In Australia, at least half of women who’ve had a child have some degree of pelvic floor damage. The most significant form of damage is prolapse.
Prolapse occurs when the muscles & ligaments that support a woman's pelvic organs (known as the pelvic floor) weaken, causing those organs (bladder, bowel & uterus) to stretch & drop down into or against the wall of the vagina.
The most common symptom of prolapse is bowel & bladder incontinence, the latter of which affects more than a third of Australian women. Symptoms also include uncomfortable feelings of fullness or swelling in the vagina, & for some women, painful sex.
Unfortunately, it is difficult to know which women will experience pelvic floor trauma. Some known factors that increase the risk of experiencing damage include: An occipito-posterior or ‘OP’ presentation (i.e., the baby’s back is along the mothers back), the bigger the baby (especially more than 4kg), the more time spent pushing during the second stage of labour & the use of forceps during delivery.
Contrary to popular belief, giving birth via caesarean does not prevent pelvic floor problems either. Pregnancy itself can damage the pelvic floor muscles, with hormone changes & the extra weight/pressure of a baby over-stretching these muscles.
What to do about it? While severe prolapse can be addressed with surgery, physiotherapists that specialise in women’s health & the pelvic floor can be hugely beneficial. The goal of pelvic floor physiotherapy is to improve pelvic floor function through exercises, lifestyle modifications, education & hands on treatment to decrease and/or eliminate symptoms.
Pelvic floor exercises (or ‘Kegels’) are designed to strengthen the pelvic floor muscles, reduce symptoms & prevent disorder. Over time, strengthening these muscles can help women to better control their bladder/bowel motions & help reduce or stop leakage. While such exercises are crucial to the recovery of muscle function and bladder control (especially after birth), all women should exercise these muscles regularly as a way to prevent pelvic floor weakness.
References: Caudwell-Hall et al 2017; Lien et al 2004; Friedman et al 2018; Dietz et al 2016