Ideas to help you to remember to do your pelvic floor exercises.

Whether you are pregnant, planning a pregnancy or have had a baby, it is important to remember to do your pelvic floor muscle exercises and your tummy bracing exercises. This will help to keep your muscles strong if you are pregnant and help them to recover more quickly after your baby has been born. All women should do pelvic floor exercises, even once they have returned to normal after pregnancy.

Do you forget to do your exercises regularly? If so, you could place dots in places that will remind you to do the exercises. For example, on the mirror, television, phone or computer; in the toilet (for after you have finished going, not during your flow); in your wallet; where you sit to feed your baby or toddler; or anywhere else that will remind you to tighten your pelvic floor and tummy muscles. We have included some dots for you in Your Powerful Pregnancy Program.

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Don't neglect your pelvic floor muscles!

Freda (not her real name), would like to share her story, her comments and feelings, to let you know how important pelvic floor muscle exercises are, and to encourage you to take note now, before it is too late and problems start. (It is never too late to actually get help, but it is easier to stop a problem from happening).

Freda has 3 children, and had her first baby when she was 22 years old. She was 26 when she had her second baby and then in her late 30's for her third. This is when the problems started, or became apparent.

Freda came to the Physiotherapist, not sure if she was doing her pelvic floor muscle exercises correctly. She experienced incontinence (leakage of urine) when she coughed and also on the way to the toilet - not always making it when she needed to go. This had been happening for a few months. She had been thinking "hopefully this will get better", but it didn't, and it was very upsetting. She was brave enough to mention it to her doctor, who suggested physiotherapy but also surgery if physiotherapy didn't help.

Luckily with the help of her Physiotherapist, Freda's problem slowly improved and she regained control over her bladder and pelvic floor muscles. But she felt strongly enough to share her story in the hope that other women will not neglect their muscles and will enjoy the benefit of all of the information, and physiotherapy advice that is available now.

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How NOT to do your pelvic floor exercises!

Over the years many women have become more aware of their pelvic floor muscles and of the need to do pelvic floor exercises to keep these muscles strong and working correctly. But also over the years there has been a lot of incorrect information on what is a pelvic floor exercise, and some women still are confused, or unsure if they are doing their exercises correctly.

Some of the ways NOT to do your exercises include:

• Stopping and starting your flow of urine every time you go to the toilet.
  This used to be promoted as an exercise, but is not recommended. This is a good check to see that you can do it, and to feel the muscles working. If you are just learning how to do the exercises it can help you to contract the right muscles. Doing this as a check before your baby is born, and also sometime after can help you to make sure that this action of the muscle is working well. But it does not mean that your muscles are completely back to normal if you can do this, as the muscles work in other ways too (like holding on if you need to go to the toilet, supporting our pelvic organs and tightening when we cough, sneeze, laugh, run or jump).
  
  
• Tightening your muscles quickly and relaxing and doing 100's of these per day.
  This is OK to do as an exercise, but it is not the only way that the muscles should be worked. Some people mistakenly think that they are doing a great job of exercising their muscles this way, but it is also important to think quality, not quantity. The pelvic floor muscles should also be exercised by holding them tight, not just pulling them up quickly and relaxing them straight away. So it is important to do a combination of both quick contractions (and you don't have to do 100 per day - although you can if you want to), and slower holding contractions. To find out how to work out your hold time, use the booklet As Your Shape Changes. You can then also record your hold time, using the charts included in the booklet.
  
  
• Lying on the floor and lifting your pelvis and hips up and down, while flattening your back against the floor.
  This exercise is called the pelvic tilting exercise, and does NOT exercise the pelvic floor muscles (unless of course you deliberately tighten your muscles at the same time, which can be quite tricky to do). In the past this exercise was mistakenly taken to be pelvic floor exercises. Some women still think that this is what pelvic floor exercises involve and that they need to get on the floor to do them. Pelvic floor exercises can be done in sitting or lying, and standing positions if you are able to do them well, but do not involve the moving of your pelvis at all, except for when you are trying to get yourself in the right position to start with. (Refer to The Importance of the Pelvic Tilt, in Your Powerful Pregnancy Program). Then your pelvis should not move, while your pelvic floor muscles, which are on the inside of your pelvis, lift up and tighten.
  
