Evidence  

https://www1.racgp.org.au/ajgp/2022/march/exercise-after-pregnancy 

Philippa Inge, Jessica J Orchard, Rosie Purdue, John W Orchard   

In the postnatal period, women can benefit from individualised assessment and guided pelvic floor rehabilitation for prevention and management of urinary incontinence and pelvic organ prolapse and improved sexual function.  

Consequently, educating women in the postnatal period about optimal health choices, including correct pelvic floor muscle training as part of safe return-to-exercise guidance, is a priority for primary care 

Pelvic floor education for new mothers: timing the message for best effect 

Nicole Tweddle 

Postnatal physiotherapy classes are an effective tool in educating new mothers’ about the pelvic floor muscles during both the acute inpatient stay and at greater than 6 weeks postpartum. 

Education 

The pelvic floor is the base or the floor of the pelvis and is made up of layers of muscle and other tissues. These layers stretch like a hammock from the pubic bone to the tail bone and from side to side. 

Pelvic floor muscles: 

• support the bladder, uterus (womb) and bowel 
• help control your bladder and bowel 
• work with your abdominal (tummy) and back muscles to support your spine and keep it steady as you lift, move or carry weight 
• assist with pregnancy and giving birth, and 
• help with sexual function. 

Why is it important to exercise your pelvic floor? 

When you are pregnant, pregnancy hormones are released throughout your body. The hormones soften your body’s tissues and muscles, allowing them to stretch as your baby grows. The softening effect of the pregnancy hormones and the increasing weight of your baby places pressure on your pelvic floor muscles. This can make it harder for the muscles to hold your pelvic floor organs in their correct position and squeeze to control your bladder. So, exercising your pelvic floor muscles is important to retain their strength. 

Pelvic floor problems after birth 

There are factors that can increase the risk of pelvic floor problems developing after birth. These include: 

• use of forceps or a vacuum device to assist with the birth 
• big tears with stitches around the vagina 
• a baby with a birth weight over 4kg 
• long pushing stage of labour. 

If you have experienced any of these, you need to give your pelvic floor recovery extra attention. 

• Start with gentle pelvic floor muscle squeezes while lying down, first holding for three seconds, resting for 15 seconds, and repeating three times. Build up to longer holds when you are able to. 
• Rest and lie down at every opportunity to allow your pelvic floor muscles to recover. 
• Ice your perineum area (between the anus and the vulva, the opening to the vagina)) for the first few days after the birth to reduce swelling and pain. 

Pelvic Floor Muscles 

The muscles in your pelvic floor have been stretched after the birth of your baby, so it is an important part of your recovery to help them return to normal. 

If you have had stitches, you may feel reluctant to start exercising your pelvic floor muscles. Whether you have had stitches or not, you should be able to start your exercises between one and two days after the birth.  

It takes a minimum of eight weeks before your abdominal muscles are toned enough to support your lower back and pelvis. This means that if you return to running, sport or high-impact exercise too soon, there is a lot more movement in your lower back than there should be.  

Steady progression of postnatal abdominal bracing and pelvic floor exercises are important to improve the strength and tone in these muscles. This will then give support to your lower back and pelvis while you exercise. Protect your pelvic floor first as you rebuild your deep and lower abdominal muscles with safe postnatal exercise choices. 

Pelvic floor exercises  

• Sit with an upright posture. As you become better you can progress to standing.
• “Squeeze and lift” – close your front and back passages and gently draw them up inside you. Imagine that you are trying to stop urine midstream or trying to hold in wind.
• Try to hold this contraction for approximately five seconds whilst you breathe normally.
• Relax and feel your muscles let go.
• Rest for 10 seconds.
• Repeat this exercise 5-10 times (one set).  

Aim for two or three sets per day. Do your pelvic floor exercises any time of the day and during the time your baby is in the neonatal ward, you can do them while waiting for a lift, while making a drink in the parent’s kitchen and even when you are having Kangaroo cuddles with your baby.  

You can do the exercises sitting, standing or lying down. 

A pelvic floor physiotherapist can help with this and ensure you are engaging these muscles correctly.  

Empowerment  

It takes time for the pelvic floor muscles to return to normal after childbirth. For some women this is within 3-6 months, for others it can be longer.  

Early treatment with pelvic floor exercises may help prevent long-term problems. 

If you have pain, find it difficult to feel your pelvic floor muscles, have problems with bladder or bowel control, or feel a bulging sensation in your vagina, speak to the nurses on the maternity ward if you are still admitted or during your follow up appointments with your healthcare team.  

If there is a problem with bladder or bowel control, it is important to be properly assessed as weak pelvic floor muscles are just one of the many causes of incontinence. 

In many cases incontinence can be prevented, better managed and even cured. 

Support 

You can search for a list of women's, men's and pelvic health physiotherapists on the Australian Physiotherapy Association website and on the Continence Foundation Australia’s service directory.  

You can also contact the National Continence Helpline on 1800 33 00 66. The National Continence Helpline is staffed by Nurse Continence Specialists who offer free and confidential information, advice and support.  They also provide a wide range of continence-related resources and referrals to local services. 

Useful Links  

Special thanks to The Continence Foundation of Australia for content sharing and providing support for families.   

Continence Foundation of Australia 

www.continence.org.au 

The national peak body for continence awareness, management, education, research and advocacy. Free information and resources are provided to individuals, carers and professionals.  

National Continence Helpline 

1800 33 00 66 

Pelvic Floor First 

www.pelvicfloorfirst.org.au 

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists 

https://ranzcog.edu.au/wp-content/uploads/Pelvic-Floor-Exercises.pdf 

Need support? NurtureConnect allows you to connect with our NurtureProgram support team, or call our 24 hour NurtureLine 1300 622 243 or join our Facebook community.

NurtureConnect