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Pevlic floor

Anatomy

  • The pelvic floor muscles are the sling of muscles between our legs that attach to the pubic bone and coccyx (front to back) and ischial tuberosity (sit bones) side to side
  • Skeletal muscle – can be stretched or tight, weak or strong, strained, torn and have scar tissue
  • In women, there are three sphincters: urethra, vagina & anus.

Function

  • Supports pelvic organs – bladder, uterus, large bowel & rectum
  • Good muscle tone is important to keep urethra & anus closed to prevent incontinence
  • Need to be able to relax pelvic floor muscles voluntarily to allow urination & defecation
  • Is part of the ‘core’ – work with deep muscles of the lower abdomen, lower back for pelvic stability

Dysfunction

  • Urinary and faecal incontinence – 30% to 50% of women will experience during pregnancy and/or immediately after birth
    • Urgency incontinence
    • Frequency incontinence
    • Stress incontinence
  • Pelvic girdle pain and low back pain due to pelvic instability
  • Prolapse due to lack of support of pelvic organs

Changes during Pregnancy

  • The pelvic floor muscles, connective tissue and fascia are softened and made more pliable by the release of relaxin and progesterone
  • The work of the pelvic floor muscles are increased by supporting the growing baby
  • Downward pressure and cause stretch, strain & weakness
  • Relaxin softens the ligaments of the pelvis – all ‘core’ muscles need to work harder to maintain pelvic stability including pelvic floor
  • Change in posture can influence function of pelvic floor muscles

Changes during Childbirth

Vaginal Delivery

  • In preparation for childbirth, there is an increase in flexibility and elasticity of the pelvic floor to allow for birth
  • Perineal and pelvic floor stretching and/or tear or episiotomy
  • Can sustain nerve damage due to compression of nerves

C-Section

  • Labour before a C-section can increase pelvic floor dysfunction
  • Longer recover for abdominal muscles – greater work for pelvic floor

Risks

  • Number of births (vaginal > C-section)
  • Size of baby (gestational diabetes)
  • Multiple birth
  • Instrumented deliveries
  • BMI
  • Size of tear / episiotomy – scarring
  • Greater age during pregnancy
  • Caring for and lifting other children

What to do

  • Skeletal muscle takes 6 weeks to heal
  • Referral to Women’s Health Physio
  • Pregnancy and post-pregnancy specific compression garments may be of assistance
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