Pelvic floor injuries occur in 13-36% of pregnant women who have a vaginal delivery, and is associated with trauma to the pelvic floor and its muscles and ligaments. In some cases, this can lead to issues with urinary incontinence (leakage of urine) anal incontinence (leakage of faces), overactive bladder, painful intercourse, or organ prolapse where the bladder, uterine, or rectum can slip into the vagina. These can occur post-delivery, or some years later. Too often these conditions are left untreated, as women are too embarrassed to discuss this issue of pelvic floor dysfunction, which can have devastating impacts on their quality of life. Often women think that it is a natural part of pregnancy, when treatment is available.
Many studies have linked a traumatic birth, instrumental delivery, prolonged second stage of delivery, and increased birth weight with pelvic floor injuries. Research supports the importance of pelvic floor exercises during pregnancy and early post-partum, with a decreased risk of urinary and faecal incontinence.
Pelvic floor injuries are common and often overlooked, and can be a major risk factor in pelvic organ prolapse. MRI and 3D/4D ultrasound are used to accurately diagnose such trauma, most commonly in the form of a tear of the pelvic floor muscle.
In recent years, requests for caesarean sections without medical indication have increased, as patients believe that it will reduce the impact of vaginal childbirth on the pelvic floor, and reduce the risk of urinary incontinence. However, given the lack of scientific evidence, the current viewpoint is that a caesarean section should not be chosen over a vaginal delivery, in order to prevent pelvic floor dysfunction.
Prevention of Pelvic Floor Injury
Pelvic Floor Exercises
Research supports the importance of pelvic floor exercises during pregnancy and early post-partum, with a decreased risk of pelvic floor injury, and a decreased risk of urinary and faecal incontinence. It is theorised that when the muscles of the pelvic floor are routinely exercised, they are more able to stretch and contract at the time of birth, which may lead to a lower rate of prolonged second-stage labour, and less impact on the pelvic floor. (See exercises below).
Focus should also be on modifying obstetric practices which predispose women to pelvic floor injury. These factors include: the promotion of spontaneous vaginal births without forced or early pushing, avoidance of instrumental assistance, or use of episiotomy. If assistance is needed, vacuum extraction over forceps delivery is recommended.
Warm compresses to the perineum and perineal massage with a lubricant both antepartum and during delivery could also help. These methods have the potential to reduce perineal damage – by increasing vasodilation to the area, which can help with tissue stretching, increasing muscle relaxation and altering pain perception.
Position of Delivery
In contrast to the traditional position of lying on back with legs in stirrups, upright and side lying birthing positions have been found to have many benefits. These include shorter second-stage deliveries, reduction in instrumental deliveries, fewer episiotomies, and reduced muscle tearing.
Treatment of Pelvic Floor Dysfunction
Pelvic floor dysfunction can most definitely be treated. Treatments normally include a combination of physical therapy, lifestyle changes, treatment of underlying medical issues, relaxation techniques, and hormone treatment. For more serious dysfunction such as prolapses, the use of pessaries (non-surgical) and reconstructive surgery is used. So it is important that women of all ages learn how to strengthen their pelvic floor muscles, in preparation for child birth and post menopause, where oestrogen levels drop, and the pelvic floor muscles weaken, leaving women with a greater risk of urinary incontinence and prolapse.
How Can Osteopathy Help Me Strengthen My Pelvic Floor?
During pregnancy we will treat any strains and dysfunction in your spine and pelvis, to ensure that the pelvic bones and muscles are aligned and balanced, providing optimum conditions for positioning, descent, and passage of the baby through the birth canal during delivery. Post-delivery we will treat any strains that may have occurred during labour and align your pelvis and spine. A well aligned pelvis can provide the optimum environment for the pelvic floor muscles to heal. Throughout labour and post-pregnancy we teach strengthening exercises of the pelvic floor and gentle core exercises to strengthen the body during these demanding times.
Pelvic Floor Strengthening Exercises
Lots of women find it extremely difficult to contract their pelvic floor. The exercises in the video below will certainly assist you to better feel the contraction and relaxation of your pelvic floor muscles. You can do these daily, sitting at your desk, standing and washing the dishes, in the car at traffic lights, lying down, or during exercise. Enjoy and please ignore the minor profanities! 🙂
If you have any queries about pelvic floor issues or exercises, feel free to call your local Christchurch Osteopath (Lorraine Herity) and discuss your condition.
Lorraine Herity is the Clinic Director of Better Health Osteopathy in Christchurch, New Zealand. She previously worked in Osteopathic clinics in London and Ireland, before moving to New Zealand. Lorraine trained at the British School of Osteopathy in London, where she gained her Master of Osteopathy (M.Ost). Lorraine is a dedicated and passionate Osteopath. Her main aim is to help her patients regain their health, and to return her patients back to their everyday activities, in as quick a time as possible.