  Pelvic tilting exercises are good for back mobility, but after you are 19 weeks pregnant it is not recommended that you continue to exercise while lying on your back. They can then be done in a hands and knees position as a back stretch (also called the cat curl). A pelvic tilt can also be a good exercise to help start your tummy muscles to work again after your baby has been born, in addition to your post natal abdominal bracing exercises. But again remember, it is NOT an exercise for your pelvic floor.
  
  
• Sitting to do the exercises and your body moves up and down.
  If you are tightening your bottom muscles as well as or instead of your pelvic floor muscles, you will notice that your body moves quite a bit when you try to do the exercise, especially if you are sitting. This is incorrect, and does not work the pelvic floor muscles effectively. If you are tightening your bottom instead of your pelvic floor muscles, you will often feel more, but it means that your pelvic floor muscles are not working, so you won't get the desired results from doing the exercises this way. If you are tightening your bottom as well as your pelvic floor muscles, again you will probably feel like you are doing more, but all your extra effort is going into your bottom, not into improving or maintaining the strength of your pelvic floor muscles.
  
  Focus more on the pelvic floor muscles on the inside, and try to keep your bottom relaxed as you do the exercise.
  
  
• Squeezing your legs together.
  Although this may help in an emergency, if you do need to do this, it is a sign that your pelvic floor muscles are not working as well as they should. Again if you do this when you exercise, it is the same effect (or lack of effect) as if you are tightening your bottom muscles instead of, or as well as your pelvic floor muscles.
  
  Often when the pelvic floor muscles are weak or getting tired, the leg and bottom muscles will work. If you cannot stop this from happening it is a good idea to seek some extra advice and a check from a Physiotherapist working in the area of women's health, or your Midwife.
  
  
• Holding your breath when you tighten your muscles.
  Often when you are first learning how to do the exercises and you need to concentrate very hard, you will hold your breath. As you get better at doing the exercises, then you should learn to be able to tighten them, and to breathe at the same time. This may take several weeks or even a month or two to be able to master this.
  
  
• Tightening your tummy really hard.
  Although it is OK for your lower abdominal muscles to tighten (the area below your belly button), you should not feel your whole abdominal wall tighten and pull in. If you feel the area under your rib cage really pulling in then you are probably trying too hard, or tightening your tummy instead of your pelvic floor muscles. Focus lower down in your vaginal area as you try to contract your pelvic floor muscles.
  
  You will still read in some books, magazines and brochures that you shouldn't tighten your tummy muscles at all when you do your pelvic floor muscle exercises. The latest research by Physiotherapists in Australia shows that it is OK for the lower tummy muscles to work when you tighten your pelvic floor muscles, and in fact this should happen. It is normal that your pelvic floor and lower tummy muscles actually do work together. To start with this may not happen, but as you get better at both your pelvic floor and abdominal bracing exercises, this should get easier. Check in As Your Shape Changes, in the section called "Putting it all together", for further information on progressing to this, once you have mastered each exercise individually.
  
  
• How to correctly tighten your pelvic floor muscles.
  To get an idea of how to correctly do your exercises, use the checklists in As Your Shape Changes and Stages of Knowing Your Pelvic Floor which are in Your Powerful Pregnancy Program. These checklists, together with the information in the booklet have been carefully compiled to assist you to know that you are doing your exercises both correctly and accurately. It also will help you to know your pelvic floor muscle fitness, and monitor it before, during and after pregnancy. Knowing your muscles really well, as well as knowing that you are doing the exercises correctly will give you the best results in keeping these muscles fit and healthy for the rest of your life.
  
  To order Your Powerful Pregnancy Program click HERE.

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Testing Your Pelvic Floor

How well is your pelvic floor really working?

Test your pelvic floor muscles yourself in the privacy of your own home:

• Learn to really know that you are doing the exercises correctly.
• No longer wonder if you are using the right muscles.
• Find out how strong your pelvic floor muscles really are.
• Find out if you are holding your pelvic floor muscles for as long as you think you can.
• Have a measure of your pelvic floor muscles during your pregnancy, so you can get them back to this or better after the birth.

