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Welcome to Prepare, the Mimisi Prenatable podcast dedicated to helping parents prepare for the journey of pregnancy, childbirth, and early parenthood.
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Mimessi Prenatal would like to begin by acknowledging the Rawundri Wu-Warung people, traditional custodians of the land on which we gather today, and also the traditional custodians of the lands in which you're listening from today.
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We'd like to pay our respects to the elders past, present and emerging, and we extend that respect to Aboriginal and Torres Strait Islander peoples listening today.
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Hi everyone, welcome back to another episode of Prepare.
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My name's Dr.
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Rangi DeSilva, and I'm your host.
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And today we are again so excited to be joined by Professor Helena Frawley, who is our pelvic floor expert, and we talked about what is the pelvic floor, how does it change both before and during pregnancy and birth in our previous episode, and more importantly, what we can do to try and help support our pelvic floor, strengthen our pelvic floor at every stage.
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And today we're going to be talking more about how the pelvic floor changes in birth and what we can do after birth to help make sure it's the best it can be.
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So thank you again, Professor Helena Frawley, for joining us.
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Thank you, Rangi, for inviting me back, and it's a pleasure to be here discussing this topic with you.
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So just quickly, we did cover it briefly in our part one of this topic, but how does the pelvic floor change during pregnancy or the later stages of pregnancy and birth itself?
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Yes.
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So during pregnancy there are changed levels of hormones which will help the pelvic floor muscle relax for birth and stretch.
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So we have increased elasticity in the muscle.
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During birth, the muscle will undergo quite a significant stretch, up to two and a half times its normal length.
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So if you think of a muscle that you then stretch beyond its normal resting length and two and a half times, like a bicep or hamstrings, that's a significant stretch.
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But our body is built to do that.
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However, it may not always bounce straight back postnatally.
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So there may be a period of weakness and laxity, as we say, so a loss of support.
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And the best way to help that is through exercise.
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And we can talk about what to do postnatally in a few minutes in terms of how to build up that program of recovery.
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But yes, during birth, the muscle is under load and stretch.
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But we do have good blood vessels in the area, so they will help bring healing to the muscle.
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It's completely something that we can work on and support.
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Yes, it's a normal process we need it to happen to allow birth, and then we can work on the recovery.
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Not everybody has any consequences or long-lasting effects of birth, but up to a third of women do postnatally.
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And some of it will be because of that large amount of stretch that the muscle and the tissues, the ligaments and the connective tissues went through during the process of birth.
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And sometimes there's increased risk from assisted deliveries, the use of forceps and other factors that can occur to ensure a safe delivery and a healthy baby.
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But they may also compromise the pelvic floor muscles.
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So that is important when we're discussing if there's a situation where, as the clinician involved, we we might think that that's the best course of action.
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But that's something that we would discuss with you in terms of potential risk factors or risks of that happening.
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What are some of the other risk factors for pelvic floor compromise or damage during labour?
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You kind of mentioned a couple of them briefly, but maybe things like the size of the baby.
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Yeah, so the pelvic floor muscles are perhaps one player in the game, and they're not the only player in the game.
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So there are other factors outside of the pelvic floor muscles that will play a role in how easily or how difficult birth is.
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So it could be the size of the baby, the position of the baby, other maternal factors, size of the pelvis, the maternal pelvis.
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So if you're a very petite person and with a very large baby, that's going to be more difficult.
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We can't do anything about those factors though.
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It's difficult because those factors are beyond our control.
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That's right.
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But that's why we need our good obstetric caregivers.
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Yeah.
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And it's all about trying to make sure we're talking together with our patients about those factors and considering them.
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What about things like ethnic background?
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Does that play any role in the risk of perineal injury or pelvic floor trauma in birth?
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Do you know?
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I'm actually not aware of any research on the differences from that perspective, but we know that different ethnicities may have different connective tissue.
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Yeah.
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So a different makeup of collagen.
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So that's considered to be quite important in, for example, prolapse, that the integrity of the collagen and the connective tissue can be a genetic factor that we again we can't control that.
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Yeah.
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But what we can do is compensate for any deficiencies by working on the things we do have control over, which is our muscle function.
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So those pelvic floor exercises that we talked about in part one and also perineal massage.
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That's right.
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From 34 weeks onwards and also during labour.
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And the warm compressors on the perineum and positioning the mother's position to reduce the pressure and the speed of the stretch on the perineum by being forward-leaning, kneeling on hands and knees.
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Mm-hmm.
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Great.
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And I suppose you mentioned post-birth, if you have a vaginal birth, it's fairly normal to feel some difference in your pelvic floor, of course, isn't it?
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Because it's been through a huge load, a huge stretch.
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An upheaval.
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An upheaval in the biggest possible way.
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Yes.
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What are some of the symptoms that people might feel in those first few weeks post-birth that we want to reassure people about that's completely expected and normal?
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And when should we be concerned?
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It's not uncommon to feel some discomfort.
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So depending on the difficulty of the birth and any physical trauma that has occurred to the tissues, that will determine how much discomfort, perineal discomfort, or vaginal discomfort, or pelvic area discomfort the woman feels.
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So it's not unusual to feel some degree of discomfort.
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The more intense the pain is, of course, we do want women to talk to their doctor about that or their maternal and child health nurse.
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So that we're making sure that there's nothing that's been missed and that does need medical attention.
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But it's quite common, as you say, from the upheaval you've been through, to have some degree of discomfort, swelling.
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And for some women, there's a degree of numbness initially, that they have no sensation because the there's been such a stretch.
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And the nerves are part of the stretch.
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So while the muscle stretches, so does everything else in that area.
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So nerves, ligaments, muscles, blood vessels will all undergo some degree of stretch and compression.
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So that can affect their function as well.
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And that's why there is a recovery period.
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So those tissues don't bounce back within 24 hours.
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And that period of recovery depends on many factors and is different for most women.
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But up to six weeks and up to three months for some women if there's been more difficulty with the birth.
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So there are some symptoms that women or sensations that women may feel after birth that are quite expected and normal.
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And they would include a feeling of swelling because of the process of childbirth and the stretching, there will be some inflammation and swelling.
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Like if you strain your knee or your ankle ligaments, there's always swelling.
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So it's not unusual to have some swelling.
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Discomfort, most women will have some degree of discomfort because they have been through an enormous upheaval.
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So we just want to make sure that that discomfort does settle and doesn't escalate with increasing pain.
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So a degree of swelling that should go down, a degree of discomfort that should go down, sensation should return.
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There may be some numbness or altered feeling initially that should return to normal within six to twelve weeks.
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And control, bladder and bowel control, that they're important too.
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So any loss of control of the bladder or bowel that doesn't improve or gets any worse, that's also something to be aware of and to make sure you talk to your maternal and child health nurse or doctor.
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So be alert for those things.
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They should all be improving gradually over the first six to twelve weeks, right?
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Depending on what's happened with your birth.
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And if you're concerned about is this normal for me, certainly talk to your healthcare team when you've given birth and ask them what would they expect you to be feeling over the next few weeks.
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And they will know, given the type of birth and the difficulty of birth, what should be normal for you to expect.
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And I suppose anything that is particularly bothering you and uncomfortable is not something that you should keep to yourself.
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Absolutely not.
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So definitely discuss those sensations with your team.
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But the good thing is to remember that there are things we can do to help improve our recovery.
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So we have a couple of acronyms called Peace and Love.
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Oh, great.
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So PEACE stands for protection, elevation, avoid in anti-inflammatory drugs, compression and education.
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So they're the things that we would recommend for the first few days after birth.
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That's the PEACE episode, where you really should be relaxing as much as possible and lying horizontal and not up on your feet and being too active because your tissues have been through that stretch we've discussed.
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So for them to recover, you want to have as little loading on the tissues as possible.
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So that's the protection.
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Don't overload the tissues.
