While pregnancy and childbirth can be wonderful experiences for many women, they take a toll on the body, especially on the pelvic floor. Pelvic floor damage is very common in both vaginal and cesarean-section deliveries, and can lead to urinary incontinence, prolapse, and pelvic and lower back pain. These symptoms can be isolating and embarrassing.
The good news is that these dysfunctions are treatable and preventable. Dr. Vicki Hemmett is co-owner of Hemmett Health — a team of chiropractic, massage therapy and athletic training health care professionals. She explains how education, simple exercises and manual treatment techniques can provide pelvic floor rehabilitation.
Kids VT: What is the pelvic floor?
Vicki Hemmett: Anatomically, the pelvic floor includes the muscles, ligaments, tendons and soft tissue that occupy the space between the pubic symphysis (the cartilaginous joint uniting the left and right pubic bones in the front of the pelvis) to the hips and tailbone. It's a wonderfully dynamic structure that supports pelvic, hip and low back function. Proper coordinated movement among the joints of the hips, pelvis and low back, along with the soft tissue structures of the pelvic floor, is crucial for locomotion and stabilization of the pelvic organs, as well as for pregnancy and delivery.
KVT: What kind of pelvic floor exercises can pregnant women do to prepare for birth?
VH: Talk to your provider first, and then begin by making the mind-body connection: Try to stop your flow of urine midstream, so you can identify those muscles. You need to use them to deliver the baby. But, more importantly in pregnant women, are abdominal exercises — the transverse abdominis muscle which lies underneath the rectus abdominis (the six pack) that actually co-contracts in conjunction with the pelvic floor. This muscle is commonly overlooked and is a key component of your core. You don't want to forget how to use these muscles, and in many cases you must learn how to use them for the first time.
KVT: Is this as simple as doing a Kegel exercise?
VH: I'm shying away from the term Kegel because it's not as simple as Squeeze your pelvic floor and you're great. Up to 50 percent of women perform these exercises incorrectly. You really have to challenge all the components of the pelvic floor. For example, the deeper, posterior aspects of the muscular pelvic floor are responsible for a longer endurance-style hold, whereas the superficial region is mostly associated with a flicker or fast-twitch contraction. Being very specific with which muscles you are contracting, and fine-tuning and finessing these contractions, will result in much more efficient and effective control, more confidence and more empowerment over pelvic floor dysfunction.
KVT: Are women who've had C-sections less likely to have pelvic floor issues?
VH: Not necessarily. Women who have had C-sections still have had the weight of the placenta and the baby on the pelvic floor for nine months, so can still unfortunately suffer from the same pregnancy-related pelvic floor dysfunctions. Pelvic floor dysfunction is very common in women who have participated in athletics or have suffered physical or emotional trauma or abuse. Research suggests that almost half of women with low back pain suffer from pelvic floor dysfunction. The bottom line is that you do not need a traumatic natural delivery to cause pelvic floor dysfunction.
KVT: What do you recommend for postpartum women?
VH: I would love every postpartum woman to have a six-week pelvic floor checkup. I assess for any healed scarring from episiotomies or natural tearing that prevents a good pelvic floor contraction. I feel for low tone — not a lot of strength in the pelvic floor — or the opposite end of the spectrum, high tone, or the non-relaxing pelvic floor. If there is weakness, I would identify your ability to perform three different kinds of pelvic floor contractions, and then would coach and guide you with a combination of verbal cues and manual palpation on how to perform a really good one. It's so much easier to proactively educate all women about how to manage and take care of the pelvic floor and support them before they develop symptoms. Otherwise it becomes one of those things that, unfortunately, people accept as normal.
KVT: So you're saying it's not normal for women who have had children to have a bit of urinary incontinence when jumping or sneezing?
VH: It is very common, but not normal. You should be able to control all voiding. It's a medical dysfunction, and it's only going to get worse if you do nothing about it. Most of the time it's a musculoskeletal issue that responds beautifully to rehab, which is all manual — no lights and probes! It's reeducating those muscles, like going to the gym. If I told you to do 100 pushups every day for a month, you would be much stronger. The muscles on the pelvic floor function the same way.
KVT: Why do so few women know about this?
VH: I don't know if it's a modesty thing or a cultural thing that we don't really talk about it. In France, for decades, the government has been paying for 10 to 20 postnatal pelvic floor retraining sessions regardless of if you have a dysfunction — it's just standard protocol after you have a baby. It's the same as if you have plantar fasciitis or neck pain; it's a medical issue. It's just a different part of the body that we are not comfortable talking about. Forty to 60 percent of women suffer from some form of pelvic dysfunction, yet no one wants to talk about it. If you let it go too long, it takes so much more intervention and possibly surgery, but catching it early can prevent it. Culturally, we really need to engage each other and discuss pelvic floor health.