Pelvic floor, take care of it in pregnancy

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Marie-Ange Demory
@marie-angedemory
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Pelvic floor, this stranger! How many of us know what it is, what muscles are involved and what is it for? Not many. Yet it is a very important part of our body, responsible for our well-being in many ways. And when something is wrong (for example if a sneeze or a laugh makes a little urine escape) you don't need to be ashamed.

Pregnancy and especially childbirth are very stressful moments for the pelvic floor and therefore extra attention is needed. The Del Paesena Association of Obstetrics (AIO) has created a special group of midwives specialized in pelvic floor. Let us therefore deal with this issue with Lara Arduini, midwife graduated in 2006, expert in pelvic floor rehabilitation and national coordinator of the GOIPP-AIO.



Lara Arduini

    What is the pelvic floor and what is it for?

    “The pelvic floor is the set of muscles and ligaments that close the pelvis at the bottom. It has three important functions: to support the organs (bladder, uterus and rectum) to prevent prolapse, to guarantee the continence of urine and feces, and not least the role it has in the sexual sphere (to have a good sensitivity and not feel pain during relationships). It is essential from a very young age to have perception and care of this part of the body to keep it healthy and therefore to avoid the onset or worsening of perineal dysfunctions ". 

    When is the pelvic floor most stressed?

    "The most delicate and stressful moments in life for the pelvic floor are: intense sports activities (50-60% of athletes have stress urinary incontinence between the ages of 16-24, especially for sports such as volleyball, basketball, running, etc. ), pregnancy and childbirth, menopause (due to the drop in estrogen which negatively affects muscles, ligaments and mucous membrane tropism), pelvic surgery ". 



    Let's talk about pelvic floor and pregnancy ...

    "Generally we hear about the pelvic floor only at the time of birth due to the risk of perineal lacerations but it is important to underline that pregnancy in itself weakens the pelvic floor due to a change in posture in hyperlordosis which puts all the abdominal pressures on the front part of the body ( the weakest) of the perineum, hormonal activity that relaxes the pelvic floor (in preparation for childbirth), weight gain and therefore greater pressure on the perineum. 
    The risks of giving birth on the pelvic floor are not only muscle tears but also the possibility of nerve damage and damage to supporting structures. Hence the importance of having an evaluation during pregnancy (also essential in postpartum) by a midwife specialized in rehabilitation of the pelvic floor and to arrive at delivery (or even a cesarean) with a healthy pelvic floor. A healthy pelvic floor is essential to feel less pain in labor and to have a shorter expulsive period and with a lower risk of lacerations.
    Pregnancy is the most important risk factor on the pelvic floor (but we can't think of not having more children). If a woman has a cesarean she is not free from pelvic floor problems, as is often thought: the muscle and nerve damage that may occur can trigger incontinence, chronic pelvic pain, prolapses, constipation, etc. and also women with a cesarean have faced pregnancy (therefore change of posture, abdominal hyperpressions on the perineum, etc.) ".

    Where is my pelvic floor and what can I do to find out if I can activate it?


    “It is the area that rests on the bicycle seat. I can take a mirror to look at myself better: it is the area between the vagina and the anus. I can try to touch in the area between the vagina and anus and try to contract the pelvic floor. How? It is the same movement I do to stop the flow of pee. It's called a 'pee-stop' and it's a test to see if I can effectively contract the pelvic floor. I want to clarify that it is only a one-off test, it should not be performed as a routine exercise because it increases the risk of urinary infection and alters the physiological mechanisms of urination. If I have a finger resting on the perineum and I try to contract, I feel an inward movement and, observing carefully, I see an inversion of the tissues, the clitoris lowering and the walls of the vulva approaching ".


    How to tell if your pelvic floor is healthy?

    “I have to visit a midwife who specializes in pelvic floor rehabilitation, no do-it-yourself methods. Posture and breathing have a decisive influence on the functionality of the pelvic floor ".

    What are pelvic floor disorders? 

    “Some urinary loss with coughing, jumping, sneezing, urinary urgency (having to run to the bathroom to urinate), haemorrhoids, constipation with difficulty in evacuation, poor sensitivity or pain in sexual intercourse, incontinence to gas and so on. When mild dysfunctions related to the pelvic floor arise, it means that the pelvic floor has been in pain for some time ”. 


    Why is there so little talk about it?

    “Probably because you think there is nothing to be done. Often our mothers and grandmothers pass on to us that, having children and / or getting older, these are problems that we must take into account. In the last few years, many scientific studies have been carried out on the pelvic floor (of all ages, from the youngest to the elderly) because, given the considerable lengthening of life, women find themselves spending several years with disabling perineal dysfunctions and operating theaters they are overcrowded (with all the consequences of surgical interventions that do not always give the desired results, on the contrary, sometimes worsen the existing situation).
    We must tell all women that if we take care of our pelvic floor already in prevention (by perineal rehabilitation experts), we can be well all our life, or have minimal discomfort. Being aware of this, we can promptly resort to rehabilitation without having to live in highly disabling conditions that greatly affect the quality of life ".

    How does a specific pelvic floor visit take place?

    "When an initial evaluation of the pelvic floor is made, in the first part there is an accurate medical history (physical activity, type of work, sexual life, urination function with any incontinence and defecatory function, drug intake, current pathologies etc. ) followed by a second part of both external and internal examination to evaluate the function of the musculature, the evaluation of nerve reflexes, the presence of any prolapses, the ability to contract and relax the pelvic floor ('squeeze and release'). All this leads to understand why there are the reported dysfunctions or, in the absence of problems, to evaluate the state of health.
    The midwife decides whether it is enough to implement 'preventive' measures and teach a correct lifestyle (urination, defecation, posture, perineal contractions in moments of effort: lifting heavy objects, coughing, sneezing, blowing of the nose, etc.) or if the situation requires a real rehabilitation which consists of some therapy sessions to restore physiological conditions as much as possible. In pregnancy, the therapy is manual physiokinesitherapy because you cannot use electric currents (TENS or muscle electrostimulation for example) ". 


    Are there any differences with a visit to the gynecologist?

    "Doing a gynecological examination is not the same as a pelvic floor examination, completely different aspects are observed, so it is important to go to the gynecologist but it is equally important to do a perineal evaluation, they are two different things". 

    How can you find an experienced pelvic floor professional?

    "The GOIPP (Del Paesene pelvic floor group) was created within the Del Paesena Association of Obstetrics (AIO) and for some time a register of midwives specialized in pelvic floor rehabilitation has been set up (available on the AIO website ) to find a competent professional in your area. If an area midwife is not found, you can write or call AIO to request information. GOIPP has also just published recommendations for pelvic floor midwives to help midwives address this issue in line with the latest scientific evidence. "

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