Are you among the 1 in 3 women who have problems with their pelvic floor after having children? Rosie Conway of Roseanna Grace Physiotherapy explains why you don’t have to live with it…
75% of women will experience prolapse after a vaginal delivery, while for others simply being pregnant is enough to cause long-term incontinence. Here are the symptoms to look out for and how pelvic floor physio can help...
It’s a common adage among those who have had children, one that many expectant mothers can expect to hear any day now: you give up a lot for your kids. And it starts from the moment you become pregnant.
Sure, it can come in plenty of different forms: maybe it’s morning sickness (or full-day sickness, come to that); maybe it’s a cheeky bit of insomnia; acne and fatigue can become commonplace, while you better get used to bloating, gas, an aching back and needing a wee all the time, too.
Then, of course, your little bundle of joy comes along and, while you wait for your body to recover, you simply cope with the after-effects of pregnancy because, well, you can cope. And you are no longer the most important person in your life.
But when does that interim period end? When should women stop just ‘coping’ and actually get help for their symptoms? Symptoms which, we may add, often last for years after childbirth.
Many of us are guilty of sweeping symptoms under the carpet, pretending they’re not as bad as we think or that they’re simply ‘what happens’ once you’ve had kids. We just have to live with them. Or do we?
MEET ROSEANNA GRACE
As it turns out, no – we don’t. That’s what our new best friend, Roseanna Grace Physiotherapy tells us, anyway. And she should know, she is a pelvic floor physiotherapist, after all.
‘Our pelvic floor muscles are a figure of eight loop around front and back passage,’ explains Rosie. ‘They attach to our coccyx and pubis, both our sit bones, and then layer up internally, so they’re a really big muscle group.
‘Pelvic floor dysfunction is really common in women. One in three women will have incontinence and 50% of women will have prolapse. And those stats increase among those who have children. Around 78% of women – following a vaginal delivery – will have some degree of prolapse, and pregnancy itself is quite a big risk factor for pelvic floor dysfunction.
‘These stats show how common pelvic dysfunction is. But they don’t – and shouldn’t – make these problems “normal”. More than 85% of women can resolve the symptoms simply by pelvic floor physio.’
HOW DOES PREGNANCY AND CHILDBIRTH AFFECT OUR PELVIC FLOOR?
Whenever we’re trying to recognise what might not be normal with our health and wellbeing, it’s always important to remember what is normal. And, in order to do that effectively, as well as listening to our bodies, it helps to have a basic understanding of what they go through when we become pregnant.
‘Pregnancy is such a risk factor because we put extra abdominal weight onto our muscles, so they’re stretching and thinning to support extra weight,’ Rosie explains. ‘Along with new hormonal peaks of relaxin and oxytocin which makes our soft tissue structures (ligaments and tendons) more stretchy to support a growing bump.’
‘That’s exactly the same if someone puts on weight for other reasons. Even with one extra stone, our muscles are stretching and thinning to support extra body fat, rather than our pelvic organs. Constipation, which is a common side-effect of pregnancy (and actually, the menopause too), can also cause pelvic floor dysfunction – if you’re regularly straining and pushing, it will gradually weaken your pelvic floor.’
Ok, that’s the pregnancy side of our pelvic health explained, but what about how childbirth affects our figure of eight muscle group? (We’ll try not to get too graphic here…)
‘If you’ve had a vaginal delivery, the muscles can undergo trauma which can cause weakness, but it’s the actual stretching during pregnancy that can be a big enough risk factor,’ Rosie continues. ‘That’s why it’s also common for women who have had a C-section to experience pelvic dysfunction. ‘Gynaecological surgeries of any kind – such as hysterectomies and pelvic floor repairs – can also affect our muscle structures. Basically, any changes to our muscle structure can mean some muscles become weaker than they should be – which is when pelvic problems usually arise.’
SO, WHAT IS PELVIC FLOOR DYSFUNCTION?
‘Pelvic health is anything affecting areas around the pelvic floor: so, bladder health, bowel health, sexual health, and pregnancy factors, both pre-and post-natal, all come into play,’ explains Rosie.
‘Everything is so closely interlinked. Someone might come into our clinic with pelvic organ prolapse symptoms, but when I’m asking questions about their bladder function, bowel function and intercourse, it may be that the same patient with bladder prolapse also has urge incontinence and vaginal atrophy, which is dryness of the area. They all affect each other. Similarly, if someone’s constipated and straining on the toilet, that might be the cause of prolapse or is simply an aggravating factor. It’s a massively interlinked area, which means we can help a number of different symptoms in one go.
