#AskTheExpert: Anastasia Uvarova: The Pelvic Floor Part 1 – Before and During Pregnancy

We’re very pleased to have with us today, Anastasia Uvarova, talking about a vitally important but rarely discussed part of your body – the Pelvic Floor, its function and how it can be affected by childbirth.   

Anastasia is a practicing, qualified Physiotherapist and Clinical Pilates Instructor, with a special interest in musculoskeletal (MSK) dysfunctions in pregnancy, pelvic floor dysfunctions and post-partum rehabilitation. She acquired her training from the University of Bradford, UK and later the Pelvic, Obstetric and Gynecological Physiotherapy Association, UK. Working for five years as an MSK Physiotherapist and after having two children of her own, Anastasia has seen firsthand the extended physical struggles women can experience post birth as a result of poor Pelvic Floor function. Anastasia’s passion about this subject has motivated her to raise more awareness of woman’s health and continence issues in Cyprus. Anastasia has written several Physical Health- and Fitness-related articles for the online media in both Russian and English and has presented this topic in a number of public presentations for both professionals and the general public. She believes that a gradual and individual approach to physical well-being in pregnancy and post birth is the key to helping avoid many complications later in life.

With so many changes occurring and issues affecting our Pelvic Floor function during pregnancy, labour, delivery and post-birth, we guess that you will want to hear quite a bit about it! So, we’re going to do three-part #AskTheExpert with Anastasia on this topic, with: Part 1 covering the Pelvic Floor changes that occur during pregnancy and what it’s important to know during this stage of your life; Part 2 discussing the Pelvic Floor Before, During and Immediately After Birth and Part 3 telling you more about your Pelvic Floor Post-Birth and how to maintain healthy function for life.

The Pelvic floor is a group of muscles that sit across the outlet of your pelvis and ‘fill in’ the gap that is created by your pelvic bones. It has deep, superficial layers of muscles and fascia, the biggest of which is the levator ani. These muscles play a crucial role in keeping the pelvic organs in place, as well as helping sustain optimal abdominal pressure together with the deep abdominals and diaphragm (the breathing muscle).  

During pregnancy and childbirth your Pelvic Floor muscles undergo significant strain that can leave them weakened, leading to various degrees and types (both urinary and faecal) of incontinence, as well as misplacement of your pelvic organs such as the womb and bladder!

And yet, we don’t always pay enough attention to these important group of muscles until there’s already a problem (for example, peeing yourself when you sneeze… does that sound familiar to any of you Mums out there?). So, on that note, we’ll begin!

Is there anything I should be aware of with regards to my Pelvic Floor before even trying to get pregnant?

The most important thing to be aware of is the actual existence of your Pelvic Floor. It is not unusual, however, for a healthy woman who doesn’t have any children to not really be that aware of this group of muscles, if all is well. A chat with a close friend who’s already had a baby and is willing to share her experiences with you would be a great start. Later on, when you want to get pregnant, you can try out a variety of antenatal, yoga and pregnancy Pilates classes, during which you’ll usually find out more about your pelvic floor function.

Just a note: If you have an issue with joint hypermobility, you are more likely to have lax ligaments and Pelvic Floor musculature, so it’s especially important to keep your Pelvic Floor toned with regular exercises.

What is the function of my pelvic floor during pregnancy?

The actual function does not change majorly during pregnancy in terms of inner organ support, optimal intra-abdominal pressure and continence maintenance. However, your growing baby will be putting increased stress on your Pelvic Floor muscles, hormones and your posture. While it is almost impossible to control the first two, you are able to sustain a correct posture and lifestyle during your pregnancy that will ‘support’ your Pelvic Floor. Regular exercises, optimal diet to avoid constipation (and the subsequent strain of this on your Pelvic Floor!), modification of work when possible (such as reducing heavy lifting or prolonged sitting without breaks) can all help to reduce any negative effects on your Pelvic Floor muscles.

If you take care of your body and your Pelvic Floor now, during pregnancy, become more aware of the ways your body functions (how, when and to what extent to contract and relax your muscles), then your chances of a quicker and smoother recovery post-birth are much higher.

‘The Tight Pelvic Floor’: is it a myth or reality?

Strictly speaking, it is a myth with a “but”. Like any other striated muscle (the ones we can control consciously), you should be able to contract your Pelvic Floor well, sustain low-level contraction well (without getting tired too quickly) AND also be able to relax it. There is no need to prepare for childbirth by doing hundreds of squeezes a day and definitely no need to use any special weights for that purpose! Incorporating some Pelvic Floor exercises into your fitness routine and daily life is good enough (providing you have not developed any other health issue that needs specialist attention). After each contraction of your Pelvic Floor muscles, you should follow this with a complete relaxation of them to ensure an optimally functioning muscle.

When and where should I practice Pelvic Floor exercises? Do I need to dedicate a special time and place for them?

If you do yoga, Pilates or any other structured non-aerobic exercise routine, you can do Pelvic Floor squeezes while doing a bicep curl for example. If you do not exercise regularly, you can incorporate a twice daily mini-routine in to your time at home or at work. When done correctly, no one should be able to tell you are doing Pelvic Floor contractions (note: no funny face is needed whilst doing them!). If you do them whilst sitting and your body goes up and down slightly, then you are probably compensating Pelvic Floor squeezes with gluteal muscles… ie., doing it wrong!

How do I know if I am doing my Pelvic Floor exercises correctly?

Most women with no health issues will be able to feel a tightening around their vagina (think, for example, when you need to stop mid-urine-flow or want to pull a tampon deeper inside you). You should be able to vary the intensity of a Pelvic Floor squeeze, from light to strong. If in doubt, a health care professional should be consulted to make sure you’re using the right technique. Please don’t actually practice stopping your urine mid-flow on a regular basis though, as it can result in bladder dysfunction and infection – it’s just useful to do it once to make sure you’ve identified the correct muscle.

Will Pelvic Floor exercises affect my pregnancy?

Usually no, however if you have a condition that requires cessation of intercourse, or you’ve been told you have a higher risk of premature labour or miscarriage, it is best to avoid Pelvic Floor exercises. You can always mention it to your doctor and they can advise you accordingly.

If I have developed a dysfunction, shall I wait until delivery or act straight away?

If you have a low risk pregnancy, you can and should start acting now. Even in cases where a full rehabilitation needs to be postponed until after delivery, things like correcting your posture, control of abdominal separation (diastasis) and Pelvic Floor weakness can be addressed during pregnancy. Moreover, a lot of time and effort will be saved if you learn the techniques and exercises now as you’ll be able to get to Pelvic Floor rehab straight away if needed. A multidisciplinary approach is in your best interests and considerate specialists of different professions should always discuss the case together in order to develop the best treatment plan for you (a Gynaecologist, an Urologist and a Physiotherapist, for example).

Thanks for joining us today Anastasia. It’s true, that such an important issue as our Pelvic Floor is one that often gets ignored during pregnancy – and it’s something that can have a great effect upon our ability to birth, our health and our daily lives post-birth! We’re really looking forward to Part 2, where you’ll be telling us more about Pelvic Function right before, during and shortly after birth! 

A-Z Physio Health offers a professional consultation and treatment on pelvic floor, musculoskeletal dysfunctions and clinical Pilates (private and groups) in pregnancy and post-partum. You can find and contact us on Facebook @azphysiohealth, visit our website www.azphysiohealth.com or call 22446988 for more information.

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