Pelvic floor exercises are incredibly beneficial for women of all ages. Pregnancy is a time when the pelvic floor can sustain significant damage. Conditions such as incontinence and prolapse are least common in women who have never had a baby, moderately common in women who have carried a baby and delivered by Caesarean section and are most common in those women who have had a vaginal delivery.
Ideally women should start a pelvic floor exercise programme with a dedicated pelvic floor physiotherapist as early in pregnancy as possible. These programmes are often started at 12 weeks gestation. In these programmes women are taught which parts of the pelvic floor to activate and how to activate them correctly. Pelvic floors which have been prepared in an incorrect manner may lead to more significant trauma at the time of delivery and in some circumstances may actually prevent a normal vaginal delivery.
In my practice I recommend that women should have at LEAST one or two physiotherapy sessions prior to delivery and at LEAST one or two sessions after delivery. This recommendation is altered depending on specific circumstance. Women are taught which parts of the pelvic floor to activate either through a finger examination of the vagina whilst exercises are being performed, or with the use of an ultrasound machine where a probe is placed next to the labia.
Women who have had adequate preparation of the pelvic floor are more likely to achieve a vaginal delivery with minimal tearing and less need for an episiotomy. Some women will sustain major tears to the perineum and even the anal as gestational diabetes, large birth weight and instrumental delivery (forceps or vacuum). After delivery, whether a repair of the perineum is required or not, some women may experience pelvic floor weakness which may manifest itself in the form of incontinence or even prolapse. The first form of treatment in this situation would be to have intensive physiotherapy. This form of treatment can fix around 95% of problems.
Women who continue to have problems may need further treatment such as the use of vaginal ring pessaries for prolapse or surgery to control urinary incontinence. Definitive surgery for prolapse or incontinence is preferably left until women have completed their families. I recommend pelvic floor physiotherapy to all women after delivery whether they have had a vaginal delivery or a Caesarean section. This will include women who have had twin pregnancies delivered by Caesarean section as these pelvic floors are particularly weak.
I refer to specialist pelvic floor physiotherapists including Melissa Harris and Sally O’Brien. These physiotherapists will not only treat pelvic floor issues, but will also look after other musculoskeletal problems in pregnancy such as posture, pelvic and hip pains, sacroiliac joint dysfunction, pubic symphysis joint dysfunction and back care.