• Back Pain in Pregnancy
• Stomach Muscle Strength and Stability
• The Pelvic Floor Muscles
• The Effects of Childbirth on Your Bowels
• Are These Physical Problems All That Common

BACK PAIN IN PREGNANCY

Did you know ....

• There is an increased strain on the muscles, ligaments and joints of the body during pregnancy. This is due to posture changes as the baby grows, and loosening of ligaments due to the hormonal softening effects.
  
  
• 47% of pregnant women report serious back or posterior pelvic pain.
  
  
• If you suffered with back pain in a previous pregnancy, you have increased risk of experiencing back pain that lasts longer, in your new pregnancy. Improving your physical fitness between one pregnancy and the next will lessen this risk.
  
  
• Obtaining and using information on back care and body posture before twenty weeks of pregnancy reduces the frequency of back pain during and after pregnancy. This includes appropriate abdominal exercise as strong abdominal muscles provide support for the back (refer to Stomach Muscle Strength).
  
  
• You can dramatically reduce your risk of back pain during pregnancy by gaining and using correct information about safe levels of exercise during pregnancy. Inappropriate exercise during pregnancy may actually induce or increase back pain.

For more information on Taking care of your back, click HERE.

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STOMACH MUSCLE STRENGTH AND STABILITY

The strength of your stomach muscles has a great effect on back pain in pregnancy. Why is this?

• The low back and pelvis need to be supported and stabilized by muscles to protect the lower spine from being injured when lifting, moving and carrying objects, including your baby in utero!
  
  
• The deepest abdominal muscle layer is like a living corset. It helps to stabilize the spine before any movement or action. This is known as the Transversus Abdominus (TA) muscle.
  
  
• In people who have had back pain in the past, the TA muscle does not work as well as it should. These people may be more prone to experiencing back or pelvic pain during pregnancy.

Can anything be done to improve the effectiveness of the stomach muscles at protecting and supporting the lower spine during pregnancy? The answer is most definitely "yes"!

• Learning how to accurately work the TA muscle can improve its ability to support the spine and pelvis. This is most effective when done during early pregnancy; but, even women later in pregnancy who have pain, notice an improvement once they begin to work and strengthen their TA muscle (see Jessica's Story).
  
  
• Learning TA muscle exercises early in pregnancy is important for all women. This helps to reduce the strain on the ligaments, lower abdomen, spine and pelvis. It is important to do this exercise correctly in order to gain the maximum benefits to prevent back and pelvic pain.
  
  
• TA muscle exercise and some checkpoints are described in the booklet, As Your Shape Changes. A Physiotherapist can also check that you are doing this exercise correctly, or teach you how to do it right if you are not sure.
  
  
• Sit-ups (curl-ups) and pelvic tilting do not work the TA muscle correctly, or promote pelvic and spinal stability. Abdominal hollowing and bracing, as described in the booklet, As Your Shape Changes, are the best ways to work the TA muscle to improve pelvic and spinal stability.

What happens to your abdominal muscles after the birth?

• It takes at least eight weeks after childbirth for the abdominal muscles to effectively stabilize the pelvis and protect the spine.
  
  
• As the TA muscle stretches during pregnancy, it is necessary to work this muscle soon after the birth to return it to normal function. This is especially important to help prevent the development of low back pain. Effective exercise for restoring the TA muscle after childbirth can be fitted into the daily routine of caring for a new baby more easily than making time to do sit-ups, which do not promote the stability of the spine. This exercise is described in the booklet, As Your Shape Changes.
  
  
• Going back to sport before the abdominal muscles stabilize and support the spine properly increases the risk of a back injury (see What about my back ~ can exercising too soon after the birth cause back pain?). As Your Shape Changes includes some vital checks ~ ways of knowing if your muscles are back to normal and ready to take up sport again.

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THE PELVIC FLOOR MUSCLES

The muscles that make up your pelvic floor provide support for your pelvic organs and help maintain continence of your bladder and bowel. The pelvic floor muscles are frequently weakened by pregnancy and childbirth and they require special attention during this time. Click HERE to view Pelvic Floor Muscles.

Pelvic floor muscle weakness can result from:

• lack of use.
• the weight of the baby on the muscles in pregnancy.
• stretching of the muscles during childbirth.
• regularly straining to use the bowels.
• pushing, or straining to finish emptying the bladder.
• lots of heavy lifting.
• carrying extra weight.

The muscles may continue to weaken as a woman ages and experiences the hormonal changes of menopause. This means that minor problems that start after childbirth may progressively worsen with age.

Did you know ....

The Continence Foundation of Australia statistics reveal that:

• 1 in 3 women who have had children will experience some degree of poor bladder control after childbirth, or around menopause.
• 64% of pregnant women are incontinent.
• 47% of women may experience urine leakage during exercise, or while playing sport.