A PFX unit is specially designed to test your pelvic floor muscles. It helps you to check if you are working the correct muscles and can help to show you how well your pelvic floor muscles are working. As you tighten your pelvic floor muscles, when using the PFX, you will see a reading of between 0 and 10. You will also be able to see how long you are holding your muscles for, as when they start to get tired, the reading will start to lower. As you continue to repeat your pelvic floor exercises, you can also monitor the number of contractions that you can do before your muscles start to get tired. This will confirm to you that you have recorded correctly in your pelvic floor chart in As Your Shape Changes.

To view the PFX unit, Click HERE [not available as yet ~ will be forthcoming].

It is not recommended that you rely just on your PFX. It is a good screening tool, and is good for helping you to exercise your pelvic floor muscles, but it is not a substitute for professional advice. Seek advice if:

• You are still unsure if you are doing your exercises correctly.
• You cannot feel your pelvic floor muscles tightening and relaxing.
• You do not register a squeeze on the PFX.

Physiotherapists who work in the area of Women's Health can check your pelvic floor muscles for you. Take your PFX in with you and you can also find out if you are using it correctly. There are other more sensitive machines available to Physiotherapists to help to check your pelvic floor muscles. Your PFX tester can be connected to these to give you a better indication of how you are going.

Physiotherapists can also help to tailor an exercise program especially for you when they have checked your pelvic floor muscles. If you find that you do not improve by yourself, again please seek further advice.

You may have seen a health professional in the past. If you did not improve as much as you would have liked to, then consider following up with another visit. New technology and research mean there may be some other treatment options for you now. A different approach may give you the chance to improve from where you are now.

To order your PFX unit, Click HERE [not available as yet ~ will be forthcoming].

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Help - I have just had my baby and I can't feel my pelvic floor!

Isabel (not her real name/story used with permission) was shocked after the birth of her baby that she couldn't feel her pelvic floor muscles. She was expecting them to feel normal after the birth and was not prepared for the fact that she couldn't feel anything when she did her exercises. Now unlike a lot of women, Isabel had done her pelvic floor exercises regularly during her pregnancy, and had felt that her pelvic floor muscles were actually quite strong and working well, even at the end of her pregnancy.

What happens during labour is that the pelvic floor muscles help to guide your baby through the pelvis to be born. The muscles are designed to stretch and open up to allow your baby to be born, but sometimes they will stretch more than others. This can cause a weakness and 'numbness' of the pelvic floor muscles, as the nerves in the pelvic floor have also been stretched. This accounts for the lack of feeling experienced by Isabel.

Isabel contacted her Physiotherapist for an appointment and had her pelvic floor muscles checked a few weeks after the birth. The Physiotherapist was able to see that her pelvic floor muscles were working, even though Isabel couldn't feel anything happening. All of the exercises that she had done during pregnancy had paid off, as sometimes the muscles don't work at all if they get stretched a lot during the birth.

The Physiotherapist advised Isabel to continue doing her pelvic floor exercises as she was doing them correctly. The feeling would come back over time, and the exercises can help this.

The next week Isabel came back, feeling a lot better. She had felt reassured after the Physiotherapy appointment, and was now starting to feel her pelvic floor muscles again.

So if this happens to you, make sure you check that you are doing your exercises correctly, and continue to do them as the feeling should come back. It does vary as to how long it takes, from days to weeks, and sometimes even months to really feel them well again. Remember, seek help and further advice if you don't feel you are making progress. A Physiotherapist working in the area of Women's Health can help you, ask your Midwife, or see your Doctor.

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What is a prolapse?

A prolapse is the name used when the organs in your pelvis (your uterus, bladder and/or bowel), drop down into the vagina instead of sitting in their normal position. This can cause a heaviness, dragging or aching type of feeling in the vaginal area, which often feels worse at the end of the day, and better in the morning or after lying down. Some women also notice lower abdominal aching and backache due to having a prolapse. A bulge in the vaginal area may also be felt, and sometimes this bulge may actually be felt outside of the vaginal opening. Another way many women describe the feeling of having a prolapse is "that it feels like everything is going to fall out".

Click HERE to view a picture of a bladder and bowel prolapse.