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Elevation, if you've got a swollen ankle, you would always have your leg up on a pillow or a chair.
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So that will help reduce the swelling.
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Avoiding anti-inflammatories in those first few days, if you can, but under medical advice, if they're required, they're required.
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Compression, so having a pad and wearing firm-fitting, for example, lycra bike shorts on top of your underwear, and being aware of avoiding pressure, for example, constipation can be a big challenge in those first few days if you've been on some analgesic medication for pain.
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It's important to try to avoid being constipated because that will push down again on your pelvic floor like childbirth.
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And many people describe how difficult that's particularly first bowel action after birth.
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Yes, absolutely.
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So to try to minimize that uh strain by having good fluid intake those first few days at least, and good fibre, and you may need to supplement it with some natural supplements of fibre to try to avoid that bowel action being an overload on the pelvic floor.
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Yeah, because everything's so sensitive at that point.
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Yes.
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And then the love?
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Yes.
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So then after the first few days or week or a couple of weeks again, depending on your own personal circumstances, then we want some love to the pelvic floor.
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And so that stands for load, optimism, vascularisation, and exercise.
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So what we want to do is still be very mindful of the load, not overloading.
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When we've had an injury anywhere in the body, we need to gradually increase the loading to those tissues so that they do respond to the application or the pressure of the load, but in a controlled way, not an overload.
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So being mindful of lifting heavy things around the house, laundry baskets, the weight of your baby is about uh the best guard.
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Exactly.
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If it weighs more than your baby, try to get some help.
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Optimism, feeling uh as optimistic as you can, even though at that time you might be in a fog of sleeplessness and discomfort and fatigue, etc., but all of that will recover and pass.
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Vascularization, we do want good blood supply to the pelvic floor area to help the healing and the inflammatory process.
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And exercise is one of the ways we can achieve that.
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As we said earlier, as you contract a muscle, it's a muscle pump.
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So you are pumping the fresh blood and nutrients into the area and then they pump out.
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So that's why it is a good idea to start pelvic floor muscle exercises postnatally.
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You could give a give yourself a rest for a couple of days, but you might want to start with the first week, gently tightening and letting go so that you're getting that muscle pump to help reduce the swelling and return sensation and good blood flow to the area, and gradually increasing your pelvic floor muscle exercise program so that by about six weeks postnatal you'd be back to where you were at the end of the pregnancy.
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In terms of how often we're not sure.
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Correct.
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Being doing that two and eight is great.
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Okay, great.
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Three, four days a week.
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Oh, that's really good to know because I think there's probably a a common misconception that you really need to rest that pelvic floor without doing those pelvic fluorocises for the first six weeks or so.
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No, in fact, that will give you atrophy and further weakness is the old saying, use it or lose it.
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So we know that if you don't exercise a muscle for a couple of days, you start to lose strength.
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Just a couple of days.
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Just a couple of days.
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Wow.
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And that's the same with every muscle in the body.
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So if you've had surgery or an injury and you're resting that muscle, very quickly you'll be weak in that muscle.
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And then you're more at risk of injury.
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So a weak pelvic floor muscle that is not exercised at all for six weeks is at a higher risk then of overload, whether that's difficulty with a bowel action or you're desperate to get back to exercise and play netball and go running at six weeks, but your pelvic floor muscles have been sleeping for six weeks, that's not a good combination.
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So we do want to gradually increase the strength and get recovery back into the muscle by gradually increasing your exercise program.
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And you'll be doing other exercise as well, walking, of course, walking with Pram, you might have a dog as well for a bit more pace.
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So you will be gradually increasing your general exercise levels over six weeks.
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So of course you need your pelvic floor muscles to be building up as well.
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To support that.
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Correct.
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And you'd obviously be advising to be guided by your own comfort as well.
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So if those pelvic floor exercises are uncomfortable, then just go slow and build up.
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And moderate what you're doing.
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So going back to those factors that we said be aware of early postnatally, such as swelling, discomfort, altered sensation, or loss of bladderal bowel control, keep an eye on those so that as your pelvic floor muscle is strengthening, they should all be improving.
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But if they're not, then it's definitely time to see somebody.
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And doing a pelvic floor muscle exercise should not hurt.
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So if you're gently tightening and drawing in, you're actually bringing the tissues that have been injured or stretched or torn together.
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You're not stretching them apart.
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That's where the injury occurs and the pain.
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So initially you might think, oh, it's a very weird sensation.
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So you do it very gently, but that should improve and normalize over six weeks.
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Great.
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And it's really reassuring to know that we can start early with maintaining our strength and recovering with the pelvic floor.
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How long would you recommend someone wait before they say get back into that normal exercise that you described, like perhaps playing sport or going for a run?
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Yes.
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That kind of thing.
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Yes, because we've got to remember the benefits of exercise, and we had a previous episode on that, and it's hugely important.
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So we do want to encourage women postnatally to resume exercise, and unfortunately, too few women do.
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Yes.
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So the rates of return to exercise postnatally are disappointingly low.
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And that means women often never get back to the level of exercise they were doing previously, and we don't meet the physical activity guidelines, and the the levels are lower in women than men.
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So we have fewer women who are exercising even at the minimum level required for good health.
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So we want to do as much as we can in that early postpartum period to encourage women to resume exercise.
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But it's a balancing act.
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We want people to do the exercise they love because they're more likely to do it.
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Whereas if you tell someone to do an exercise they don't enjoy, you won't have any adherence.
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So if they love something that is a load to the pelvic floor, such as an impact exercise, running, jumping, netball, whatever the activity is, the pelvic floor muscle needs to be strong enough to cope with that load.
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So we would need to build up the exercise program, the pelvic floor muscle training program, to withstand that load.
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A good test is if you're doing an exercise that involves some jumping, try a jump at home on a full bladder.
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And if you can't prevent leakage, that means your exercise activity, fitness activity may well cause some leakage.
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And that's not a good thing because it means it's overloading your pelvic floor muscles.
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But there's a lot of exercise you can do that doesn't overload the pelvic floor muscle and still give you the benefit of exercise, which is great for your general fitness, good health, mental health as well as physical health and weight control.
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So that's another factor, of course, that women are concerned about postnatally is losing excessive weight that they've gained.
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And the best way to do that is exercise combined with good diet.
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So if you can't exercise, it's a struggle to lose weight.
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So we do want exercise, but we need it to be safe for the pelvic floor muscles so that we get our pelvic floor muscle stronger as we increase the load on the pelvic floor.
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So if you were a runner, you would start by walking slowly, building up, and then walking faster, and then gentle jogging and then increasing your distance.
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And if you're noticing any pelvic floor symptoms or sensations like leakage or heaviness or bulging, that might be a sign that your pelvic floor muscles are not yet ready for that amount of load.
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And that's where it would be good to see a pelvic health physiotherapist if you can access one to get an individualized exercise program and help you get to where you want to be with your general fitness and exercise.
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And you might need to reduce the load for a while, such as doing bike riding, stationary cycling, swimming, aquaobics, all those exercises that are good for your general health and mental health and weight control, but don't compromise your pelvic floor muscles while they're recovering.
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Great.
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So there's definitely a path forward Absolutely, lots of options, lots of options where people can strengthen that pelvic floor, start early, be guided by their comfort, and return to their normal exercise.
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That's what we want.
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So that we generally have good physical activity and health and fitness in our postnatal mums.
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Great.
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Really positive and optimistic, I think, because I think it's a common issue.
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As you said, you know, over half of women who have a pregnancy will have some kind of uh potential problem with their pelvic.
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About a third.
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About a third about it.
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Postnatally, yeah.
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Um so that's really important that and reassuring to know that it's you're not alone.
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It's really common.
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But there's lots of things that we can do about it.
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There are positive things you can do, and then there are things to avoid, such as heavy lifting, um not using your pelvic floor muscles when you do try to lift.
