Today's appointment is with Martina Rossi, a Professional Midwife, who is going to talk to us about pelvic floor muscles. She explains when you need to start thinking about a rehabilitation programme and why it is important for women to have a pelvic floor assessment, particularly pre and post pregnancy.
Let's start with the basics: what is the pelvic floor and why is it so important?
What is the pelvic floor and what does it do?
The pelvic floor is a set of muscles which extends from the base of the pelvis, from the cubic symphysis anteriorly to the coccyx posteriorly, and laterally between the two ischial tuberosities.
The pelvic floor sits like a hammock within our pelvis, in fact it supports the organs above: bladder, uterus, rectum. In addition, it also helps control flow: it helps the bladder fill and empty urine; it helps the rectum fill and empty faeces; and it helps the uterus support the extra weight of a pregnancy for nine months. It also plays a key role in the final stages of labour, helping push the baby through.
Pelvic floor muscles are essential for the well-being of a woman’s vagina as well as her sexuality.
Pelvic floor muscle assessment - how and when?
A pelvic floor assessment is considered beneficial at any stage of a woman's life: during childbearing years, during pregnancy or postnatal. We often take for granted the fact that our pelvic floor is healthy, only to discover that it’s not the case.
A pelvic floor assessment is also key in preventing future issues.
It is especially important during pregnancy as it helps prepare the pelvic floor muscles for labour and helps maintain the perineum strong and healthy following the birth. Pregnant women should seek professional advice, before giving birth, on how to prevent a tear during labour and how to perform a perineal massage.
An assessment at the right time can help treat pelvic floor effectively before more serious issues arise. At such a stage, rehabilitation can achieve excellent results.
Why do I need pelvic floor rehabilitation?
Pelvic floor rehabilitation is important, even when the perineum is healthy and normal, as it helps keep the pelvic floor muscles strong and prevent future dysfunction.
It goes without saying that rehabilitation is extremely important if you’re affected by any of the following problems:
- Hypotonic perineum dysfunction: when ability to support internal organs and control continence is lost. Symptoms include a feeling of heaviness, involuntary leakage of urine and faeces, as well as passing wind, even after minimal exertion.
- Hypertonic perineum dysfunction: when muscles are tight and contracted. This may lead to recurrent conditions such as candida and cystitis, pain during sexual intercourse and chronic pelvic pain.
- Prolapse of the bladder, rectal or uterine (first, second, third or fourth degree).
- Urinary, faecal or wind incontinence, either urge, stress, or mixed incontinence.
- Problems related to sexual intercourse, i.e., discomfort or pain during sex.
- Recurrent bacterial infections.
Symptoms of pelvic floor dysfunction
Our pelvic floor muscles have many different ways of telling us that something isn’t quite right. Which symptoms should send alarm bells ringing?
- Slight leakage of urine when sneezing, coughing, jumping, laughing
- Chronic constipation
- Recurring bacterial infections
- If you go to the toilet and have to go back again five minutes later
- If you think you have finished urinating but as soon as you stand up from the toilet, a few more drops of urine come out
- If you feel as if water is coming in and out of your vagina whilst showering or swimming
- If you frequently feel air coming in and out of your vagina, perhaps during sex
- If you feel discomfort or pain following sexual intercourse and a prickly sensation, especially during penetration.
You should always consult a professional to discuss any symptoms or sensations you are experiencing, in order to assess your symptoms before commencing a rehabilitation exercise programme.
How is pelvic floor rehabilitation carried out?
I initially start treatment using physio-kinesiotherapy for pelvic floor rehabilitation, which, in my opinion, forms the foundation of any programme.
It consists of pelvic floor exercises accompanied by breathing techniques.
I work with my hands, through touch and massage on the pelvic floor area and explain to my patient how they should feel and listen to it themselves.
In some cases, electrostimulation is needed to help the pelvic floor. Other times radiofrequency is used, especially in hypertonic cases and in cases when the patient experiences pain during sexual intercourse.
Pelvic floor is a very broad subject, and the aim behind this article has been to raise awareness of the importance of strong and healthy pelvic floor muscles, to clear up any doubts you may have, and to answer any questions you may have.
Martina Rossi, a Healthcare Professional in Midwifery
A healthcare professional midwife, she graduated from the Marche Polytechnic University and then undertook a two-year master's degree in independent midwifery management of physiological pregnancy at the University of Modena and Reggio Emilia. She currently works and specialises in the field of pregnancy, assistance during labour and birth, and support with breastfeeding. She also deals with pelvic floor rehabilitation, obstetrical services such as tampons and pap smear tests, as well as obstetric consultations.