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Why can a prolapse happen?

The pelvic organs are supported from above by supportive ligaments and from below by the pelvic floor muscles and fascia (fibrous tissue within the pelvic floor). If either or both of these structures weaken, there is less support for the pelvic organs and they can start to drop down.

There are many reasons that this could occur. These include:

• Having a weak pelvic floor.
  Not doing your pelvic floor muscle exercises regularly can increase the chance of your pelvic floor muscles weakening during and after pregnancy. This means that they are less able to support your pelvic organs, and more pressure is placed on the supportive ligaments. If these stretch, then it is more likely that the pelvic organs can drop down and a prolapse can occur. A strong pelvic floor provides more support for your pelvic organs, and hence reduces the chance of a prolapse developing.
  
  
• Body type
  Some women have softer 'connective tissue' than others, which means the ligaments that support your pelvic organs loosen more easily. This means they are more likely to stretch during pregnancy and childbirth or after, so there may be a higher risk of developing a prolapse if this is the case. Unfortunately there is not a lot you can do about this, apart from following the advice on "What can I do if I have a prolapse?" as a precaution. Also, diligently doing your pelvic floor exercises will improve the ability of your pelvic floor to support your pelvic organs.
  
  
• Pregnancy
  Pregnancy weakens the pelvic floor muscles due to the weight of the growing baby, and due to the relaxin hormones, which soften the ligaments in the body together with the fascia in the pelvic floor. If the pelvic floor muscles are not strengthened during pregnancy, they are more likely to stretch and weaken, which can increase the chance of a prolapse occurring. There is not much that we can do to control the amount of relaxin hormone in our body, but we can strengthen our pelvic floor muscles so that they do provide the best support possible for our organs.
  
  
• Childbirth
  After the birth of your baby, your pelvic floor muscles are usually stretched, unless you had a caesarian without going through the pushing stage of labour. If your baby is quite big when he or she is born, or you were pushing for a long time (more than two hours), or you needed help to have your baby (suction or forceps), it is likely that your muscles are more stretched. They often feel quite weak and when you stand up or walk around, it may feel like things are dropping down, or "everything is going to fall out".
  
  If the muscles are not strengthened and toned up again after the birth, and remain saggy, then there is more chance of a prolapse developing at some stage in the future.
  
  
• The effect of gravity on a weak pelvic floor soon after the birth.
  A lot of walking or being on your feet in the first few days or weeks after the birth can mean your muscles get tired more easily and stretch more. This can cause an uncomfortable dragging or heavy feeling down below in your vaginal area. Frequent rests lying down are important at this stage, and only walking for short periods at one time can prevent or reduce this feeling until your muscles strengthen.
  
  
• Increasing your activity levels.
  When you go home, if you suddenly start to do a lot more and are on your feet more than you were in hospital, sometimes this can cause a prolapse, or even just achiness or heaviness vaginally. Again, more frequent rests lying down can help at this stage if you do experience this.
  
  Going for a walk and suddenly increasing your distance or the time you walk for is sometimes more than your pelvic floor can 'handle'. A certain amount of walking might be fine, but if you go further your muscles get tired, and then you can feel heaviness, discomfort or achiness. This is a warning sign that you should not push through, otherwise you could encourage a prolapse to develop.
  
  
• Placing strain on the pelvic floor muscles.
  During pregnancy or after the birth, if the muscles of the pelvic floor are weak, and there is a lot of strain, eg from lifting placed on them, they are more likely to be overstretched and weakened further. Heavy lifting (more than the weight of a baby) may place undue stress on the muscles and they can weaken, increasing the risk of a prolapse developing. Some women can actually relate to a particular lifting episode when they felt some pain or pressure in their lower tummy or vaginal area. They then noticed a bulge and heaviness not long after this.
  
  Being on your feet a long time when the muscles are weak or have weakened can place strain on the pelvic floor. This may include doing all the housework in one go, or being out all day walking around at the shops. During pregnancy or after the birth you may notice any of the prolapse signs or weakness of your pelvic floor muscles. Again, consider this as a warning sign, and try to follow the advice on "What can I do if I have a prolapse?"
  