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Make sure you lift with good posture so you don't strain your back.
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No point having a good pelvic floor muscles, but back pain and neck pain.
00:20:47.279 --> 00:20:49.039
So we want to look after our whole body.
00:20:49.359 --> 00:20:59.200
So for general good health, for back pain and back support, because you're going to be needing to care for your baby for a long time and feeding and changing and lifting and carrying.
00:20:59.279 --> 00:21:05.759
So you also need your back and neck and arms and general posture to be working in your favour as well.
00:21:06.240 --> 00:21:08.319
Good physiotherapy principles.
00:21:08.559 --> 00:21:09.279
Yes, that's right.
00:21:09.440 --> 00:21:11.759
General, general body principles, yes.
00:21:30.880 --> 00:21:34.559
And how about subsequent pregnancy?
00:21:34.720 --> 00:21:35.119
Yes.
00:21:35.359 --> 00:21:42.160
What is the evidence for how that might impact the pelvic floor, having multiple pregnancies?
00:21:42.240 --> 00:21:48.400
And is there any recommendation as to the interval between pregnancies that we talk about?
00:21:49.119 --> 00:21:51.839
Yes, well, all of these things can affect your pelvic floor.
00:21:51.920 --> 00:21:52.480
You're right.
00:21:52.720 --> 00:21:58.960
I think would you recommend two years, or is the World Health Organization recommendation two approximately two years?
00:22:00.160 --> 00:22:06.880
Roughly the recommendation, but that is a holistic, I think, recommendation for multiple factors, not just the pelvic tool.
00:22:06.960 --> 00:22:16.000
That's certainly a factor, but also in terms of optimizing time for breastfeeding, if that's something that that you're choosing to do, emotional and mental well-being.
00:22:16.079 --> 00:22:26.240
It's certainly for many people who have, you know, two under two years, they know how demanding that can be on individuals and families and other children.
00:22:26.400 --> 00:22:29.519
So I think in general, that's a general recommendation.
00:22:29.680 --> 00:22:29.920
Yes.
00:22:30.160 --> 00:22:32.720
Which incorporates the pelvic floor for sure.
00:22:33.119 --> 00:22:33.519
That's right.
00:22:33.920 --> 00:22:36.000
And a good idea for all of those reasons.
00:22:36.319 --> 00:22:44.880
In terms of the pelvic floor, we do see that the risk of developing incontinence is highest with your first pregnancy.
00:22:45.119 --> 00:22:46.000
So interesting.
00:22:46.319 --> 00:22:51.839
Yes, it's not that it just gets worse and worse with every pregnancy or a higher risk.
00:22:52.079 --> 00:22:57.599
So in fact, the first is the biggest risk to the pelvic floor muscles for incontinence.
00:22:58.640 --> 00:23:01.680
However, prolapse has a different pattern.
00:23:02.079 --> 00:23:14.640
So the repeated stretching, loading and stretching and birth process tends to increase prolapse with each subsequent birth, but not necessarily incontinence.
00:23:14.880 --> 00:23:15.119
Okay.
00:23:15.599 --> 00:23:21.200
Again, if nothing we can do about that if that's your life choice and your birth choices.
00:23:21.359 --> 00:23:28.960
However, we know that pelvic floor muscle training has high level of evidence for treating both incontinence and prolapse.
00:23:29.200 --> 00:23:42.880
So whether you have three pregnancies or four, and you have some incontinence after each, by doing pelvic floor muscle training, that's the best evidence for reducing the incontinence between and after.
00:23:43.039 --> 00:23:44.240
And the same for prolapse.
00:23:44.640 --> 00:23:44.960
Yeah.
00:23:45.119 --> 00:23:45.279
Okay.
00:23:45.599 --> 00:23:46.240
That's good to know.
00:23:46.559 --> 00:23:50.240
For mild to moderate prolapse, severe prolapse may require surgery.
00:23:50.799 --> 00:23:59.200
But for mild to moderate, which is the majority, and for incontinence, pelvic floor muscle training would be your go-to treatment in the first instance.
00:23:59.680 --> 00:24:00.559
Well that's encouraging.
00:24:00.799 --> 00:24:00.960
Yes.
00:24:01.119 --> 00:24:01.279
Yeah.
00:24:01.519 --> 00:24:02.559
Again, something you can do.
00:24:02.880 --> 00:24:05.920
And something that's relatively low risk and easy to do.
00:24:06.240 --> 00:24:06.400
Yes.
00:24:07.200 --> 00:24:16.400
And in terms of prolapse, I think, as you mentioned, it can be severe, but again, we're really guided by people's symptoms and how much it's bothering them, aren't we?
00:24:16.559 --> 00:24:21.839
Trevor Burrus That is the number one factor that determines what treatment, if any, you you choose to have.
00:24:22.400 --> 00:24:27.440
So you can actually have evidence of prolapse when you're examined, but feel nothing.
00:24:27.920 --> 00:24:32.240
So if the prolapse is mild, you may not be aware that you have a prolapse.
00:24:32.400 --> 00:24:41.839
So there'd be no indication for any major treatment, but pelvic floor muscle training would be a good idea to prevent that mild prolapse from becoming more bothersome.
00:24:42.000 --> 00:24:44.480
Whereas any degree of incontinence, you're aware of it.
00:24:44.880 --> 00:24:44.960
Yes.
00:24:45.200 --> 00:24:45.599
That's the difference.
00:24:46.400 --> 00:24:47.279
It's hard not to be aware of it.
00:24:47.680 --> 00:24:52.640
That's right, because it's it's obvious and you feel it, whereas with a mild prolapse you may not.
00:24:52.720 --> 00:24:58.960
So any degree of incontinence means there is incontinence and pelvic floor muscle training is the first go-to.
00:24:59.519 --> 00:25:04.000
We'll do a separate topic on on this specifically, but just to touch on it.
00:25:04.400 --> 00:25:09.279
Sexual dysfunction in regards to the pelvic floor after birth.
00:25:09.599 --> 00:25:18.480
What would you recommend in terms of time for rest of the pelvic floor from that point of view after a birth vaginally?
00:25:18.640 --> 00:25:19.039
Yes.
00:25:19.279 --> 00:25:25.279
And how would you guide people to know when might be the right time to resume sexual activity?
00:25:25.519 --> 00:25:25.839
Yes.
00:25:26.079 --> 00:25:30.319
What are the normal things that people might feel the first time they're trying to have intercourse after the phone?
00:25:30.640 --> 00:25:39.920
Yeah, sexual dysfunction is quite a complex problem, unlike incontinence or prolapse, which are more single-dimension and anatomical and mechanistic.
00:25:40.079 --> 00:25:40.160
Yes.
00:25:40.400 --> 00:25:48.079
Whereas sexual dysfunction or a problem with sexual function, if you like, can be caused by a multitude of factors, not just the tissues.
00:25:48.319 --> 00:25:48.559
That's right.
00:25:48.799 --> 00:25:51.119
Which is the difference then with incontinence and prolapse.
00:25:51.359 --> 00:26:04.079
So if it's caused by other factors, obviously you need to address those, whether it's your emotional health, well-being, relationship, hormonal factors which affect your degree of lubrication.
00:26:04.240 --> 00:26:13.599
So there are many factors that are not related to the pelvic floor muscles, but some are because of the effect of childbirth on the pelvic floor muscle, as we've discussed.
00:26:13.759 --> 00:26:20.720
That muscle will have stretched, may have sustained some degree of injury, and be in the process of recovery.
00:26:20.960 --> 00:26:28.960
So, like any muscle, if it's had an injury, it's going to be uncomfortable if you press it, stretch it, attempt to use it too much.
00:26:29.359 --> 00:26:38.319
So discomfort the first time you resume vaginal sexual activity is not uncommon postnatally.
00:26:38.480 --> 00:26:42.559
So you want to wait until you've got some degree of healing.
