What is perinatal pelvic health?
Your pelvic floor muscles sit at the base of your pelvis. They help to keep your bladder, uterus, vagina and bowel (pelvic organs) in the right place.
Perinatal is the time from when you become pregnant up to a year after giving birth.
The London Maternity Clinical Network has created a series of videos about the changes the body undergoes before, during, and after birth >. From pelvic floor health and bladder care, to posture and returning to exercise, these videos have been developed by physiotherapists and healthcare professionals, and will provide useful advice about supporting your body’s journey through pregnancy and beyond.
Antenatal (the time when you are pregnant) pelvic health
Pelvic floor strength during pregnancy
As your baby grows, the weight of the pregnancy can put pressure on your pelvic floor, and after vaginal birth or caesarean section, the pelvic floor muscles can be weaker.
Many people who are pregnant or who have had their baby can have complications with their pelvic floor, or pelvic pain. For example, we know that leaking urine can have a big impact on how people feel in their daily lives.
Leanne, Midwife, answers questions about pelvic floor strength during pregnancy.
By finding and squeezing your pelvic floor muscles >, it can stop you leaking wee when you are pregnant, or after having a baby. You can also strengthen the pelvic floor muscles > by repeating this.
Exercise during pregnancy
Doing some mild to moderate exercise will help to keep you fit and strong throughout your pregnancy. If you are already attending fitness classes, it is important to check if the instructor is qualified to teach pregnancy exercises.
The above video includes some exercises you can do during your pregnancy.
The "Fit for Pregnancy" (Chartered Society of Physiotherapy) > booklet provides exercises and advice to help women cope with the physical demands of pregnancy.
Pregnancy related pelvic pain
Sometimes people develop pain in their pelvis during pregnancy. This is called pelvic girdle pain (PGP) >, or sometimes symphysis pubis dysfunction (SPD).
It is a collection of uncomfortable symptoms caused by a stiffness of your pelvic joints, lower back, buttocks, hips and thighs.
The above video explains what to do if you are experiencing back or pelvic pain during pregnancy.
Improving your posture and positioning during pregnancy >, and following the birth, can reduce pelvic pain and improve your comfort.
Maintaining a healthy diet and lifestyle will improve your bowel habits as constipation in pregnancy > can weaken your pelvic floor.
Sometimes it can be difficult to tell if the pain you are experiencing is PGP or something else. Pain that is not associated with PGP means that you need to urgently call Maternity Triage >.
When to call Maternity Triage
You should contact Maternity Triage if:
- your baby's movements have changed. If you think your baby's movements have slowed down or stopped, contact Maternity Triage immediately. Do not put off calling until the next day to see what happens.
- you think your waters have broken or labour has started.
- you are bleeding from your vagina.
- you have abdominal pain.
- you are having labour pains (contractions).
- you are feeling unwell and have a severe headache, swelling or have problems with your vision.
- you have any other maternity related concerns.
Pelvic health during birth
Pelvic health during birth
During vaginal birth, the area between your vagina and anus (perineum) will stretch to allow for your baby to be born. This is when tears can occur to your perineum. Most tears are not severe, and there are steps you can take to reduce your risk of a tear >.
During any vaginal birth your midwife or doctor will support you to deliver your baby slowly, to allow your perineum to stretch > and reduce the risk of severe tears.
Severe tears can have long-term effects such as leaking wee and poo, and sometimes a doctor or midwife may need to make a cut to the perineum during childbirth. This is called an episiotomy >. An episiotomy makes the opening of the vagina a bit wider, allowing the baby to be born more easily during normal birth and forceps delivery.
Perineal massage can reduce your risk of common tears, severe tears, and episiotomy.
The above video shows when, and how to do perineal massage.
Postnatal (the time immediately after birth) pelvic health
After vaginal birth or caesarean section, your pelvic floor muscles may be weaker, and it can take some time for your body to feel like normal. Pelvic floor exercises can help you regain your pelvic floor strength back after birth, and it is advised to continue these exercises throughout your postnatal period.
Katie Mann, Specialist Pelvic Health Physiotherapist, explains typical issues related to the pelvic floor, and the exercises you can do to reduce the symptoms.
Bladder problems after birth
Some women have difficulty having a wee, or may leak urine after giving birth.
If you are having difficulty having a wee > six hours after birth, or after your catheter has been removed, call Maternity Triage.
Some pelvic symptoms after birth such as leaking urine or feel pelvic pressure may seem common, but it are never normal, and the first line of treatment is to do pelvic floor exercises >.
Bowel control and constipation
If you are struggling to pass poo, then you may have constipation which can be common after having a baby. Some people have less control of their bowels, wind or leak poo after having a baby. This is known as bladder and bowel incontinence >. Speak to your midwife or doctor if this is happening.
The above video talks about constipation during and after pregnancy.
Caring for your perineum after birth
You may have some pain and swelling around your vagina after birth >, and you might find it helpful to take regular pain medication. If the pain is increasing, or you notice puss-like discharge or new bleeding, or you begin to feel unwell then call Maternity Triage.
The above video talk about pain management and wound care after birth.
After childbirth, you may have had stitches to repair a perineal tear, or an episiotomy. It is rare for the stitches to come undone but occasionally, an infection or pressure on the stitches from bleeding underneath can cause the stitches to breakdown, leaving an open or gaping wound. This is called perineal wound dehiscence, or breakdown >.
Exercise after birth
Following pregnancy and birth you may wish to return to exercise >.
Your stomach muscles may be stretched and weak for some time. If there is a visible bulge, or you have a gap between your muscles >, this is called diastasis recti and you must avoid sit ups or lifting heavy objects.
Your exercise regime can be gradually resumed as soon as it is medically safe to do so. It is safe to start with gentle pilates from four weeks >, as long as you have no concerns regarding any postnatal bleeding, perineal or abdominal wound breakdown, or pelvic floor dysfunction (bladder or bowel incontinence or signs of prolapse).
Pelvic girdle pain (PGP) may still be present following birth. Improving your posture and positioning during pregnancy and following the birth > may help with the symptoms.
Pelvic health wellbeing support
Some birthing people with severe tears or injury from childbirth > can find it difficult with to complete everyday tasks. Please speak to your midwife or doctor if you feel you need some extra support.
The Bladder and Bowel Community > support millions of people in the UK who are living with conditions that affect their bladder or bowel.
Exercise and advice after the loss of a baby
Sadly, not every pregnancy has a happy outcome and some end in the loss of a much wanted baby. At this time, your own physical recovery may be the last thing on your mind, but there are exercises and advice you might want to try following your baby loss >.