About Marta De Oliveira
What kind of problems occur?
These problems are usually related to the abdominal and pelvic floor muscles. They can present as difficulties in holding urine, stools or wind, pain during intercourse, feeling of increased pressure in the perineum or a gap between the abdominal muscles called diastasis of the rectus abdominis.
These are all problems that can result from pregnancy and childbirth and that can have a significant negative impact on women’s mental and physical health.
What happens to a woman's body during pregnancy?
During pregnancy even before the bump starts showing, the body goes through major changes.
The posture and the way the body moves changes, the weight going through the joints increases and the muscles, ligaments and soft tissues get more flexible and elastic to allow the pelvis to stretch to accommodate the baby.
All of these changes happen due to hormonal changes and they are very important. They need to occur in order for the body to be prepared to create a beautiful human being and to allow the baby to grow in the tummy during roughly the nine months that follow.
Some women feel really well during pregnancy with almost no symptoms. However, approximately 20% of pregnant women suffer from pelvic girdle pain and lower back pain during pregnancy, and approximately 7% of women continue to struggle with pain even after giving birth.
It is also known that 30 to 50% of women will experience urinary incontinence during pregnancy and even though these symptoms seem common, they are not normal and they can be treated and prevented. If they are left untreated they can become worse over time.
Why do some women experience these problems during pregnancy?
Not every woman will experience these symptoms during pregnancy so if you are pregnant or are thinking about becoming pregnant, you don’t need to worry.
We know that there are risk factors which can make women more predisposed to these problems. Women that have a previous history of lower back pain, pelvic girdle pain or pelvic floor dysfunction and have a high workload are more predisposed to struggle with pelvic girdle pain and lower back pain during pregnancy and after giving birth.
As for urinary incontinence, being overweight, the pregnancy itself and childbirth (vaginal delivery or c-section) seem to be the risk factors associated in developing it. The risks of developing pelvic organ prolapse in women are related to increasing age and number of deliveries, a family history of prolapse, pelvic floor muscle weakness, obesity, repetitive heavy lifting, and repetitive constipation and straining.
Seeing a women’s health physiotherapist can help you prevent and treat problems
The hormonal changes responsible for increasing the capacity of the muscles to lengthen and stretch during pregnancy (pelvic floor, abdominal and soft tissues surrounding the pelvis) can also make the joints more hypermobile.
When we then add the extra weight (the baby, amniotic fluid, breasts and so on) and any possible previous pain/dysfunction or weak muscles – we potentially have a perfect recipe for developing pelvic girdle, lower back pain and urinary incontinence and pelvic floor dysfunction.
The muscles that were already tight, weak and affected by previous problems may not be able to cope with having to stabilise a pelvis that is now more hypermobile.
In addition to this the muscles have to hold everything in place while the intra-abdominal pressure (the pressure inside the tummy caused by the baby growing and everyday actions such as coughing, laughing and lifting weights) will keep increasing during the nine months.
What can women do to prevent ISSUES?
Let’s compare pregnancy and postpartum to a marathon or a sports competition of some sort, where the pregnant woman is a competing athlete.
As with any other athlete, we would ideally prepare ourselves before the competition to make sure we were fit and able to give the best performance without sustaining or being affected by injury.
Preparing the muscles of the lower back, abdominal area and pelvic floor before and during pregnancy is essential for prevention and for a good postpartum recovery.
Women’s health Physiotherapy during pregnancy and after childbirth
Seeing a women’s health physiotherapist who specialises in pregnancy and postpartum for the right treatment and guidance to prevent and treat all of these issues is key.
During pregnancy your women’s health physiotherapist will help you by:
- Prescribing safe exercises and advice for you to stay fit and healthy
- Teaching you about posture and strategies that may help you to reduce the risk of strain and discomfort on your lower back and pelvic joints during pregnancy
- Treating and preventing low back pain or pelvic girdle pain
- Teaching you about the pelvic floor muscles and how to do pelvic floor exercises
- Giving you advice on how to rest comfortably as well as on how to overcome some other pregnancy-related minor problems
- Preparing your pelvic floor for labour and teaching you about perineal massage and other strategies
- Giving you advice on posture and active strategies for pain management during labour.
After childbirth you can see a women’s health physiotherapist to have an abdominal and pelvic floor muscle assessment. This can be done from 6 weeks postpartum onwards.
The six-week postpartum check is recommended for the rehabilitation of the pelvic floor muscles and abdominal area postpartum. This is especially important not only for the women who have symptoms but also for the women who want to return to exercise safely.
In this postpartum check your women’s health physiotherapist will be able to help you by:
- Giving you advice on how to recover after childbirth (whether you had a vaginal delivery or a C-section)
- Assessing your posture, breathing, abdominal muscles gap (diastasis rectus abdominis) and pelvic floor muscle function
- Creating an exercise plan to rehabilitate your pelvic floor muscles and your abdominal muscles
- Giving you advice on how to exercise safely in the postpartum
- Treating any symptoms of pelvic floor dysfunction that may have arisen from childbirth
- Teaching you about bladder, bowel and sexual health and improve your pelvic health.
For most women receiving advice alone is not enough. Evidence shows that a big percentage of women fail to perform pelvic floor exercises correctly without being formally trained and without supervision.
The goal of women’s health physiotherapy is to support women as well as possible by helping preparing their bodies for pregnancy, childbirth and postpartum.
Any views expressed in this article are those of the featured consultant(s) and should not be considered to be the views or official policy of The London Clinic
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