‘Prolapse is one of the most common issues women experience postpartum,’ Rosie continues. ‘Prolapse just means something is where it shouldn’t be. When we’re talking about “pelvic organ prolapse”, it’s where there’s weakness or movement of the anterior wall (the bladder), the posterior wall (the bowel), or the cervix being a bit low in the vaginal canal (cervical descent). So, if any of these structures are a bit weaker, the vagina has its own space occupied by something else that shouldn’t be there.
‘Incontinence is another one. And that’s an umbrella term. You can have “stress incontinence”, which is what happens when we cough, sneeze, run, laugh, lift, any sudden movements. Then you’ve got “urge incontinence”, which is leakage on route to the toilet, when you can’t get there in time. Or you might have both of those, which we’d call “mixed incontinence”’.
WHAT ARE THE SYMPTOMS?
‘Symptoms of prolapse could be a vaginal heaviness or a dragging sensation,’ says Rosie. ‘Other women don’t feel anything internally but can see or feel a bit of a bulge. Some might find tampons difficult to use. And others may have no symptoms at all. Often these women get told at a routine smear test. But whether someone is symptomatic or asymptomatic, it’s always good to get the problem addressed.
‘Other symptoms of pelvic floor dysfunction can be the need to wee more regularly. If you’re going less than every two hours, for example. Similarly, some women can come in saying that when they need to go, they need to go really quickly and their urgency goes from zero to 100% desperate. These are all elements of the bladder ‘misbehaving’, if you like.
‘If the pelvic floor muscles aren’t very strong, it will affect their ability to hold a filling bladder for long enough. So, while a lot of people don’t link these symptoms with the pelvic floor, retraining and strengthening those muscles can really help.’
DOES IT MATTER HOW LONG WE’VE HAD OUR SYMPTOMS FOR BEFORE GETTING PHYSIO?
‘No, it doesn’t matter how long you’ve had your symptoms for, or why you’ve had them,’ Rosie explains. ‘I always say to my patients: it doesn’t matter when you join the gym, when you start going three or four times a week, you’re going to get good results. It’s just a case of starting.
‘It’s never too late to fix a pelvic floor problem. See a pelvic floor physio, get your muscles checked out and let the physio give you the direction and encouragement you need to reach your goals.’
WHAT HAPPENS AT AN APPOINTMENT AT ROSEANNA GRACE PHYSIOTHERAPY?
‘We offer to assess these muscles in clinic. We’re looking for how strong someone’s pelvic floor is,’ explains Rosie. ‘So, we’ll find out how many seconds they can hold for, how many repetitions they can do, the tone of the muscle – is it too tense? Is it too relaxed? – and assess their coordination, (how well they can contract and relax quickly).
‘We’ll then ask them to bear down to assess any weakness in the muscles, which might be prolapse or any other painful areas. And then we personalise an exercise or management plan to help address those areas.’
Sounds a little… embarrassing!
‘Nothing’s embarrassing!’ Rosie assures us. ‘Never be embarrassed. Pelvic floor physios like myself talk about this all day, every day. We really are here to help you and listen and give you that guidance and support that will improve your quality of life.’
SO, JUST TO CLARIFY – WE DON’T HAVE TO LIVE WITH THESE SYMPTOMS, THEN?
‘Absolutely not!’ says Rosie. ‘We should keep this conversation going, because everyone should know just how common pelvic floor dysfunction really is. One in two of us will have some type of prolapse in our life, and one in three of us will have urinary leakage. Over three quarters of women following vaginal childbirth will experience prolapse. These are all really huge statistics that we don’t have to live with.
‘But if we’re more aware of those problems, then we’ll be more mindful about how we can prevent and resolve them, too. And pelvic floor physio really can help.’
You heard it here first! If you’re pregnant or have children and would like to get your pelvic health assessed by Rosie and her expert team, book an appointment via the Roseanna Grace Physiotherapy website or follow the business on Facebook and Instagram
Roseanna Grace Physiotherapy branches:
15a Clayton Road, Jesmond, Newcastle NE2 4RP
89 Holly Avenue, Jesmond, Newcastle NE2 2QB