00:26:42.799 --> 00:26:49.359
So that will depend on the birth, but for many women it'll be several weeks, if not six or more.
00:26:49.839 --> 00:26:57.200
So not to be alarmed, if it's six weeks, any touch around the vaginal area is still very uncomfortable.
00:26:57.440 --> 00:27:01.119
It might mean that you're you're needing more time and recovery.
00:27:01.359 --> 00:27:05.119
But some things can help, such as using adequate lubrication.
00:27:05.279 --> 00:27:19.599
So if your natural lubrication is compromised for any reason, whether that's fatigue and crying baby and emotional well-being, etc., then that might lower your usual arousal mechanisms to help your lubrication.
00:27:20.079 --> 00:27:21.279
Also adding hormonally.
00:27:22.079 --> 00:27:24.480
That is actually what happens, isn't it, with breastfeeding?
00:27:24.720 --> 00:27:25.039
Very true.
00:27:26.319 --> 00:27:27.359
It's going to be suppressed.
00:27:28.160 --> 00:27:28.319
Yes.
00:27:29.039 --> 00:27:31.759
So adding some lubrication is a very good idea.
00:27:31.839 --> 00:27:37.039
And again, we we talked about using edible oils, natural oils, for perineal massage.
00:27:37.119 --> 00:27:39.359
It's the same for sexual activity.
00:27:39.519 --> 00:27:46.240
So you can buy sexual activity lubrication from a pharmacy, but you can also use oils just as comfortably.
00:27:46.559 --> 00:27:46.799
Great.
00:27:47.119 --> 00:27:48.799
So that means you don't need to buy anything extra.
00:27:49.039 --> 00:27:49.440
Yes.
00:27:49.920 --> 00:28:01.359
And surprisingly or not surprisingly, pelvic floor muscle exercises have good evidence for improving sexual dysfunction because of those factors we talked about before, the muscle pump.
00:28:01.519 --> 00:28:06.799
So when you exercise the muscle, you contract and relax and you get more blood flow through the area.
00:28:06.960 --> 00:28:09.359
So it's generally a healthier muscle.
00:28:09.599 --> 00:28:16.559
So that has been shown in research that if you do pelvic floor muscle exercises, it has a good effect on sexual dysfunction.
00:28:17.119 --> 00:28:30.960
In terms of discomfort, it depends whether that discomfort is due to some of those other factors we discussed, the hormones, lubrication, injury, the recovery of your injury, and that that's just going to take some time.
00:28:31.200 --> 00:28:58.799
And that's where some of that, not exactly the perineal massage, but if the the problem postnatally is that the muscle has tightened with some scar tissue, then your pelvic health physiotherapist can do some gentle massage of the muscle and the vaginal tissues, like we would use elsewhere in the body after an injury or surgery where the skin and the connective tissue are tightening around the injured muscle.
00:28:59.119 --> 00:29:00.240
Like remedial massage.
00:29:00.480 --> 00:29:00.799
Correct.
00:29:01.039 --> 00:29:03.759
Some gentle stretching muscle uh massage.
00:29:04.000 --> 00:29:04.319
Mm-hmm.
00:29:04.960 --> 00:29:05.359
Great.
00:29:05.599 --> 00:29:12.400
So again, really important to know that sexual dysfunction after a birth can be normal.
00:29:12.640 --> 00:29:12.880
Correct.
00:29:13.279 --> 00:29:14.000
It's quite common.
00:29:14.240 --> 00:29:14.400
Correct.
00:29:14.720 --> 00:29:23.599
But potentially reversible and often something that will get better with time and can be benefited from pelvic fluorexis.
00:29:23.920 --> 00:29:24.240
That's right.
00:29:24.480 --> 00:29:28.480
And of course it's hard not to feel distressed about it because it is very distressing.
00:29:28.640 --> 00:29:41.279
And pain anywhere in the body is distressing, but particularly in our pelvic area and vaginal area, it's very distressing if an activity that we'd like to feel pleasure with is causing us pain.
00:29:41.519 --> 00:29:53.839
So it's very important to discuss that with your healthcare provider if you feel comfortable, so that you can receive some good advice and confidence that it will improve with time, recovery, and some good treatment.
00:29:54.079 --> 00:30:01.119
For example, you might need to see a pelvic floor physiotherapist to get some direct treatment to the tissues if that's part of the problem.
00:30:01.839 --> 00:30:09.039
We've discussed pelvic floor exercises so much, and it obviously there's so much benefit in doing them at any stage of life.
00:30:09.440 --> 00:30:19.119
Would you recommend, in general, if we have the means to, that everybody consult a pelvic floor physiotherapist in pregnancy and postpartum?
00:30:19.759 --> 00:30:26.400
Ideally, if there's any time in your life that it would be grand to have that opportunity, that would be it.
00:30:26.640 --> 00:30:32.559
A window of opportunity, we'd call it, because that's a time of high risk to the pelvic floor.
00:30:33.039 --> 00:30:40.240
So if there's only one opportunity in your life to see a pelvic floor physiotherapist, yes, that's a good idea during the childbearing year.
00:30:40.480 --> 00:30:40.640
Yeah.
00:30:40.880 --> 00:30:41.119
Yes.
00:30:41.519 --> 00:30:45.119
And you don't need many appointments with that healthcare professional, do you?
00:30:45.440 --> 00:30:45.920
It depends.
00:30:46.000 --> 00:30:51.119
If you have no symptoms but you're taking a preventative approach, one appointment might be sufficient.
00:30:51.599 --> 00:31:01.359
If you actually have symptoms and you've had them for some time and the haven't improved off your own resources and self-management, it may take several appointments.
00:31:01.759 --> 00:31:13.599
So it's important to be realistic about what is required for physiotherapy treatment, unlike medication or surgery, where you don't have to do anything yourself.
00:31:13.839 --> 00:31:17.359
The treatment is doing it for you, the surgical or the drug treatment.
00:31:17.680 --> 00:31:24.799
For any physiotherapy treatment, usually you do need to be involved in improving and doing it with the physiotherapist.
00:31:24.880 --> 00:31:30.079
So that might mean exercise, changing your lifestyle, doing things differently.
00:31:30.319 --> 00:31:32.400
And the effects take time.
00:31:32.880 --> 00:31:40.640
As we discussed before, if you wanted to get fit or lose weight, it's not going to happen with one session at the gym or with a personal trainer.
00:31:41.119 --> 00:31:46.640
So any change to our tissues that we need to make ourselves is going to take time.
00:31:46.799 --> 00:32:02.559
So most of the research that has tested physiotherapy to do pelvic floor muscle training to treat incontinence or prolapse or pelvic pain or sexual dysfunction usually requires a course of treatment, six to eight weeks, maybe three months.
00:32:02.960 --> 00:32:03.119
Okay.
00:32:03.519 --> 00:32:19.759
So if you can factor that in, and you may then need occasional follow-ups during other periods of your life when you're at high risk other changes or you get the flu, and you're coughing and sneezing, and your pelvic fore muscles have suffered a bit under that load again.
00:32:20.400 --> 00:32:23.599
So there might be top-ups throughout your life.
00:32:23.680 --> 00:32:26.799
But think of it as like an exercise or a fitness program.
00:32:26.960 --> 00:32:28.240
You need to do something yourself.
00:32:28.319 --> 00:32:33.599
The physiotherapist needs time to help you, so it may take six to eight weeks.
00:32:34.079 --> 00:32:35.759
Which is a relatively short space.
00:32:36.160 --> 00:32:36.720
In scheme of things.
00:32:38.160 --> 00:32:45.839
And as you said, thinking beyond this childbearing window of time, the pelvic floor can be under stress for many other reasons.
00:32:46.079 --> 00:32:46.400
That's right.
00:32:46.720 --> 00:32:49.680
Such as infection where we might have chronic coughing.
