The pelvic floor muscles form a sling between your legs, running from the tail bone at the back to the pubic bone at the front. Their job is to shut off both the bladder and the bowel to prevent leakage and to support the organs inside your pelvis in their correct position (the bladder, bowel & uterus).
During pregnancy the weight of the growing baby stretches the muscles and puts pressure on the bladder. During a vaginal delivery, the baby's passage stretches the vagina, the nerves and pelvic floor muscles. This can leave the muscles weak and unable to keep the bladder from leaking.
Leakage of urine may occur while coughing/sneezing, laughing, lifting or exercising (stress incontinence). Women may also find they need to go to the toilet more often, more urgently and may leak on the way (urge incontinence).
About 65% of women notice some leakage first occurring during pregnancy, which may go away after the birth. It is important to know that leakage problems often occur again in later life, as the pelvic floor muscles get weaker as we get older. Other factors that contribute to pelvic floor weakness include: hormonal changes at menopause, obesity, constipation and chronic coughing.
The pelvic floor muscles can be strengthened to prevent leakage by exercise:
Try the exercise while lying, standing or sitting, with a straight back.
Keep your thigh and bottom muscles relaxed and keep breathing!
Imagine you are trying to stop the flow of urine at the front passage and trying to stop wind from escaping at the back passage
You should feel a squeeze/ lifting sensation inside, between your legs.
To start with, tighten and “lift” the muscle as hard as you can for five seconds, ensuring that you are continuing to ‘lift’ the muscles throughout the entire contraction.
Rest for 5 seconds between contractions
Repeat this exercise 5 times in a session.
Aim to do your exercise twice a day.
As you get stronger, you can increase the length of time that contractions are held to 10 seconds, and increase the number of contractions done to 10 in one session.
Once you have learned the correct pelvic muscle contraction technique, it can help you right away to avoid leakage. When you feel a cough or sneeze coming on tighten your pelvic muscles as tight as you can, and keep them tight throughout the cough or sneeze.
Even if you do not suffer post-natal urinary stress incontinence, your pelvic floor muscles have taken a real beating during the birth and it is therefore important that pelvic floor exercise are started within 24 hours of the baby’s delivery.
Women who have had a caesarean section or vaginal delivery should gently start pelvic floor muscle exercises 24 hours after the birth. As pain decreases, you can slowly build up how many are done.
Aim eventually for 40 squeezes a day, doing 5-10 squeezes at a time.
Hold each squeeze for 5 seconds (you may have to build up to this).
Do this exercise with a regular activity (baby feeds, watching TV) to act as a reminder.
Tightening the muscles while you cough or sneeze will also help to prevent leakage.
Mantle. J, Haslam. L, Barton. S (2004) Physiotherapy in Obstetrics and Gynaecology (2nd edition) Butterworth & Heineman. UK.
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