Pelvic Floor Muscles

Pelvic Floor Muscles

PVM Diagram

WHAT ARE THE PELVIC MUSCLES?

These are the muscles at the base of the pelvis, extending from your tailbone at the back to the pubic bone at the front.

How do these muscles become dysfunctional?
Pelvic floor problems can be caused by a variety of reasons. Sometimes it is an unfortunate combination of causes;
- If the muscles have been strained they will weaken. For example, if you repeatedly lift heavy loads, or cough excessively; if you are constipated and strain when evacuating your bowels.
- Hormones influence these muscles not just in pregnancy but in later life when you are going through the menopause.
- But the obvious culprit is childbirth, especially if you have a prolonged second stage of labour with a lot of pushing, a large or awkwardly positioned baby, deep tearing, or complications leading to medical interventions such as the use of forceps and episiotomies. Even if you have a caesarean section, you may not avoid pelvic floor problems. You have still been carrying the baby for 9 months. As the uterus becomes heavier, it is the pelvic floor that must bear the weight. It may drop down as much as 2.5cm, not to mention the fact that towards the end the baby is likely to use the pelvic floor just like a trampoline!
The benefits of pelvic floor therapy

So gaining control over your PFMs can help with a range of antenatal and postnatal problems such as urinary and faecal incontinence. PFM exercises can also improve circulation to the pelvic area and help prevent haemorrhoids. This improved circulation will also aid the healing process after the birth itself. And let’s be honest, good pelvic floor control enhances sexual enjoyment too so may even be said to have a role to play in preparing for a baby!

But what about overactive muscles?

Notice that we have been talking about pelvic floor control rather than just strength. These are muscles like any other muscles and to work properly, they need the appropriate amount of tone and length. They are designed to stretch so that your baby can come out, but you will need to learn how to release them. In this way, you may be able to prevent tearing or having to have an episiotomy during the delivery. It is also important to be able to release your PFM even when you are not pregnant to help avoid over-activity in these muscles, and prevent patterns of chronic pain which can develop when these muscles are overactive.
The challenges of retraining these muscles..

The pelvic floor muscles can be hard to locate and to feel working because they are deep inside your pelvis. Many women have difficulty isolating a pelvic floor contraction and tend to brace the bigger surrounding muscles in compensation such as the buttock, abdominal and thigh muscles. Research shows that many women do not have a good technique of activating their muscles or actually contract them incorrectly, bearing down instead of drawing in. Your Women's Health physiotherapist can instruct you in good technique and provide an individualised rehabilitation plan for you, and an internal examination of these muscles may assist with this process.