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The pelvic floor is important for bladder and bowel control and for increase satisfaction during sex. Weak pelvic floor muscles do not support the pelvic organs correctly, which along with bladder and bowel weakness, can lead to prolapse (dropping of the uterus, bladder or bowel).
The first 24 hours after the birth
• Empty your bladder every couple of hours. The feeling of wanting to pass urine may not return straight away. You must tell your midwife if you are unable to empty your bladder within 6 hours following delivery.
• Do short pelvic floor muscle squeezes at first. It will help any swelling to go down and can help to heal tears and stitches. Lying on your side is a comfortable position to start exercising.
• Keep the perineum clean and dry until healed using only warm water to wash. Do not use any creams, gels or soap in the area as they can cause infection and irritation to new skin. Stitches should dissolve within 10-14 days – discomfort should reduce daily. If not, please ask your midwife or GP to check them at your post-natal appointments.
• Use medication as advised by your midwife or doctor if your perineum (the area between the vagina and back passage) is uncomfortable. This will help to keep you mobile, which in turn helps the healing process.
• Refer to the Perineal care booklet provided on the ward.
• You could also try using an ice-pack – this will help to reduce swelling and discomfort and ease bruising. When you are at home you can use a damp frozen pantyliner or a ready-made gel ice pack in a damp clean flannel and placing it on the perineum (the area between the vagina and anus) for 5 minutes, while you are lying down. Do not sit on it.
Caution: ice can burn so do not leave it in place for longer than 5 minutes.
• If you have difficulty controlling your bladder or bowels after delivery please ask your GP /Midwife to refer you to Women’s Health physiotherapy. You may feel worried about emptying your bowels for the first time.
• Using a wad of toilet paper or maternity pad, support the area just in front of your back passage to support it while you gently bear down with a series of short pushes (rather than straining).
Find and exercise your pelvic floor
The pelvic floor muscle group is like a hammock stretched across the base of the pelvis. There are three openings in the muscle – the anus (back passage), vagina (birth canal) and urethra (bladder outlet).
Sit comfortably or lie on your side
Imagine that you are trying to stop yourself passing urine and ‘wind’, by drawing the area ‘upwards and forwards’ from bowel to bladder, then let go. Start this ‘squeezing and lifting’ movement gently at first. Next ‘squeeze and lift’ and try to hold for a few seconds (breathe normally –don’t hold your breath and ensure your buttocks and thighs are relaxed!). This is a ‘slow hold’.
Rest for a moment and then repeat 4 times if you can.
Now try squeezing the pelvic floor muscles quickly 5 times, with a little rest between each squeeze. This exercise helps your muscles react quickly when you cough or sneeze.
• Try 5 ‘slow hold’ squeezes, followed by 5 ‘quick’ squeezes at least 4 times a day.
• As your muscles get stronger, try holding the ‘slow’ holds for longer
Don’t stop and start your flow of urine – this can interfere with normal bladder function.
• Use the NHS approved ‘Squeezy’ App available on all smart phones/mobile devices to help remind you to complete exercises using the exercise plan described above.
Getting back to normal
• Do your pelvic floor exercises regularly. The hardest part is remembering to do them – a good time could be every time you feed your baby or wash your hands.
• Tighten your pelvic floor when you do any activity that requires effort – e.g. cough, sneeze or lift. The reflex that makes you do this naturally can stop working after having a baby. Regular practice protects your pelvic floor and helps to train it to work automatically again.
• Avoid heavy lifting where possible – e.g. vacuuming, wet washing, car seats.
• Avoid sit ups and high impact exercise for at least 3 months after the birth – it can take the pelvic floor this long or more to return to its previous pre-natal strength.
• Drink at least 1.5 – 2 litres of fluid a day, which is about six to eight drinks. If you are breast-feeding or it is very hot you should maintain good hydration by drinking according to your thirst and ensuring that you have lightly coloured urine.
• Avoid constipation – it puts pressure on the pelvic floor.
• Once your pelvic floor muscles are back to full strength, you will need to do one set of ‘fast’ and ‘slow’ exercises every day to keep them strong. Aim for 10 fast and 10 slow holds for 10 seconds.
For further advice and safe exercises: https://pogp.csp.org.uk/publications/fit-future
Are you at risk of developing pelvic floor problems?
• Did you have urinary leakage in pregnancy?
• Did you struggle with continence – bladder or bowel post-natally?
• Does/ did your mother have continence or prolapse problems?
• Did you have a large baby (over 4kgs) or an instrumental (forceps/ventouse) delivery?
• Did you have a very long or very fast ‘pushing’ (second) stage of labour?
• Do you suffer regularly from constipation?
If you answered ‘yes’ to any of these questions, you may benefit from specialist advice. If you would like further help, ask your GP to refer you to our specialist Women’s Health physiotherapist; or call the physiotherapy department direct on 01908 995432 and request a self-referral form.