  
• Straining to use your bowels or bladder.
  If you push or strain to empty your bladder, then this can increase the strain on the pelvic floor muscles and over time weaken them. You should be able to empty your bladder without having to strain. If you strain regularly to use your bowels, this also causes a lot of strain downwards on the pelvic floor muscles. If this happens over long periods of time, it can cause a prolapse to develop, and also can increase the chance of incontinence. See Samantha's Story.
  
  
• Going back to sport, aerobics or high impact exercise too soon.
  Returning to sport or high impact exercise soon after the birth can also increase the chance of a prolapse, if the pelvic floor muscles are not yet back to normal. Bouncing type of activities can increase the stretch also to the supporting ligaments, so that they do not hold the pelvic organs up in place so well. This can mean that a prolapse can occur, even though you may actually be feeling ready on the outside for more vigorous activity.
  
  For more information read How does returning to sport or exercise too soon affect my pelvic floor muscles? about Jondelle (not her real name), who developed a prolapse after her first baby, when she went back to sport too soon.

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I thought prolapses only happened to women when they got older, but I heard that younger women can get them too. Is this true?

Yes it is true. Women can develop a prolapse even after their first or second baby. It does not only happen to older women. It is not uncommon to have women come in during the later stages of pregnancy, or soon after the birth of their baby saying "everything feels heavy down below in my vaginal area".

An example is Alicia (not her real name), who's story has been used with permission.

Alicia was 29 years old when she had her first baby. When her baby was 6 weeks old, Alicia noticed a bulge in her vaginal wall, which she felt and could see when having a look. It felt uncomfortable, and she thought at first that she had developed a growth overnight. She was quite worried as she didn't know what it was. She also felt some heaviness in her vaginal area and achiness in her lower abdominal area. After an exercise session she felt worse.

After seeing her doctor, she then went to see her Physiotherapist. She had been doing her pelvic floor muscle exercises, but after recently reading the article How NOT to do your pelvic floor exercises, had discovered that she hadn't been doing them correctly. She had been tightening her bottom and leg muscles more than her pelvic floor muscles. This had made her feel that she had been getting a good strong squeeze of her pelvic floor muscles, when in fact she hadn't.

Checking of her pelvic floor muscles by her Physiotherapist showed also that her pelvic floor was really only holding for about 1 - 2 seconds, rather than the longer hold she thought she was experiencing. Her muscles got tired very quickly, as she hadn't been exercising them correctly. She now realized that during her pregnancy, she probably wasn't exercising the muscles correctly either.

Once she learned how to really feel her pelvic floor muscles, she was able to work them properly together with her lower abdominal muscles (which can also help the pelvic floor to work when done correctly). She was given some other advice from her Physiotherapist, to help minimize strain on the prolapse.

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What can I do if I have a prolapse?

If you develop a prolapse during pregnancy or after the birth of your baby, there is a good chance that it can be temporary, due to your pelvic floor muscles being weakened, and the effects of the relaxin hormone from pregnancy. As the effects of the relaxin leave your body, and your pelvic floor muscles strengthen, the support for your pelvic organs can continue to improve over the months following the birth.

You can follow the advice given to Alicia by her Physiotherapist, which can help the prolapse to reduce or go away, or prevent it from getting any worse. Do everything possible initially to reduce the strain on and improve your pelvic floor muscles, otherwise the longer the prolapse stays there, the more likely it is to become permanent.

Follow the advice below, even if you do not notice a bulge or feel like everything is going to fall out. Heaviness, aching or dragging feelings can also be a warning sign that your muscles are weak, and can be felt before a prolapse develops. These should not be ignored if experienced.

ADVICE INCLUDES:

• Regular pelvic floor exercises.
  Work regularly throughout the day on your pelvic floor muscle exercises. If your muscles get tired quickly, like Alicia's, it is better to do shorter sessions, but more often through the day. If you do too many exercises at one time, you can make your muscles really tired, and then the prolapse may feel worse.
  