One survey of 1505 women showed that:

• At three months post partum, 34.3% admitted to some degree of urinary incontinence.
• 8.5% needed to wear a pad for their incontinence.

Of those in this survey who had just had their first baby:

• 62.6% reported their incontinence began during pregnancy.
• 17.6% reported it started after childbirth.
• 19.4% had urine leakage before pregnancy.

Of all 1505 women surveyed:

• only 16.9% did daily pelvic floor muscle exercises during pregnancy.
• only 14.9% did daily pelvic floor muscle exercises at 3 months post partum.

In one study:

• 78.5% were unable to properly contract their pelvic floor muscles one year after having a baby.
• Many pregnant women incorrectly believed incontinence was a transient problem, caused by giving birth, that would correct itself.

Many people are unaware of how to correctly exercise the pelvic floor muscles. The booklet, As Your Shape Changes, will help you to become more aware of your muscles, enable you to check that you are doing the exercises correctly and help you know when to seek the advice and assistance of your Physiotherapist.

So, just what are the benefits of performing pelvic floor muscle exercise during pregnancy?

• Daily pelvic floor exercises during pregnancy reduce the risk of urinary incontinence.
  
  
• Exercising the pelvic floor muscles regularly during pregnancy makes it easier to contract and tighten the muscles after childbirth.
  
  
• The stronger the pelvic floor muscles during and after pregnancy, the less the risk of stress incontinence, which is leakage of urine during a cough, sneeze, laugh, movement, lifting, sport, or exercise (see Serena's Story).

What is the role of pelvic floor exercises after childbirth?

• Starting pelvic floor exercises within the first few days after childbirth will help the muscles to recover more quickly. Even women who have had stitches can do pelvic floor exercises.
  
  
• The condition of the pelvic floor muscles during and after pregnancy affects the life long health of a woman. Studies have shown that women who are unaware of their pelvic floor muscles, or who do not exercise them, are more likely to experience problems in future life.

Does sport have any effect on the pelvic floor muscles?

• Women may incorrectly believe their sport and other high impact exercise is taking care of their pelvic floor muscles. Participating in sport, running or other high impact activities during pregnancy and early after childbirth may actually reduce pelvic floor muscle strength and cause long-term bladder and bowel problems. These physical problems may include the risk of organ prolapse requiring surgical repair. (See Returning to sport or exercise after the birth of my baby..)

As Your Shape Changes contains valuable advice and a checklist that should be used to determine readiness to return to sport and high impact exercise after childbirth. Further information is available in the information leaflet entitled, Considerations for Pregnancy and Post Natal Exercise.

For more information on Pelvic floor exercises, click HERE.

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THE EFFECTS OF CHILDBIRTH ON YOUR BOWELS

It is not often that we stop to talk about our bowel habits with other people; so, how do you know what you experience is normal? Many women have, in fact, grown up with bowel habits that are not normal. Regularly straining to use the bowels, even just a small amount, can weaken the muscles that make up your pelvic floor. The stretching associated with pregnancy and childbirth also weakens these muscles.

The weakened pelvic floor muscles may not work properly when you empty your bowels. Some women with weakened pelvic floor muscles experience pain or difficulty in using the bowels, which results in straining. The effect of straining actually weakens the pelvic floor muscles even more, further increasing the need to strain. It's a vicious cycle!

Over time, the weakened pelvic floor can lead to leakage of urine (also known as incontinence). Prolapse (where your pelvic organs drop down or feel like they are falling out) is also much more common in women who strain to use their bowels. Samantha's Story gives an account of what can happen over time as a result of straining and a weakened pelvic floor.

The booklet, As Your Shape Changes contains valuable information and advice for women to consider before, during and after pregnancy to help prevent the physical problems often associated with pregnancy and childbirth.

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ARE THESE PHYSICAL PROBLEMS REALLY ALL THAT COMMON?

While not wanting to alarm pregnant women or mothers, some of the statistics during and after pregnancy are frightening. It is easy to get caught up with the excitement of motherhood and pregnancy, and neglect to take the necessary preventative measures to ensure continued pelvic floor, back, abdominal and bowel health.

Many, not realizing, leave it until too far down the track, with "old wives tales" from friends, family, and health professionals reinforcing that it is normal for physical problems to occur during and after pregnancy. This should not be the case! With some simple advice and assistance, most women will be able to avoid the development of bowel, bladder, back and pelvic floor problems.

As Your Shape Changes is an informational diary created specifically to meet this need. It enables women to record and monitor their physical status and progress during the after pregnancy. It provides simply advice to raise awareness of potential problems as well as tips and exercises to prevent their occurrence. The booklet also assists with the early detection of any problems that may occur, helping women identify when it is important to seek professional advice.