00:32:50.000 --> 00:33:06.160
But certainly as we get older and we go through hormonal changes, perimenopause, menopause, postmenopausal, these issues that we've talked about with the pelvic floor can become more apparent as well.
00:33:06.720 --> 00:33:06.960
That's it.
00:33:07.279 --> 00:33:10.240
So we think of it as a compounding situation.
00:33:10.480 --> 00:33:26.799
So while you might have got through your childbearing years without too many symptoms of pelvic floor dysfunction or problems, you might notice that with aging and the effects of menopausal changes, you then become aware of pelvic floor problems where you might not have had them before.
00:33:27.279 --> 00:33:30.400
So it's a bit like overloading.
00:33:30.640 --> 00:33:31.759
There's a threshold.
00:33:31.920 --> 00:33:33.920
We call it the pelvic floor threshold.
00:33:34.319 --> 00:33:44.240
And below that threshold, you may have had activities or events that have compromised your pelvic floor, but you're managing and you don't feel any symptoms.
00:33:44.480 --> 00:33:52.880
But as life events build up and start overloading, you cross over your threshold of becoming aware of symptoms.
00:33:53.119 --> 00:33:56.319
It doesn't mean that anything dramatic has happened.
00:33:56.720 --> 00:34:00.640
It's just that accumulation of several things that are working against you.
00:34:00.960 --> 00:34:04.000
And that's when you might need a good course of treatment.
00:34:04.400 --> 00:34:04.559
Yeah.
00:34:04.640 --> 00:34:06.079
And to up those pelvic fluoride.
00:34:06.480 --> 00:34:08.800
Correct, and just to get your threshold higher.
00:34:09.119 --> 00:34:13.039
But it's really important to know, I think, that it's very common.
00:34:13.440 --> 00:34:14.079
Very common.
00:34:14.320 --> 00:34:16.159
But that something can be done about it.
00:34:16.480 --> 00:34:16.719
Absolutely.
00:34:17.360 --> 00:34:31.760
I think I often find that it's a symptom, whether it's pre-pregnancy, in-pregnancy, postpartum, or beyond, or any of these symptoms are things that people often dismiss, may feel ashamed about, embarrassed about.
00:34:32.239 --> 00:34:41.920
But it is certainly something that we should be talking more about with our close friends or health professionals so that we can do something about it.
00:34:42.239 --> 00:34:48.400
That's it, because information and knowledge is power and gives you the opportunity to choose what you'd like to do.
00:34:48.559 --> 00:35:04.719
But you're right, we do have low self-disclosure, meaning women don't volunteer this information because it is embarrassing, they feel there's some shame or stigma, or there could be cultural reasons for not disclosing their symptoms.
00:35:04.800 --> 00:35:18.719
And that's very sad because we have no uh barriers to disclosing other symptoms from other health problems, but anything to do with the pelvic floor, unfortunately, has historically been shrouded.
00:35:18.800 --> 00:35:18.960
Yeah.
00:35:19.199 --> 00:35:28.159
And we really need to encourage women to discuss these symptoms with somebody they trust who can give good advice because there is lots of help available.
00:35:28.480 --> 00:35:32.079
Yeah, and that's the important message I think is that we shouldn't be ashamed.
00:35:32.320 --> 00:35:32.639
That's right.
00:35:32.960 --> 00:35:39.760
It's something that we can be very proactive about and do something about, and it can significantly improve people's quality of life.
00:35:40.079 --> 00:35:40.559
It does.
00:35:40.719 --> 00:35:43.840
It absolutely does, which affects your physical health and your mental health.
00:35:44.400 --> 00:35:47.599
And to remind women that it's their choice.
00:35:47.760 --> 00:35:51.280
So whatever treatment option they choose, that is their choice.
00:35:51.440 --> 00:35:55.440
And some women will choose an option that another woman would not choose.
00:35:55.519 --> 00:36:00.480
But that's okay, you've got to weigh all the things up: access, time, all of those things.
00:36:01.760 --> 00:36:02.079
Correct.
00:36:02.559 --> 00:36:03.039
Yeah.
00:36:03.360 --> 00:36:06.239
That's a really great note, I think, to finish on.
00:36:06.400 --> 00:36:07.840
Thank you so much, Alina.
00:36:07.920 --> 00:36:23.840
I think we've covered a lot about, again, about the pelvic floor, how it changes in birth and postpartum, what can be common and normal, and how reassuring it is that we can actually do a lot about those common symptoms that we feel postpartum and beyond.
00:36:24.000 --> 00:36:24.239
Absolutely.
00:36:24.639 --> 00:36:26.159
A lot of it is within our control.
00:36:26.239 --> 00:36:28.159
So thank you so much, Alina.
00:36:28.559 --> 00:36:31.280
Thanks very much, Rangy, for inviting me to participate.
00:36:31.599 --> 00:36:32.239
Thank you.
00:36:32.480 --> 00:36:34.159
Every pregnancy is unique.
00:36:34.320 --> 00:36:39.599
The information provided in today's podcast is for educational and general purposes only.
00:36:39.760 --> 00:36:43.519
It is not intended to be substitute for professional medical advice.
00:36:43.760 --> 00:36:54.159
It is important that you always seek the guidance of qualified health professionals with any questions you may have regarding your health, pregnancy, or any medical conditions.
00:00:01.439 --> 00:00:09.839
Welcome to Prepare, the Mimisi Prenatable podcast dedicated to helping parents prepare for the journey of pregnancy, childbirth, and early parenthood.
00:00:10.080 --> 00:00:22.320
Mimessi Prenatal would like to begin by acknowledging the Rawundri Wu-Warung people, traditional custodians of the land on which we gather today, and also the traditional custodians of the lands in which you're listening from today.
00:00:22.559 --> 00:00:31.600
We'd like to pay our respects to the elders past, present and emerging, and we extend that respect to Aboriginal and Torres Strait Islander peoples listening today.
00:00:31.920 --> 00:00:34.799
Hi everyone, welcome back to another episode of Prepare.
00:00:34.960 --> 00:00:35.520
My name's Dr.
00:00:35.600 --> 00:00:38.079
Rangi DeSilva, and I'm your host.
00:00:38.240 --> 00:01:04.400
And today we are again so excited to be joined by Professor Helena Frawley, who is our pelvic floor expert, and we talked about what is the pelvic floor, how does it change both before and during pregnancy and birth in our previous episode, and more importantly, what we can do to try and help support our pelvic floor, strengthen our pelvic floor at every stage.
00:01:04.640 --> 00:01:16.159
And today we're going to be talking more about how the pelvic floor changes in birth and what we can do after birth to help make sure it's the best it can be.
00:01:16.480 --> 00:01:19.840
So thank you again, Professor Helena Frawley, for joining us.
00:01:20.079 --> 00:01:24.239
Thank you, Rangi, for inviting me back, and it's a pleasure to be here discussing this topic with you.
00:01:24.640 --> 00:01:36.640
So just quickly, we did cover it briefly in our part one of this topic, but how does the pelvic floor change during pregnancy or the later stages of pregnancy and birth itself?
00:01:37.040 --> 00:01:37.359
Yes.
00:01:37.519 --> 00:01:47.280
So during pregnancy there are changed levels of hormones which will help the pelvic floor muscle relax for birth and stretch.
00:01:47.439 --> 00:01:50.079
So we have increased elasticity in the muscle.
00:01:50.400 --> 00:01:58.640
During birth, the muscle will undergo quite a significant stretch, up to two and a half times its normal length.
00:01:58.799 --> 00:02:08.879
So if you think of a muscle that you then stretch beyond its normal resting length and two and a half times, like a bicep or hamstrings, that's a significant stretch.
00:02:09.520 --> 00:02:12.240
But our body is built to do that.
00:02:12.479 --> 00:02:16.800
However, it may not always bounce straight back postnatally.