  
• When possible, lying down is better than sitting or standing.
  Even 5 - 10 minutes throughout the day when you get the opportunity can help to take the weight of your pelvic organs off your pelvic floor and give it a rest so it doesn't get so heavy and drop down. Learning to feed your baby lying down can be helpful, rather than having to sit every time. As you feed your baby regularly, this can provide a good opportunity for that rest. Often heaviness and achiness from a prolapse can be worse at the end of the day, particularly if you have been on your feet a lot. Frequent rests throughout the day can prevent or reduce this.
  
  
• Space out your activities.
  If you have housework, washing or ironing to do for example, try not to do it all in one hit. Spread what you can throughout the day, or try to space housework over different days when possible. Make the most of any help that you do have available, so that you can avoid some of these activities until you are feeling better.
  
  
• Don't push through warning signs or the feelings of a prolapse.
  It is best not to push through the feeling of heaviness in your pelvic floor or vaginal area. This usually happens when your muscles are quite tired and the organs are dropping down more. Take the time to rest, to help this feeling to go away more quickly.
  
  
• Brace your pelvic floor muscles during daily activities.
  Brace (try to tighten) your pelvic floor muscles when you lift your baby, hang out washing, are standing at the sink, or if you have to squat down to pick something up or out of a low cupboard.
  
  
• Minimize lifting.
  Try to avoid lifting anything heavier than your baby. If you have a toddler, try to encourage your toddler to climb up to you while you are sitting on the lounge or a chair. Wherever possible, try not to lift them. This will reduce the strain downwards on your pelvic floor muscles.
  
  
• Avoid straining to use your bowels.
  Try to keep your motion soft by drinking plenty of water and looking at your fibre intake if your motion is hard. Refer also to "How do you go to the loo" in As Your Shape Changes for further tips on how to make it easier to go to the toilet.
  
  
• Do your pelvic floor exercises lying down.
  Try your pelvic floor exercises lying down with a cushion or pillow underneath your bottom. Alicia did this and she felt everything lift back up, compared to when she was standing, and she could really feel her pelvic floor muscles drawing up inside in this position. Even resting in this position during the day can be helpful. If you are still bleeding a lot after having your baby, you may prefer just to lie flat, rather than lifting your bottom up while resting or exercising, until the blood flow has reduced. If you are pregnant, just lying on your side can be helpful, but not flat on your back to exercise (after 19 weeks).
  
  
• Minimize squatting down.
  Avoid squatting down when possible, if you feel like "everything is going to fall out" in this position (which Alicia did feel). As your muscles get stronger, you can tighten them as you squat down, and this feeling should lessen.
  
  
• Be careful when exercising.
  Try not to do any bouncy type of exercises, or to walk for long periods at one time. If you feel any heaviness, achiness or bulging after you have exercised, this means that you have done too much at this stage. Reduce the amount of exercise you do, so that you do not feel any worse after you have finished, or the next day.
  
  
• Avoid abdominal curls ups, sit ups and crunches.
  Avoid doing abdominal curl ups, sit ups or crunches as these can place pressure downwards on your pelvic floor muscles and further weaken the muscles.
  
  
• Start abdominal bracing exercises.
  Abdominal bracing exercises will help your pelvic floor muscles to work and won't place any strain or pressure on the prolapse (provided you do them correctly). Don't hold your breath and focus on just working lower tummy muscles, as described in As Your Shape Changes.

NOTE: It is OK to gently push a bulge back into your vagina, when you notice it has dropped down. Obviously make sure you do this with clean hands, and try to follow this with bracing your pelvic floor muscles, or lying down for a while. Check with your doctor, or Midwife if you are not sure about doing this.

It is also OK to have intercourse if you have a prolapse. It is not likely to make it worse, however you may need to lie down for a while afterwards if your pelvic floor muscles feel tired, or you feel any heaviness or achiness due to the extra blood flow to the area during intercourse.

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How quickly can I expect to improve if I do have a prolapse?

Alicia followed the advice above, and diligently did her pelvic floor muscle exercises (correctly), after seeing her Physiotherapist.

The following week she came back for a check and was feeling a lot better. There was no heaviness or achiness and she could even squat down, holding her pelvic floor muscles in and not feel everything dropping down. She had exercised the day before and felt OK afterwards. She no longer had the bulging feeling, nor could see the bulge. She felt that it was getting much easier to do her pelvic floor exercises and when they were checked by her Physiotherapist, this was confirmed. They were working much better.

