Maeve Whelan is a specialist Chartered Physiotherapist trained in Physiotherapy in Obstetrics and Gynaecology. She treats pelvic dysfunction of any origin resulting in various symptoms like bladder and bowel control problems, overactive pelvic floor disorders and pelvic pain. These amazing top tips will help you to keep your pelvic area healthy during pregnancy, take heed of this incredible advice. You and your pelvis will thank us.
Contrary to popular belief, there are many safe and helpful exercises to do when pregnant. Pilates, Yoga, swimming and walking will look after many of the body’s needs but before you get going, you need to mind your pelvis, think of the weight your baby will put on your pelvic area.
Get to know the 4 S’s: Symmetry, Stability, Strength and releaSe
Symmetry
- The introduction of pregnancy hormones in the first trimester means that there is more movement through the joints of the pelvis and a greater possibility of an asymmetry of the pelvis setting in. Alignment of the pelvis should be optimal with the pelvic bones level on both sides in relation to one another.
Tips Look in the mirror and see if you can spot asymmetry in how you are standing. Lie down flat on the floor and place your hands over the front of your pelvis and see if you can feel any of the bony landmarks of the pelvis higher or lower in relation to the other side. If there is an asymmetry you may need the help of a Chartered Physiotherapist or Osteopath to help you address the alignment issues , particularly if a pain pattern has started to present itself through the joints at the front or back of the pelvis
Stability
- Once again, because of the introduction of hormones relaxing the joints and then as a result of the growing weight of the baby, the pelvis will be prone to becoming unstable as the locking function of the joints reduces. It becomes increasingly important to facilitate this locking of the pelvis by working on pelvic and core stability. This is promoted by focusing on the Transversus Abdominis muscle, which forms a corset around the waist, up to the ribs and down to the pubic bone.
Tips
Lying on your back, on your side or on all fours, find your pelvic neutral position, the half way or “neutral position” of your lumbar spine is found by accentuating the hollow in the spine and then flattening it out completely and then returning to the middle between those two extremes. Slowly and gently draw your lower tummy in away from your knicker elastic or the zip of your trousers. Don’t brace or force this action. Breathe and keep holding for up to 10 seconds and repeat up to 10 times. Do this in lying first, then sitting and then standing as you become better at controlling the action.
Always remember to relax. Don’t overdo it by bracing or bulging out the stomach. When you press in with the fingers it should not feel the same as the stomach does when you cough but instead only feels like a drawing away action from the fingers but the abdomen remains relatively soft.
Strength
- Once you have the basics of this core abdominal draw it is possible to work the muscles of the buttocks, inner thighs and spine harder once maintaining this core control and this is how strength develops in a controlled way. Ideally strengthening under the guidance of a Pilates or Yoga instructor in a class setting will yield greatest benefit.
Pelvic Floor Strength
- The pelvic floor muscles comprise a sling of muscle attached from the pubic bone at the front to around the rectum at the back. In pregnancy as the weight of the baby increases it may be that the pressure on the bladder increases and the mother is more prone to experiencing urinary leakage so exercising the muscles during pregnancy is necessary. The growing weight of the baby on the pelvis and pelvic floor later in pregnancy can also give rise to considerable pressure and discomfort and this is another reason to exercise the pelvic floor. Later on after delivery the pelvic floor will have sustained considerable trauma through childbirth so having exercised before childbirth will mean that it is easier to regain strength afterwards.
Tips
Pelvic Floor Exercises
Make sure the pelvic floor and abdomen are completely soft before you start.
Breathe (sigh) all the way out emptying the lungs.
Slowly and gently draw in your back passage upwards and forwards towards your bladder or pubic bone.
Hold this for five seconds and then release it completely backwards towards the coccyx. Repeat this 10 times.
Once you can hold for five seconds you can then start trying to increase to 10 seconds and keep breathing while you hold.
Do 10 fast contractions holding and then releasing completely. Repeat 10 times.
When the core abdominal contraction is correct it can be contracted at the same time as the pelvic floor.
Do your pelvic floor exercises 3 times per day.
Always release completely after each rep. Think of the lift, if you have gone to the 6th floor then always release to the basement afterwards.
ReleaSe
- The pelvic floor also needs to be mobile to ensure that it is as well prepared as it might be for labour and delivery. Recent research has shown that more than 60% of women who have never had a baby show some evidence of pelvic floor symptoms and therefore pelvic floor dysfunction. It is important that we don’t assume that the pelvic floor needs to be strengthened only but that there is also focus on the release as tension disorders give rise to dysfunction.
Always focus. Focusing on the release to the basement part of pelvic floor exercise will help and spending longer on this part of the exercise than on the strengthening can be a good idea if you suspect that your pelvic floor is quite tight or tense. Breathing is a key part of releasing, Holding the abdomen tense all the time leads to over tension and over holding in the pelvic floor.
Tips
To release the pelvic floor lie in your back or on your side and put your hands on your upper tummy. Breathe in through your nose and fill up you upper tummy softly and gently into your hands and at the same time relax or release your pelvic floor muscles backwards in the direction of your coccyx, the direction of the release of the muscle fibres. Stay on this soft in breath for three seconds and then exhale with a soft ‘hah’ sound – the entire release of the pelvic floor should be on the in-breath, it should be effortless with no pushing or forcing outwards.
Always be careful with timing. Perineal massage may be helpful with assisting pelvic floor release in advance of labour and delivery and can be started from 34 weeks. Contact a Chartered Physiotherapist in Women’s Health to help you with these Pelvic Floor Manual Therapy techniques.
Consider keeping a diary of your pelvic floor exercises or using a phone app, such as Squeezy to remember.