00:02:16.960 --> 00:02:23.919
So there may be a period of weakness and laxity, as we say, so a loss of support.
00:02:24.159 --> 00:02:27.439
And the best way to help that is through exercise.
00:02:27.759 --> 00:02:34.240
And we can talk about what to do postnatally in a few minutes in terms of how to build up that program of recovery.
00:02:34.400 --> 00:02:38.879
But yes, during birth, the muscle is under load and stretch.
00:02:39.120 --> 00:02:45.520
But we do have good blood vessels in the area, so they will help bring healing to the muscle.
00:02:45.919 --> 00:02:48.639
It's completely something that we can work on and support.
00:02:49.039 --> 00:02:54.400
Yes, it's a normal process we need it to happen to allow birth, and then we can work on the recovery.
00:02:54.639 --> 00:03:03.520
Not everybody has any consequences or long-lasting effects of birth, but up to a third of women do postnatally.
00:03:04.000 --> 00:03:14.319
And some of it will be because of that large amount of stretch that the muscle and the tissues, the ligaments and the connective tissues went through during the process of birth.
00:03:14.879 --> 00:03:26.240
And sometimes there's increased risk from assisted deliveries, the use of forceps and other factors that can occur to ensure a safe delivery and a healthy baby.
00:03:26.560 --> 00:03:29.360
But they may also compromise the pelvic floor muscles.
00:03:29.759 --> 00:03:39.360
So that is important when we're discussing if there's a situation where, as the clinician involved, we we might think that that's the best course of action.
00:03:39.520 --> 00:03:46.240
But that's something that we would discuss with you in terms of potential risk factors or risks of that happening.
00:03:47.520 --> 00:03:54.719
What are some of the other risk factors for pelvic floor compromise or damage during labour?
00:03:54.960 --> 00:04:00.879
You kind of mentioned a couple of them briefly, but maybe things like the size of the baby.
00:04:01.280 --> 00:04:07.199
Yeah, so the pelvic floor muscles are perhaps one player in the game, and they're not the only player in the game.
00:04:07.280 --> 00:04:15.759
So there are other factors outside of the pelvic floor muscles that will play a role in how easily or how difficult birth is.
00:04:15.919 --> 00:04:23.360
So it could be the size of the baby, the position of the baby, other maternal factors, size of the pelvis, the maternal pelvis.
00:04:23.600 --> 00:04:29.199
So if you're a very petite person and with a very large baby, that's going to be more difficult.
00:04:29.439 --> 00:04:31.360
We can't do anything about those factors though.
00:04:32.000 --> 00:04:34.079
It's difficult because those factors are beyond our control.
00:04:34.480 --> 00:04:34.800
That's right.
00:04:34.879 --> 00:04:37.279
But that's why we need our good obstetric caregivers.
00:04:37.759 --> 00:04:38.000
Yeah.
00:04:38.079 --> 00:04:45.920
And it's all about trying to make sure we're talking together with our patients about those factors and considering them.
00:04:46.639 --> 00:04:49.360
What about things like ethnic background?
00:04:49.600 --> 00:04:55.360
Does that play any role in the risk of perineal injury or pelvic floor trauma in birth?
00:04:55.439 --> 00:04:55.839
Do you know?
00:04:56.319 --> 00:05:06.800
I'm actually not aware of any research on the differences from that perspective, but we know that different ethnicities may have different connective tissue.
00:05:07.199 --> 00:05:07.360
Yeah.
00:05:07.680 --> 00:05:09.839
So a different makeup of collagen.
00:05:10.639 --> 00:05:24.000
So that's considered to be quite important in, for example, prolapse, that the integrity of the collagen and the connective tissue can be a genetic factor that we again we can't control that.
00:05:24.240 --> 00:05:24.399
Yeah.
00:05:24.720 --> 00:05:32.720
But what we can do is compensate for any deficiencies by working on the things we do have control over, which is our muscle function.
00:05:33.360 --> 00:05:39.040
So those pelvic floor exercises that we talked about in part one and also perineal massage.
00:05:39.360 --> 00:05:39.600
That's right.
00:05:41.120 --> 00:05:43.600
From 34 weeks onwards and also during labour.
00:05:43.839 --> 00:05:56.079
And the warm compressors on the perineum and positioning the mother's position to reduce the pressure and the speed of the stretch on the perineum by being forward-leaning, kneeling on hands and knees.
00:05:56.240 --> 00:05:56.560
Mm-hmm.
00:05:57.199 --> 00:05:57.839
Great.
00:05:58.160 --> 00:06:08.959
And I suppose you mentioned post-birth, if you have a vaginal birth, it's fairly normal to feel some difference in your pelvic floor, of course, isn't it?
00:06:09.040 --> 00:06:12.000
Because it's been through a huge load, a huge stretch.
00:06:12.399 --> 00:06:12.959
An upheaval.
00:06:13.360 --> 00:06:16.720
An upheaval in the biggest possible way.
00:06:16.959 --> 00:06:17.120
Yes.
00:06:17.600 --> 00:06:26.560
What are some of the symptoms that people might feel in those first few weeks post-birth that we want to reassure people about that's completely expected and normal?
00:06:26.720 --> 00:06:28.639
And when should we be concerned?
00:06:29.120 --> 00:06:32.399
It's not uncommon to feel some discomfort.
00:06:32.639 --> 00:06:47.040
So depending on the difficulty of the birth and any physical trauma that has occurred to the tissues, that will determine how much discomfort, perineal discomfort, or vaginal discomfort, or pelvic area discomfort the woman feels.
00:06:47.279 --> 00:06:50.560
So it's not unusual to feel some degree of discomfort.
00:06:50.800 --> 00:06:57.839
The more intense the pain is, of course, we do want women to talk to their doctor about that or their maternal and child health nurse.
00:06:58.160 --> 00:07:04.000
So that we're making sure that there's nothing that's been missed and that does need medical attention.
00:07:04.160 --> 00:07:10.480
But it's quite common, as you say, from the upheaval you've been through, to have some degree of discomfort, swelling.
00:07:11.040 --> 00:07:17.600
And for some women, there's a degree of numbness initially, that they have no sensation because the there's been such a stretch.
00:07:17.680 --> 00:07:19.279
And the nerves are part of the stretch.
00:07:19.439 --> 00:07:23.120
So while the muscle stretches, so does everything else in that area.
00:07:23.199 --> 00:07:29.439
So nerves, ligaments, muscles, blood vessels will all undergo some degree of stretch and compression.
00:07:29.600 --> 00:07:32.319
So that can affect their function as well.
00:07:32.480 --> 00:07:35.040
And that's why there is a recovery period.
00:07:35.199 --> 00:07:38.720
So those tissues don't bounce back within 24 hours.
00:07:39.199 --> 00:07:44.800
And that period of recovery depends on many factors and is different for most women.
00:07:45.040 --> 00:07:51.680
But up to six weeks and up to three months for some women if there's been more difficulty with the birth.
00:07:52.240 --> 00:07:58.800
So there are some symptoms that women or sensations that women may feel after birth that are quite expected and normal.
00:07:58.879 --> 00:08:08.160
And they would include a feeling of swelling because of the process of childbirth and the stretching, there will be some inflammation and swelling.
00:08:08.319 --> 00:08:12.240
Like if you strain your knee or your ankle ligaments, there's always swelling.
00:08:12.399 --> 00:08:14.720
So it's not unusual to have some swelling.
00:08:14.879 --> 00:08:20.560
Discomfort, most women will have some degree of discomfort because they have been through an enormous upheaval.
00:08:21.040 --> 00:08:27.199
So we just want to make sure that that discomfort does settle and doesn't escalate with increasing pain.
00:08:27.519 --> 00:08:34.879
So a degree of swelling that should go down, a degree of discomfort that should go down, sensation should return.