Not everyone will improve so quickly after experiencing prolapse symptoms. Sometimes it can take a few months and unfortunately for some women, it does not completely go away. Some women have found that they continue to gain improvement even over twelve months after the birth. Sometimes once women stop breast feeding, they continue to notice that their muscles tone up and that their prolapse improves.

So again, prevention where possible is better than cure!

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Do Pelvic Floor muscle exercises really help?

Several weeks later Alicia returned for a follow up Physiotherapy appointment. She had not been able to do her exercises as regularly over the past week, due to having visitors staying with her. She had noticed that her pelvic floor muscles didn't feel quite as strong, and while exercising the day before, "things felt a bit looser" than they had previously. Her lower tummy muscles also felt less toned and more saggy, from not having time to do the abdominal bracing regularly.

This weakening occurred even over a week, because Alicia was still in the process of returning back to normal after the birth. Once she starts her exercises again more regularly, she will again improve quickly because of the work she had done the weeks before. But it does show how the exercises do help!

Alicia admitted she didn't regularly do her pelvic floor exercises through her pregnancy as she didn't think they were that important. Now that she knows how to do them properly though, she will make sure she continues with them and will be extra diligent next pregnancy.

Another lady found that she was better after her second baby than her first, because she knew what to do. She did her exercises more regularly the second time around during her pregnancy, and also knew how to do her exercises really well, after having Physiotherapy following her first baby due to a prolapse.

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Another reason for discomfort in the vaginal region - varicose veins (also known as vulval varicosities)

Colleen (not her real name) was 30 years old, and 23 weeks pregnant with her second baby. She also had a 2 year old. (Her story has been used with permission).

She noticed a lumpiness in her vaginal area, after experiencing heaviness for a few days before. She felt swollen, and it also was uncomfortable against her underwear. Colleen was very concerned as she didn't know what this was, so she checked with her doctor who confirmed it was varicose veins around her vaginal area and the skin on the outside. This can sometimes happen during pregnancy and can be quite uncomfortable as you can imagine. Unfortunately some women are more prone to varicose veins than others, and they can occur in this area too, not just in the legs.

Colleen also contacted her Physiotherapist, who she had seen after her first baby was born, for pelvic floor exercises. Her Physiotherapist checked her pelvic floor muscles, and gave her a pelvic floor muscle exercise program to continue. When the muscles are working well, it helps to reduce the feeling of pressure in the vaginal area due to the varicose veins.

Colleen was also advised to rest where possible, spacing her activities out throughout the day. She should sit down when able, instead of standing, and minimize lifting of her toddler when she is able to. Following the advice above, in the "What can I do if I have a prolapse?" article, can be helpful if you experience vulval varicosities. Other advice includes wearing lycra bike pants, two pairs of underwear or a sanitary pad for support.

Unfortunately, these will probably not go away until after the birth of your baby, when you no longer have the pressure of your baby pushing down, or all the extra fluid in your body, or the effects of the pregnancy hormones softening your veins. It is a matter of using the advice above to minimize the chance of them becoming worse and to help you become more comfortable.

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What are hemorrhoids?

Hemorrhoids are varicose veins of the rectum. They are also known as piles. The blood vessels that supply the anus (back passage or bottom) can actually come outside the anus. They are usually noticed as lumps outside of your back passage (bottom), and they can cause quite a lot of pain or discomfort. Some people can have hemorrhoids however without feeling pain. Hemorrhoids may also be itchy at times.

Sometimes women may experience hemorrhoids for the first time during pregnancy or after the birth. They can be caused by the hormonal changes of pregnancy that soften the walls of the veins and cause them to protrude so that you can feel them outside your bottom. The extra weight of the uterus on the bowel and pelvic veins may also contribute to the development of hemorrhoids. Constipation during or after pregnancy can increase the chance of hemorrhoids developing, so it is important that you gain further advice if you are constipated rather than allowing it to continue. The pushing stage of labour can also place strain on the pelvic floor and back passage area, and this may be when hemorrhoids first occur.

Sometimes women may notice blood on the toilet paper after passing a bowel motion. If this occurs, or you notice hemorrhoids for the first time, check with your Doctor, or your Midwife if you are in hospital.

