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The Pelvic Floor and Birth

How birth affects the pelvic floor and what to do to strengthen your pelvic floor before and after childbirth

Does childbearing weaken the pelvic floor?
Over half of pregnant women report symptoms of urinary incontinence and most studies have found that women who have had children are more likely to suffer from urinary incontinence than women who have never had children (Rortveit, Grodstin). A US study has found that the risk of moderate to severe pelvic floor disorders increases with the number of babies a woman has had. Problems are experienced by 12.8% of women who have never given birth, 18.4% of women who have had one child, 24.6% of women who have had two children, and 32.4% of women who have had three or more children (Nygaard & others).

For many women the symptoms that are experienced in the months after birth do diminish naturally. However, in a large Swedish study, over 1 in 5 women reported symptoms of stress incontinence a year after having a baby (Schytt) and for many they persist for life, worsening with age. A recent Danish study found that urinary incontinence increased significantly during the 12 years following the birth of a woman's first baby to the point where 47% of women in the study group had some level of incontinence (Viktrup 2009). 

Some studies suggest that stress incontinence symptoms that appear after the birth, rather than during the pregnancy, are much more likely to persist, with 25% of these women still incontinent one year later.

Can a caesarean birth reduce pelvic floor damage?
Some research does indicate that women who have had caesarean deliveries have a lower rate of incontinence than women who have had vaginal deliveries (Rortveit, Farrell). Several studies have found that a forceps delivery increase a woman's chance of suffering from incontinence after giving birth.

Does pelvic floor exercising after having a baby make a difference?
Definitely, YES! Research shows that a regular program of pelvic floor exercise does make a difference; it reduces the likelihood of ongoing stress incontinence and increases muscle strength, with results of an eight-week program still sustained a year later :

[A program of] pelvic floor muscle strength training programme can add significantly to physical recovery after childbirth. (Morkved & others).

However pelvic floor exercises need to be performed for life to fully protect the pelvic floor. New mothers need to incorporate exercises into their own routines, rather than relying on supervised postnatal exercising. which research shows is unlikely to be sustained effectively once the health professional support is no longer available (Agur & others)

Is it possible to reduce the likelihood of damage to the pelvic floor by exercising before or during pregnancy?
A strong pelvic floor is an excellent insurance against stress urinary incontinence at any stage of life.
There is evidence that a program of pelvic floor exercise during the first half of pregnancy can substantially reduce incontinence symptoms in later pregnancy and after birth (Sampselle) for women who are pregnant for the first time. And the strength of the pelvic muscle at 20 weeks of pregnancy is an excellent indicator of whether a woman is likely to suffer from incontinence later.
A pelvic floor exercise program during pregnancy can also have a positive effect on the second stage of labour (Salvesen).
 

What are the best exercisers for strengthening the pelvic floor BEFORE pregnancy?
All our pelvic floor exercisers can play a role in strengthening the pelvic floor before and after pregnancy, so it is a question of choosing the type of exerciser that suits you most.
Are you already able to locate your pelvic floor muscle, and now want to build strength? Or do you need help to locate the muscle and know if you are squeezing correctly? Do you want a product you can use while you move around? Or are you able and willing to allocate the time each day to laying still while you exercise your pelvic floor?
Ask yourself these questions, then visit:

 

What are the best products for strengthening the pelvic floor DURING pregnancy?
Manufacturers are cautious about the use of vaginal devices during pregnancy, and generally advise against their use then, primarily to protect themselves against the possibility of claims following adverse events.
If you are currently pregnant, the gentle low-impact pelvic floor exercise component of The Core and the Floor DVD may be an appropriate choice for you (and this DVD will definitely be an essential aid in your postnatal recovery).
Alternatively if you are already fairly fit, you may prefer the all-round exercise program for pregnancy, Great Expectations.. This program includes some pelvic floor work, but is primarily a whole body fitness program for pregnancy.

Whatever your choice, we advise that you check with your health practitioner before beginning any exercise program during pregnancy.

More information on our special page for women who are planning or recovering from a pregnancy, or who are currently pregnant.

What are the best exercisers for strengthening the pelvic floor AFTER having a baby?
It's important to begin exercising the pelvic floor muscles without an aid, as soon as possible after childbirth. The Core and the Floor DVD demonstrates a gentle pelvic floor and abdominal exercises that can be started as soon as a woman feels ready after the birth. More strenuous core strength routines on the DVD are appropriate after the six week postnatal checkup.

For women who would prefer to use an exercise aid, exercisers should generally not be used for eight weeks after having a baby (and we advise that you should consult your health care provider before beginning an exercise program).

Research has shown that vaginal weights, vaginal balls, electrical stimulation and feedback devices can all be useful for pelvic floor strengthening after birth, so it is a question of choosing the type of exerciser that suits you best.
Are you already able to locate your pelvic floor muscle, and now want to build strength? Or do you need help to locate the muscle and know if you are squeezing correctly?
Do you want a product you can use while you move around? Or are you able and willing to allocate the time each day to laying still while you exercise your pelvic floor?
Ask yourself these questions, then visit:

 

If you still need specific information about the best exerciser for your needs, you should consult a health professional, such as your gp, a women's health physiotherapist or gynaecologist.

 

RESEARCH
Are you worried that strong pelvic floor muscles might slow down your labour? Research tells us this is not the case:

"..training of the pelvic floor muscles during pregnancy results in improved muscle control and strong flexible muscles and seems to facilitate rather than obstruct labor.."
Salvesen & others

"Exercising at least three times per week [before and during pregnancy] was not associated with third-degree and fourth-degree perineal lacerations, episiotomy, vacuum/forceps delivery, or acute cesarean delivery."
Bo K and others 2009


The material presented in this information sheet is intended as an information source only. The information is provided solely on the basis that readers will be responsible for making their own assessment of the matters presented herein and are advised to verify all relevant representations, statements and information. The information should not be considered complete and should not be used in place of the advice of a health care provider. Pelvic Floor Exercise does not accept liability to any person for the information or advice provided , or for loss or damages incurred as a result of reliance upon the material contained herein.

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