00:08:34.960 --> 00:08:43.039
There may be some numbness or altered feeling initially that should return to normal within six to twelve weeks.
00:08:43.279 --> 00:08:46.720
And control, bladder and bowel control, that they're important too.
00:08:46.879 --> 00:08:58.639
So any loss of control of the bladder or bowel that doesn't improve or gets any worse, that's also something to be aware of and to make sure you talk to your maternal and child health nurse or doctor.
00:08:58.960 --> 00:09:01.519
So be alert for those things.
00:09:01.600 --> 00:09:06.720
They should all be improving gradually over the first six to twelve weeks, right?
00:09:07.360 --> 00:09:08.879
Depending on what's happened with your birth.
00:09:09.200 --> 00:09:19.600
And if you're concerned about is this normal for me, certainly talk to your healthcare team when you've given birth and ask them what would they expect you to be feeling over the next few weeks.
00:09:19.919 --> 00:09:26.159
And they will know, given the type of birth and the difficulty of birth, what should be normal for you to expect.
00:09:26.639 --> 00:09:34.159
And I suppose anything that is particularly bothering you and uncomfortable is not something that you should keep to yourself.
00:09:34.480 --> 00:09:35.120
Absolutely not.
00:09:35.200 --> 00:09:38.159
So definitely discuss those sensations with your team.
00:09:38.320 --> 00:09:42.960
But the good thing is to remember that there are things we can do to help improve our recovery.
00:09:43.120 --> 00:09:47.279
So we have a couple of acronyms called Peace and Love.
00:09:47.600 --> 00:09:48.240
Oh, great.
00:09:48.480 --> 00:09:56.720
So PEACE stands for protection, elevation, avoid in anti-inflammatory drugs, compression and education.
00:09:56.879 --> 00:10:01.279
So they're the things that we would recommend for the first few days after birth.
00:10:01.360 --> 00:10:13.279
That's the PEACE episode, where you really should be relaxing as much as possible and lying horizontal and not up on your feet and being too active because your tissues have been through that stretch we've discussed.
00:10:13.440 --> 00:10:18.480
So for them to recover, you want to have as little loading on the tissues as possible.
00:10:18.639 --> 00:10:19.919
So that's the protection.
00:10:20.080 --> 00:10:21.600
Don't overload the tissues.
00:10:21.840 --> 00:10:26.720
Elevation, if you've got a swollen ankle, you would always have your leg up on a pillow or a chair.
00:10:26.799 --> 00:10:28.879
So that will help reduce the swelling.
00:10:29.120 --> 00:10:35.600
Avoiding anti-inflammatories in those first few days, if you can, but under medical advice, if they're required, they're required.
00:10:35.840 --> 00:10:55.679
Compression, so having a pad and wearing firm-fitting, for example, lycra bike shorts on top of your underwear, and being aware of avoiding pressure, for example, constipation can be a big challenge in those first few days if you've been on some analgesic medication for pain.
00:10:56.000 --> 00:11:03.840
It's important to try to avoid being constipated because that will push down again on your pelvic floor like childbirth.
00:11:04.320 --> 00:11:08.879
And many people describe how difficult that's particularly first bowel action after birth.
00:11:09.200 --> 00:11:10.000
Yes, absolutely.
00:11:10.159 --> 00:11:27.120
So to try to minimize that uh strain by having good fluid intake those first few days at least, and good fibre, and you may need to supplement it with some natural supplements of fibre to try to avoid that bowel action being an overload on the pelvic floor.
00:11:27.440 --> 00:11:30.000
Yeah, because everything's so sensitive at that point.
00:11:30.240 --> 00:11:30.559
Yes.
00:11:30.960 --> 00:11:31.919
And then the love?
00:11:32.240 --> 00:11:32.480
Yes.
00:11:32.559 --> 00:11:40.720
So then after the first few days or week or a couple of weeks again, depending on your own personal circumstances, then we want some love to the pelvic floor.
00:11:41.279 --> 00:11:48.159
And so that stands for load, optimism, vascularisation, and exercise.
00:11:48.720 --> 00:11:53.759
So what we want to do is still be very mindful of the load, not overloading.
00:11:54.080 --> 00:12:07.919
When we've had an injury anywhere in the body, we need to gradually increase the loading to those tissues so that they do respond to the application or the pressure of the load, but in a controlled way, not an overload.
00:12:08.080 --> 00:12:15.519
So being mindful of lifting heavy things around the house, laundry baskets, the weight of your baby is about uh the best guard.
00:12:16.480 --> 00:12:16.720
Exactly.
00:12:16.879 --> 00:12:19.519
If it weighs more than your baby, try to get some help.
00:12:20.000 --> 00:12:33.039
Optimism, feeling uh as optimistic as you can, even though at that time you might be in a fog of sleeplessness and discomfort and fatigue, etc., but all of that will recover and pass.
00:12:33.519 --> 00:12:40.399
Vascularization, we do want good blood supply to the pelvic floor area to help the healing and the inflammatory process.
00:12:40.639 --> 00:12:43.440
And exercise is one of the ways we can achieve that.
00:12:43.600 --> 00:12:47.840
As we said earlier, as you contract a muscle, it's a muscle pump.
00:12:48.000 --> 00:12:53.360
So you are pumping the fresh blood and nutrients into the area and then they pump out.
00:12:53.600 --> 00:12:58.799
So that's why it is a good idea to start pelvic floor muscle exercises postnatally.
00:12:59.200 --> 00:13:25.519
You could give a give yourself a rest for a couple of days, but you might want to start with the first week, gently tightening and letting go so that you're getting that muscle pump to help reduce the swelling and return sensation and good blood flow to the area, and gradually increasing your pelvic floor muscle exercise program so that by about six weeks postnatal you'd be back to where you were at the end of the pregnancy.
00:13:25.759 --> 00:13:27.039
In terms of how often we're not sure.
00:13:27.200 --> 00:13:27.519
Correct.
00:13:27.759 --> 00:13:29.440
Being doing that two and eight is great.
00:13:29.759 --> 00:13:30.320
Okay, great.
00:13:30.639 --> 00:13:31.679
Three, four days a week.
00:13:32.000 --> 00:13:44.000
Oh, that's really good to know because I think there's probably a a common misconception that you really need to rest that pelvic floor without doing those pelvic fluorocises for the first six weeks or so.
00:13:44.559 --> 00:13:51.759
No, in fact, that will give you atrophy and further weakness is the old saying, use it or lose it.
00:13:52.080 --> 00:13:56.960
So we know that if you don't exercise a muscle for a couple of days, you start to lose strength.
00:13:57.279 --> 00:13:58.000
Just a couple of days.
00:13:58.240 --> 00:13:59.120
Just a couple of days.
00:13:59.279 --> 00:13:59.600
Wow.
00:14:00.000 --> 00:14:02.240
And that's the same with every muscle in the body.
00:14:02.320 --> 00:14:10.080
So if you've had surgery or an injury and you're resting that muscle, very quickly you'll be weak in that muscle.
00:14:10.240 --> 00:14:13.279
And then you're more at risk of injury.
00:14:13.519 --> 00:14:35.919
So a weak pelvic floor muscle that is not exercised at all for six weeks is at a higher risk then of overload, whether that's difficulty with a bowel action or you're desperate to get back to exercise and play netball and go running at six weeks, but your pelvic floor muscles have been sleeping for six weeks, that's not a good combination.
00:14:36.240 --> 00:14:44.480
So we do want to gradually increase the strength and get recovery back into the muscle by gradually increasing your exercise program.
00:14:44.799 --> 00:14:52.480
And you'll be doing other exercise as well, walking, of course, walking with Pram, you might have a dog as well for a bit more pace.
00:14:52.720 --> 00:14:57.360
So you will be gradually increasing your general exercise levels over six weeks.
00:14:57.519 --> 00:15:01.200
So of course you need your pelvic floor muscles to be building up as well.
