain-free. Do this a few times during the day. A good time is when you’re feeding your baby.
  2. As each day goes by, you’ll find you can squeeze and lift them with more strength until you will be able to squeeze and lift with maximal force and no pain. You’re ready for Stage 3.

Stage 3

Build endurance – At this point, you are ready to start holding the contraction for longer.

  1. Squeeze and lift your pelvic floor as strongly as you can keeping everything else relaxed (thighs, stomach, buttocks). Continue to breathe. It sounds obvious but you’d be amazed how easy it is to forget!
  2. Gradually increase the length of time you can hold this contraction.
  3. Your aim is to hold it for 10 seconds and repeat this 10 times in one go.
  4. It’s ok if you can only hold it for 2 seconds initially and it fatigues after 3 repetitions. This is your starting point. Build up gradually from here as you get stronger.
  5. Do these endurance holds once or twice per day.

Regain your speed – Speed is essential when you get those urges to sneeze or cough and you want to protect your perineum.

  1. Squeeze and lift your pelvic floor as strongly and as quickly as you can.
  2. Then relax it as quickly as you can.
  3. Repeat this quick contract/relax sequence up to 20 times.
  4. Rest assured, your coordination and speed will improve with practice.
  5. Do this x3/day.

Protect – Before you lift your baby, or the pushchair, or cough, or sneeze, or get up out of the chair, get used to contracting your pelvic floor first. This teaches it to contract pre-emptively as it would have naturally done before giving birth.

Stage 4

Functional exercise

Sub-maximal holds – when you are out walking, or doing your other post-natal exercises such as abdominal bracing, get used to feeling your pelvic floor work at about 30% of maximal strength. This is a hard number to discover without help, but if you’re working less than 50% you’re about right. Maintain the sub-max contraction for as long as possible. It will naturally fade as it fatigues. Give it a rest then try again. With time and practice, you’ll find you can hold it longer and longer. Make sure you relax it fully at the end.

Get help at any point if you are:

  1. Experiencing urinary or faecal leakage, pain, heaviness, vaginal bulging or feeling a lump.
  2. Finding it difficult to connect with your pelvic floor muscles
  3. Unsure if you are doing it right
  4. Not progressing as you’d expect

Post-Natal Screening

This assessment is designed to check your spinal and pelvic alignment and mobility, abdominal muscles, core stability function, pelvic floor (coordination, strength and endurance), whether or not you have a pelvic organ prolapse and whether you are fit to return to exercise and sport. It is 45 minutes and can be done anytime after your 6-week check. If there are any issues, I will tailor a treatment programme specifically for you to enable you to achieve your goals.

If you have any questions about your pelvic floor, come chat to Jenni Davies on the 1st Friday of every month at the end of the Buggy Bootcamp session.

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