Together with Dr Amal Hassan, I appeared on an episode of The Hotbed Collective podcast, which aired yesterday. The trio that make up the Hotbed Collective - Lisa Williams, Cherry Healey and Anniki Sommerville - are on a mission is to get people talking honestly about the highs and lows of sex. They're steering away from air-brushed perfection and focusing on telling it like it is. Dr Amal and I were talking about Pelvic Paw Patrol, a (campaign we are launching together with Anya Hayes, Pilates teacher, author of The Supermum Myth and maternal mental health warrior, Dr Ria Clarke, Trainee Gynaecologist, and Emma Brockwell, women's health physiotherapist. Through our campaign we want to raise awareness and start conversations around pelvic health. We hope to help women realise that they don't have to put up with common-but-not-normal postnatal issues like incontinence or pain during sex.
This Q&A can be used on its own or as an adjunct to the podcast which you can - and should - listen to here.
Q - What is the pelvic floor?
A - The pelvic floor muscles are the layer of muscles that span the bottom of the pelvis and support the pelvic organs (uterus, bowel and bladder). They stretch from the tailbone at the back to the pubic bone at the front.
The pelvic floor is actually the bottom of the core. Think of the core as a unit with four sides. The diaphragm is at the top, the deep abs (the TvA) are at the front, the deep muscles of the spine (the multifidus) are at the back and the pelvic floor is the unit’s foundation.
Q - What is the fuss about pelvic floor exercise? Why should I bother?
A - The pelvic floor becomes weakened through pregnancy and childbirth. Remember we said that the pelvic floor forms the base of the core unit? What happens when we build a house on a weak foundation? Carry that analogy over and there is your answer as to why pelvic floor exercise matters. Weakened pelvic floor muscles will mean the internal organs are not fully supported. This can lead to incontinence and pelvic organ prolapse.
As the podcast touched on, pelvic floor muscles are also important for sexual function, because the contraction of the pelvic floor during sex contributes to sensation and arousal.
Q - I had a C-Section so that means I don’t need to exercise my pelvic floor. Am I right?
A - You are not right. Pregnancy in itself puts a strain on the pelvic floor because of the weight of the growing baby bearing down on the muscles. Also, a C-Section involves cutting through the fascia which connects the abdomen muscles. This is major surgery and leaves the whole of the core - including the pelvic floor as part of that team - in need of retraining.
Q - In the podcast you mention red flags which mean I should see my GP. What are those?
A - By red flags we mean warning signs. In the case of Pelvic Floor Dysfunction these can include:
needing to urgently or frequently go to the toilet (for either a wee or a poo)
accidentally wetting yourself or soiling yourself, however small an amount
difficulty emptying your bladder or bowel; some women report needing to use a finger to apply pressure as they poo, to get all of the poop out
vaginal bulging or heaviness (the dragging sensation Amal speaks about in the podcast) or
pain in the bladder, bowel or in your back near the pelvic floor area when doing your pelvic floor exercises or during sex.
Q - But what do I say to my GP?
A - GPs are caring professionals who want to help you to feel your best. Explain your symptoms and when they started. Your GP may carry out an internal examination there and then to determine next steps. You can ask for a referral to a women’s health physiotherapist if one is not offered.
Q - You mentioned something called a Mummy MOT. What is that?
A - The MummyMOT® is a postnatal detailed physiotherapy assessment of the abdominal and pelvic area. It will check your posture, breathing, tummy gap and pelvic floor strength. Find out more and locate a practitioner near you on the website.
Q - How do I do a pelvic floor exercise? I am not sure whether I am doing them correctly.
A - First thing’s first, a little disclaimer. Pelvic floor exercises are most effective when individually tailored to the pelvic floor. This is the benefit of seeing a women’s health physio who can assess what is right for you. The exercises described here are just a guide.
Start by getting into good alignment. Stand in front of a mirror side on with your feet hip-width apart. Find your neutral pelvis by tilting the pelvis through full range and stopping at the midway point. You don’t want it sticking too far out but you don’t want it completely tucked, either. Next make sure that your rib cage is stacked over your pelvis, so that it isn’t pointing up or pointing down. Create length through the spine as if someone has a strand of your hair and is pulling it to the ceiling, but don’t jut the chest out in the process. Take a big roll back with the shoulders and let them fall. Tuck your chin in.
Next you need to identify the correct muscles. Do this by imagining first that you are stopping the flow of urine; second that you are sucking a milkshake up a straw inside your vagina; and third that you are trying to stop a fart in a very important work meeting. Play around with this if you need to. You may find that the fart is really easy but the wee not so much, or vice versa.
Once you’ve got the muscles, start with some slow contractions. Take an inhale into the ribs. Imagine the ribs opening up like an umbrella. Relax the pelvic floor, abs, inner thighs, bum and jaw. As you exhale through soft lips imagine you are simultaneously stopping the flow of wee, sucking a milkshake through the vagina and stopping a fart as you lift the whole of the pelvic floor. Continue to keep your abs, inner thighs, bum and jaw relaxed as you do this. Try to hold the contraction for 10 seconds, but stop if you begin clenching any of the other muscles. Inhale and fully relax the pelvic floor (this is very important, because as with any muscle we need to train through full range by relaxing between contractions). Try to do 10 of repetitions of these slow contractions but, remember, it's quality very much over quantity with pelvic floor exercises.
We also need to train the pelvic floor with fast contractions. Keep your abs, inner thighs, bum and jaw relaxed. Quickly lift the pelvic floor, keeping all of the other muscles unclenched and relaxed. Then slowly relax the whole of the pelvic floor. Try to do 10 of repetitions of these fast contractions followed by a slow release, but heed the advice concerning quality not quantity, above. Breathe in a way that's comfortable for you throughout these exercises, remembering not to hold your breath at any point.
Q - Any other tips for helping my pelvic floor to withstand the challenges of mum life?
A - Yes! Your alignment and breathing matter all day long, not just when you’re doing your pelvic floor exercises. Try to think about these throughout the day and correct them, until they become second nature. Motherhood is very physical: you’ll be getting down to and up off the floor, lifting your ever-growing little one, and hauling buggies, car seats, unwanted scooters and a million other things around. There’s a way of doing all of these things which will be kinder to the core. Let’s take lifting a whingy toddler off the floor as an example. Get as close to the whingy toddler as possible. Inhale and squat down as if sitting back into a chair. Begin the exhale and contract the pelvic floor. Continue the exhale as you lift your whingy toddler off the floor. Apply these rules - exhale on effort and blow before you go - for all physical activities of motherhood.