Pelvic Floor Myths, Legends & Post-Natal Hints

The pelvic floor muscles and the surrounding organs of the bladder, uterus and bowel are usually not uppermost in people’s minds in your teenage years but, once pregnancy looms, bladders get sat upon by an ever growing baby and sudden dashes to the loo become commonplace, then what’s going on ‘down there’ becomes more arresting.

So, as I work as a Women’s Health and Continence physiotherapist both in the NHS and private sector, I thought I would share some useful tips that I’ve learnt professionally over the years.

Myths and Legends

Bladders

The bladder is a large muscle which should be allowed to stretch and, in women, is capable of holding up to 600mls. It needs to work efficiently by emptying no more than 6-8 times in 24hours including night time. During the day, an average ‘wee’ should be half a bladder’s worth i.e 300 – 450 mls . So, despite our Mums telling us to go to the loo every time we left the house, otherwise it would damage our kidneys by holding on too long, we shouldn’t go unless we feel we really need to and then we’re training the bladder to increase its capacity.

The difficulty in holding on can be when there is bladder leakage on sudden movement such as coughing, laughing, sneezing, lifting (known as stress incontinence) or leaking by not getting to the loo in time (urge incontinence) and this may be due to weak pelvic floor muscles. That’s often why women start increasing the number of times a day they are going as they mistakenly think it will decrease their leakage.

Bladder frequency can also occur when there is an infection so, if you ever have any pain or discomfort when passing urine get it checked out by your GP or practice nurse who will do a simple urine test.

Fluid Intake Guidelines

1.5 to 2 litres of fluid needs to go through your body every day, but it can be any fluid (except alcohol!) so you can include milk on cereal or a bowl of soup. The best way to know if you’re drinking enough is to check the colour of your urine. It should be straw colour, no darker, otherwise, the kidneys are having to work harder to produce more concentrated urine which, over long periods of time, is thought to be one of the causes of the production of kidney stones.

Constipation Myths

Not true that constipation is simply not going every day! Normal bowel function is anything from up to 3 times a day to once every 3 days depending on the amount of fibre in your diet. But, if you strain when passing a motion and it’s looking solid or like rabbit droppings, then you probably are constipated and need to address the symptoms as constipation is one of the major causes of weak pelvic floor muscles.

Hints and Tips

Eat 3 Pears a Day for Constipation

It’s not widely known that pears are the best fruit for controlling the bowel due to their high fibre content. Tinned pears don’t count unfortunately as you need to eat the skin but eating 3 pears within 24 hours i.e one with each meal works wonders and is healthier than taking laxatives, although sometimes both are necessary for the short term particularly if you’ve been taking iron supplements during pregnancy!

Always Sit on a Loo – Don’t ‘Hover’

Try and always sit on a toilet rather than hover – a difficult concept I know when using public loos. Lean forwards with your elbows on your knees as this encourages the bladder neck and pelvic floor muscles to relax. When opening your bowels for the first time postnatally it’s useful to hold a sanitary towel in half and gently press upwards over the pelvic floor, particularly if you’ve got stitches, to support and give you the confidence to open your bowels without straining.

Always check that you can get your knees higher than your hips when opening your bowels. This position tilts the pelvis backwards which is a more natural position. If necessary use your toddler’s stool to put your feet on.

Pelvic Floor Muscle Exercises – How and Why?

Why?

By the way, men don’t realize they have a pelvic floor – just tell them they have because, if they didn’t, all their insides would fall out!

These amazing muscles form a sling which supports all the pelvic organs i. e the bladder, vagina and uterus and the bowel and are 3 layers thick. They are core muscles and, as well as supporting the pelvic organs, they control the bladder and bowel and also help with sexual satisfaction.

The way to visualize the pelvic floor is to imagine a structure that stretches from the pubic bone at the front of the pelvis to the tip of the coccyx (base of the spine) at the back and sideways from one side of the inner thigh to the other. These muscles are 3 dimensional and are several centimetres thick so it’s important when doing pelvic floor exercises to pull up vaginally as high as you can before starting to count.

How?

Statistically fewer than 50% of people do pelvic floor exercises correctly if given only verbal or written instructions. Either lay back in a warm bath or on your bed with your knees bent up and gently introduce 1 or 2 fingers into the vagina just up to the second knuckle and feel that squeeze and lift around your finger. Think of the pelvic floor muscles around the vagina as a clock face where 12 o’clock is up at the bladder and 6 o’clock is level with the bowel.

What is Normal?

Pelvic floor muscles can take up to 3 months postnatally to recover to normal strength. By that we mean that there is no bladder or bowel leakage on any activity, no sudden dashing to the loo and the pelvic floor muscles can contract maximally for 10 seconds repeated 10 times (these are the slow twitch muscle exercises) and can do 10 – 20 fast contractions in standing. When you have reached this level then continue doing them once a day for life to keep them toned. The adage ‘use it or lose it’ applies here just the same.

Diane Wootton
Clinical Physiotherapy Specialist in Pelvic Floor Dysfunction and Pelvic Pain