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What can be done to help hemorrhoids?

There are creams that can be used on the hemorrhoids to help to make them more comfortable. Doctors can treat hemorrhoids that do not resolve (go away) by themselves, but usually during pregnancy and after childbirth, hemorrhoids can be temporary. This means that they will often reduce in size or go away completely with other treatment.

This includes:

• Try not to strain when using your bowels.
  Straining will continue to place pressure on them and may cause them to increase in size, rather than decrease or go away. Use the advice 'How do you sit on the loo', in As Your Shape Changes. Place your feet on a footstool when you use your bowels, which will help to open up your back passage more easily. Take your time when you use your bowels so that you are less likely to strain.
  
  
• Support your perineum area when you use your bowels.
  This will help to reduce the amount of downwards strain on the back passage area.
  
  
• Take something to make it easier to go to the toilet.
  There are natural products that can be taken to help make it easier to go to the toilet after you have had your baby. Your Midwife can give you advice on what is safe for you to take. During pregnancy ask your Doctor or Midwife for advice.
  
  
• Consider your diet and fluid intake.
  Make sure that you have an adequate amount of dietary fibre and drink plenty of fluid. This will assist your bowel motion to be soft and easier to pass.
  
  
• Ice.
  While in hospital, Midwives usually have ice pads or packs available, that can be placed over the hemorrhoids. This will help reduce the swelling and discomfort that you are feeling, and make you feel more comfortable.
  
  
• Pelvic Floor Exercises.
  Pelvic floor exercises can sometimes be uncomfortable to do initially if you have hemorrhoids, but they can help to promote the circulation and encourage the blood flow from the hemorrhoids back inside. Because they lift the back passage area up, they can help to stop hemorrhoids from becoming worse.
  
  
• Avoid standing for long periods of time.
  A lot of standing may increase the pressure to the hemorrhoids, and due to the effect of gravity may encourage them to swell more. Try to sit or lie down as much as possible throughout the day.
  
  
• Ultrasound Treatment.
  Ultrasound treatment by a Physiotherapist over the hemorrhoids can help them to feel more comfortable and the swelling to reduce. This may be available both on maternity ward or as an outpatient.
  
  
• Cold witch hazel compresses.
  Some people recommend that a cold compress will help the hemorrhoids to reduce in size and become more comfortable. Witch hazel ointment has also been suggested. Please seek advice from your Doctor, Midwife or other Health Professional regarding this suggestion.
  
  
• Ask for Advice.
  Remember that if you are unsure whether you have hemorrhoids or not, ask someone to check them for you. Although this may be embarrassing, it will put your mind at rest and you can then use the right treatment to help them go away so that you can become more comfortable.

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Another sign of pelvic floor weakness or a stretched vaginal wall can be water leaking from the vagina when you get out of the swimming pool

Sometimes water can get trapped inside the vagina while you are swimming or exercising in the water. This is quite common after having a baby, but it is not normal, i.e. it shouldn't continue long term.

Continuing with pelvic floor exercises can help to tone the vaginal wall and assist it to return to its normal size. It has been stretched during the birth, so it does take some time, even months, to stop happening. Sometimes however the vagina will remain stretched after having children, but you can still improve the tone of your pelvic floor muscles by exercising them, which can help to give more firmness inside.

Urine can also leak out if your pelvic floor muscles are not yet back to normal after the birth. If you are unsure whether or not it is urine or water, the approach is the same for both anyway.

You should do your pelvic floor muscle exercises if you are not already doing them, or continue to do them to help to strengthen your muscles to relieve the problem.

Check in As Your Shape Changes and How NOT to do your pelvic floor exercises that you are doing your pelvic floor exercises correctly if you are unsure. Monitor your pelvic floor muscle fitness to try to get it back to your recorded measure taken during pregnancy. If you have not done this during pregnancy, check your muscle fitness, and monitor whether or not you are improving over the next month or so.

If the leakage does not go away, or you have been doing your exercises and it is still occurring, please seek advice from a Physiotherapist working in the area of Women's Health. There is more specific advice and treatment available that can help you to get back to normal, so that this problem does not continue.