With Women’s Health and Pelvic Floor Physiotherapist Anna Scammell
If you follow me on my Instagram @nourish_naturally, you would know that I am pregnant! *YAY* Laurent and I are so happy and excited!
But along with this happiness and excitement, comes a lot of body changes and unknowns. One of these has to do with the pelvic floor. So I decided to seek the help of a Women’s Health and Pelvic Floor Physiotherapist to assist me in this area. I met with Anna Scammell who is a Women’s Health and Pelvic Floor Physiotherapist in Bondi. She was incredible and assisted me with pelvic floor work.
I interviewed Anna on the Pelvic Floor and she has answered all your questions on the pelvic floor below. Keep reading if you want to learn more about the pelvic floor, how to strengthen your pelvic floor, how to tell if you are doing the exercises correctly and much more!
All Your Questions Answered on The Pelvic Floor
Interview with Anna Scammell
Q. What is your pelvic floor and why is it important?
Anna: Your pelvic floor is made up of several different muscles, connective tissue & ligaments that run from your public bone to your tailbone. They form a sling at the base of your pelvis.
They have 5 very important roles:
- Keep us continent (so we don’t leak)
- Support our internal organs (bladder, uterus and bowel)
- Stabilise our pelvis and spine
- Increase sexual arousal and orgasm
- Provide the passage for vaginal birth
Q. How do you know if your pelvic floor is too weak or too strong? Can either cause problems?
Anna: Firstly, you can’t have a pelvic floor that is “too strong”. You can, however, have a pelvic floor muscle that is too tight, but this is different.
A pelvic floor switches on correctly, is of good strength, and then completely releases is what your aim is. A tight PF on the other hand can also be weak, as it can’t contract or relax properly, so this can lead to issues, such as incontinence, painful sex, pelvic pain or incomplete bladder emptying.
The best way to check your pelvic floor strength is to have an assessment with a Women’s Health Physiotherapist. In order to assess the tone of your pelvic floor (whether it is loose or tight) and strength (weak or strong), a Women’s Health Physiotherapist will perform a vaginal examination, which is the most comprehensive way to assess the muscle. This may sound scary, but is performed carefully, and is nothing to fear, I promise! The other option is a real-time ultrasound assessment, which is a non-invasive way to assess the muscle; however it does not give us the level of accuracy that an internal does.
Q. How can you tell if you are fully contracting or relaxing your pelvic floor? I’m not sure if I’m doing the exercises right.
Anna: You need to make your sure your technique is right! Many women do their pelvis floor exercises incorrectly. I’ve created a FREE PELVIC FLOOR GUIDE. This Guide will teach you exactly how to contract and relax your pelvic floor correctly.
The next step is to have an assessment with a Women’s Health Physio, which is ideal to do during the second & third trimester of your pregnancy, and again 6 weeks postpartum.
Q. How can you strengthen your pelvic floor?
Anna: You can strengthen your pelvic floor by doing pelvic floor exercises correctly and regularly! Again, you can see my Free Guide for details!
Q. How often should you do pelvic floor exercises – if you are pregnant? And if you are not pregnant?
Anna: Regardless of whether you are pregnant or not, you follow the same exercise prescription to strengthen your muscles.
Do these 3 types of pelvic floor exercises:
Hold for your endurance (different for everyone): repeat 10 times, 3 x day
Fast pelvic floor lifts (on/off): repeat 10 times, 3 x day
Functional activation: engage your PF before you lift your baby or do a squat for example.
You should do your exercises in a range of positions- lying, sitting and standing. Just make sure your posture is upright and not slumped.
Q. How can you tell if the pelvic floor exercises you are doing are making your pelvic floor stronger?
Anna: If you are doing them correctly then after a couple of weeks the contraction will become easier i.e. you will be able to lift your pelvic floor easier compared when you first started.
Keep in mind that changes to the muscle fibres take about 6-8 weeks, so make sure you stick with the exercises, and don’t give up!
Another way to know your muscles are getting stronger is to see improvements in your symptoms (if you have them), such as bladder leakage.
Q. What can I do with pelvic floor in preparation for pregnancy?
Anna: The sooner you learn how to correctly contract and relax your pelvic floor the better! So you can have an assessment with a Women’s Health Physio even before you are pregnant. I strongly recommend you do this if you have any issues, such as leakage, painful intercourse, difficulty inserting a tampon, or are not confident with your pelvic floor technique.
Q. What problems can happen during and after pregnancy with your pelvic floor?
Anna: Unfortunately a multitude of issues can happen, which is why prevention is key!
- 1 in 3 women will have bladder leakage with cough, sneeze, run or jump, or when they need to use the loo.
- 1 in 2 women will have a prolapse – when an organ (bladder, uterus or bowel) descends downwards into the vaginal canal due to pelvic floor weakness. This can give you an uncomfortable sensation of vaginal heaviness or lump/bulge.
- Painful sex due to overactive (tight) pelvic floor or scar tissue.
- Difficulty with bowel control.
Q. What can I do during pregnancy to avoid pelvic floor issues after birth?
- Learn how to correctly contract and relax your pelvic floor from a Women’s Health Physio.
- Commit to regularly doing your pelvic strengthening exercises.
- Exercise safely during your pregnancy without putting your pelvic floor under more strain. You can learn more about this here.
- Ensure you’re not straining to use your bowels when going to the toilet.
- Perform diaphragmatic breathing to relax your pelvic floor and prepare for birth. Learn more here.
- Do a wholistic birthing course. I recommend Shebirths.
- Use the epi-no to prepare to your perineum for childbirth and help prevent an episiotomy or tearing
Q. What pelvic floor exercises should I do after birth? Especially if I can’t control my bladder.
Anna: You should start pelvic floor exercises DAY 1 after giving birth! This is important to reconnect to your PF, facilitate healing and rehabilitate your muscles. Start with 4-5 gentle PF contractions per day, and slowly build this up with time. Over the next few weeks, you can build back to your exercise program in pregnancy. You can use my Early Postpartum Exercise E-book to optimise your recovery.
Difficulty controlling your bladder can be common in the first few days to weeks after birth. This can be due to pelvic floor weakness, nerve injury or reduced bladder sensation. My advice is to:
- Do your pelvic floor exercises as instructed above
- Go to the loo every 2-3 hours
- Listen to your bladder and go when (and if) you get a full feeling in your lower abdomen
- If you feel urgent (busting) try to remain calm, do a pelvic floor contraction and make your way to the loo in a controlled manner (running will only make it worse)
- Make sure you empty your bladder completely each time you go
- Drink 2-3L of water
Q. Can endometriosis cause your pelvic floor to be too strong and how to relax it?
Anna: Endometriosis can contribute to your pelvic floor being too tight, but not “too strong”. For women with endometriosis, it’s beneficial to learn to relax their pelvic floor through diaphragmatic (belly) breathing, gentle internal release, abdominal massage, body scanning for pelvic floor tension throughout the day, managing their stress levels, bringing relaxation and downtime into their life such as yoga and meditation.
I highly recommend you see an experienced Women’s Health Physio to assist in the management of Endometriosis. I also offer online consults, which are very useful if you do not have access to a Women’s Health Physio.
This Blog was written in collaboration with Anna Scammell. Anna is a Masters-trained Women’s Health & Pelvic Floor Physiotherapist in Sydney, and Founder of www.thewholemother.com. Anna offers home visits, clinic consults in North Bondi, and online consults. She combines her 10+ years of clinical experience and evidence based knowledge to bring women consults, E-books and Free Resources. Anna’s mission is to educate, empower & inspire as many women as possible to be the best version of themself during their childbearing years and beyond.
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