Vaginas, wees, poos and sex: What a pelvic floor therapist tells her pregnant clients.

It’s usually during pregnancy that women first become aware of their pelvic floor muscles.  The pelvic floor muscles play an important role in maintaining our continence, our sexual function and to support the pelvic organs (essentially so we don’t pee ourselves, can have pleasurable sex and our insides don’t fall out).

As a pelvic floor physio, most women see me after childbirth when their pelvic floor is causing them trouble.  Unfortunately, there is still a lot of mystery surrounding this immensely important part of the body.  I have had women in tears as they never knew the effects pregnancy and childbirth could have on their pelvic health.

Luckily, pelvic floor physios treat conditions such as urinary and faecal incontinence, pelvic organ prolapse, sexual and pelvic pain and more.  Although it’s always embarrassing speaking about vaginas, wees, poos and sex, seeing a professional early can help you gain control of your pelvic floor now and for the future.

Here are some tips to start you on your pelvic floor journey during pregnancy:

1. Strengthen your Pelvic Floor Muscles – through the increasing popularity of Pilates and Yoga, women are becoming more aware of doing their pelvic floor exercises or ‘Kegels’.  Unlike other muscle groups such as your biceps, you cannot see the pelvic floor muscles contracting. This makes it harder for people to know if they are doing their Kegels properly. so even though you trying to do a contraction of your pelvic floor, you may not be doing it effectively. Here are some tips to make sure you are doing it right.

• Take a deep breath in to relax your pelvic floor

• Exhale to squeeze and draw up your pelvic floor muscles, most women best achieve this by drawing up through the anus as though stopping wind escaping (usually a familiar sensation for women during pregnancy, thanks to the added progesterone).

• Relax the pelvic floor as you breath in and repeat

Listen: Is birth really scary? (Post continues below).

2. BUT… It’s not all about the Kegels – The relaxation component of the pelvic floor exercise is just as important as the contraction.  In fact, some women have a "tight" pelvic floor.  For these women doing lots of repetitions of pelvic floor contractions may be inappropriate, or even worsen symptoms such as painful intercourse and urinary retention.  Other ways you can prepare your pelvic floor is by performing perineal massage in the final month of pregnancy, this can reduce your risk of sustaining a tear between the vagina and rectum during child birth.  Always speak to a pelvic floor physio or midwife before commencing these to see if it’s appropriate for you.

3. Leakage of urine is common but not normal- urinary incontinence is often seen as a right of passage when becoming a mum. One in two women will have stress incontinence -  that’s leakage during a cough, sneeze, laugh, lift, either while pregnant or postnatally and one in three women continue to experience some leakage of urine.  Most women tend to wait-and-see if the leakage will disappear post-partum, it often flies under the radar for the first few months as you learn to juggle a newborn.  Begin practicing "The Knack", which is a pelvic floor contraction prior to coughing, sneezing and laughing.  This engages the muscles at a time where there is extra pressure on the bladder.  Use the time during pregnancy to learn how to recruit your pelvic floor, so you have better reserve for after the childbirth.

4. The pelvic floor is more than just muscles - The pelvic floor is made up of both muscles and connective tissue named fascia. This connective tissue is majorly important for holding up the pelvic organs such as the bladder, uterus and rectum.  Pelvic organ prolapse is a stretch or tear through the fascia that supports these organs, and can occur due to the added weight during pregnancy or from the childbirth itself.  Post birth, around one in three women experience some degree of prolapse, meaning their bladder, uterus and/or rectum sag lower in the pelvis, towards the vagina.  Symptoms often include feelings of heaviness or dragging through the pelvis or vagina and trouble will fully emptying the bladder and bowels.

Although the diagnosis of prolapse can be devastating for many women, it doesn’t need to be.  Prolapse can be really well managed, especially in the first one to two years post birth, and working with a pelvic floor physio can help you get back to exercise and activities you like. You can try to prevent a prolapse from worsening in late pregnancy and early post birth by steering clear of high impact exercises like running and skipping and maintaining a healthy diet to avoid constipation. Training your pelvic floor muscles to be stronger and more functional can give support to the prolapse from underneath, we can also use support devises called pessaries that can be used vaginally to support the organs.

A post shared by Michelle Bridges (@mishbridges) on Aug 30, 2016 at 6:25pm PDT

5. Abdominal Separation– 80-100 per cent of women will experience separation of the abdominal muscles during pregnancy, this is considered a normal change to allow space for your growing baby. Abdominal separation is the stretching of the linea alba, the connective tissue which runs down the midline of your tummy, giving that six-pack look so many people strive for.  During pregnancy, the linea alba can become stretched and thin, and create a bulge or doming between your abdominal muscles.  Recovery of abdominal separation can depend on many different factors including: exercise prior to and during pregnancy, genetics, number of pregnancies, weight gained during pregnancy and multiple birth.  Many women will get natural thickening of the linea alba and closure of the muscles within the first 12 weeks following birth.

The jury is still out on how to best prevent and treat abdominal separation, and you may stumble across many online programs promising to help you close the gap in your abdominals.  Everybody is individual, and women most benefit from a tailored exercise program and abdominal rehabilitation.   We spend time and money rehabilitating other parts of the body after surgery and trauma, and the abdominals are no different following pregnancy.

I often recommend women to use some form of compression post-natally (such as the SRC compression shorts) to aid with recovery and give sensation over their tummy – which hopefully reminds them to use it.

6. Know your risks and when to get checked - Unfortunately many women do not know which factors put them at higher risk of developing pelvic floor dysfunctions postnatally. The focus is on the beautiful new baby and breastfeeding, and some of the needs of the woman are not always initially addressed.

Risks of pelvic floor dysfunction such as urinary incontinence, pelvic organ prolapse or pelvic pain include: multiple vaginal deliveries, forceps delivery, big bub over 4kgs, long pushing phase of labour, episiotomy or perineal tear and family history.  While many of these factors are out of our control, we can prepare our bodies for the biggest event they will ever go through.

Get chatting to your mum and grandma about their pelvic floor and birth experience.  Every women should book in to see a pelvic floor physio postnatally, or even better prior to or during pregnancy to learn about her pelvic floor, and how to give it the best care she can.

Rhyannon Spring is a Sydney based physio with a special interest in women’s health, pelvic floor and Pilates.  Rhyannon is available to consults in the Lower North Shore at Waverton Physio and Ryde Road Physio.