00:15:01.519 --> 00:15:02.240
To support that.
00:15:02.559 --> 00:15:03.039
Correct.
00:15:04.080 --> 00:15:08.879
And you'd obviously be advising to be guided by your own comfort as well.
00:15:09.039 --> 00:15:14.879
So if those pelvic floor exercises are uncomfortable, then just go slow and build up.
00:15:15.440 --> 00:15:16.879
And moderate what you're doing.
00:15:17.039 --> 00:15:32.799
So going back to those factors that we said be aware of early postnatally, such as swelling, discomfort, altered sensation, or loss of bladderal bowel control, keep an eye on those so that as your pelvic floor muscle is strengthening, they should all be improving.
00:15:33.039 --> 00:15:36.480
But if they're not, then it's definitely time to see somebody.
00:15:36.720 --> 00:15:39.840
And doing a pelvic floor muscle exercise should not hurt.
00:15:40.000 --> 00:15:47.840
So if you're gently tightening and drawing in, you're actually bringing the tissues that have been injured or stretched or torn together.
00:15:48.240 --> 00:15:49.759
You're not stretching them apart.
00:15:49.919 --> 00:15:52.879
That's where the injury occurs and the pain.
00:15:53.120 --> 00:15:56.240
So initially you might think, oh, it's a very weird sensation.
00:15:56.480 --> 00:16:01.919
So you do it very gently, but that should improve and normalize over six weeks.
00:16:02.320 --> 00:16:02.720
Great.
00:16:03.440 --> 00:16:11.519
And it's really reassuring to know that we can start early with maintaining our strength and recovering with the pelvic floor.
00:16:12.000 --> 00:16:22.799
How long would you recommend someone wait before they say get back into that normal exercise that you described, like perhaps playing sport or going for a run?
00:16:23.039 --> 00:16:23.279
Yes.
00:16:23.600 --> 00:16:24.080
That kind of thing.
00:16:24.480 --> 00:16:30.559
Yes, because we've got to remember the benefits of exercise, and we had a previous episode on that, and it's hugely important.
00:16:30.799 --> 00:16:37.840
So we do want to encourage women postnatally to resume exercise, and unfortunately, too few women do.
00:16:38.080 --> 00:16:38.240
Yes.
00:16:38.399 --> 00:16:43.840
So the rates of return to exercise postnatally are disappointingly low.
00:16:44.080 --> 00:16:56.480
And that means women often never get back to the level of exercise they were doing previously, and we don't meet the physical activity guidelines, and the the levels are lower in women than men.
00:16:56.559 --> 00:17:02.559
So we have fewer women who are exercising even at the minimum level required for good health.
00:17:02.799 --> 00:17:09.200
So we want to do as much as we can in that early postpartum period to encourage women to resume exercise.
00:17:09.359 --> 00:17:11.200
But it's a balancing act.
00:17:11.440 --> 00:17:15.119
We want people to do the exercise they love because they're more likely to do it.
00:17:15.519 --> 00:17:20.640
Whereas if you tell someone to do an exercise they don't enjoy, you won't have any adherence.
00:17:21.359 --> 00:17:36.640
So if they love something that is a load to the pelvic floor, such as an impact exercise, running, jumping, netball, whatever the activity is, the pelvic floor muscle needs to be strong enough to cope with that load.
00:17:36.880 --> 00:17:44.640
So we would need to build up the exercise program, the pelvic floor muscle training program, to withstand that load.
00:17:44.960 --> 00:17:52.319
A good test is if you're doing an exercise that involves some jumping, try a jump at home on a full bladder.
00:17:52.640 --> 00:18:00.640
And if you can't prevent leakage, that means your exercise activity, fitness activity may well cause some leakage.
00:18:00.720 --> 00:18:04.960
And that's not a good thing because it means it's overloading your pelvic floor muscles.
00:18:05.200 --> 00:18:19.680
But there's a lot of exercise you can do that doesn't overload the pelvic floor muscle and still give you the benefit of exercise, which is great for your general fitness, good health, mental health as well as physical health and weight control.
00:18:19.920 --> 00:18:26.880
So that's another factor, of course, that women are concerned about postnatally is losing excessive weight that they've gained.
00:18:26.960 --> 00:18:30.640
And the best way to do that is exercise combined with good diet.
00:18:31.119 --> 00:18:33.920
So if you can't exercise, it's a struggle to lose weight.
00:18:34.160 --> 00:18:44.240
So we do want exercise, but we need it to be safe for the pelvic floor muscles so that we get our pelvic floor muscle stronger as we increase the load on the pelvic floor.
00:18:44.400 --> 00:18:54.400
So if you were a runner, you would start by walking slowly, building up, and then walking faster, and then gentle jogging and then increasing your distance.
00:18:54.559 --> 00:19:08.240
And if you're noticing any pelvic floor symptoms or sensations like leakage or heaviness or bulging, that might be a sign that your pelvic floor muscles are not yet ready for that amount of load.
00:19:08.400 --> 00:19:21.359
And that's where it would be good to see a pelvic health physiotherapist if you can access one to get an individualized exercise program and help you get to where you want to be with your general fitness and exercise.
00:19:21.920 --> 00:19:40.559
And you might need to reduce the load for a while, such as doing bike riding, stationary cycling, swimming, aquaobics, all those exercises that are good for your general health and mental health and weight control, but don't compromise your pelvic floor muscles while they're recovering.
00:19:41.039 --> 00:19:41.279
Great.
00:19:41.440 --> 00:19:54.960
So there's definitely a path forward Absolutely, lots of options, lots of options where people can strengthen that pelvic floor, start early, be guided by their comfort, and return to their normal exercise.
00:19:55.440 --> 00:19:56.079
That's what we want.
00:19:56.319 --> 00:20:01.519
So that we generally have good physical activity and health and fitness in our postnatal mums.
00:20:02.000 --> 00:20:02.319
Great.
00:20:04.079 --> 00:20:09.839
Really positive and optimistic, I think, because I think it's a common issue.
00:20:09.920 --> 00:20:19.759
As you said, you know, over half of women who have a pregnancy will have some kind of uh potential problem with their pelvic.
00:20:20.079 --> 00:20:20.480
About a third.
00:20:20.799 --> 00:20:21.680
About a third about it.
00:20:22.079 --> 00:20:22.880
Postnatally, yeah.
00:20:23.119 --> 00:20:27.920
Um so that's really important that and reassuring to know that it's you're not alone.
00:20:28.160 --> 00:20:29.200
It's really common.
00:20:29.680 --> 00:20:31.680
But there's lots of things that we can do about it.
00:20:32.000 --> 00:20:40.400
There are positive things you can do, and then there are things to avoid, such as heavy lifting, um not using your pelvic floor muscles when you do try to lift.
00:20:40.559 --> 00:20:43.359
Make sure you lift with good posture so you don't strain your back.
00:20:43.519 --> 00:20:47.039
No point having a good pelvic floor muscles, but back pain and neck pain.
00:20:47.279 --> 00:20:49.039
So we want to look after our whole body.
00:20:49.359 --> 00:20:59.200
So for general good health, for back pain and back support, because you're going to be needing to care for your baby for a long time and feeding and changing and lifting and carrying.
00:20:59.279 --> 00:21:05.759
So you also need your back and neck and arms and general posture to be working in your favour as well.
00:21:06.240 --> 00:21:08.319
Good physiotherapy principles.
00:21:08.559 --> 00:21:09.279
Yes, that's right.
00:21:09.440 --> 00:21:11.759
General, general body principles, yes.
00:21:30.880 --> 00:21:34.559
And how about subsequent pregnancy?
00:21:34.720 --> 00:21:35.119
Yes.
00:21:35.359 --> 00:21:42.160
What is the evidence for how that might impact the pelvic floor, having multiple pregnancies?
00:21:42.240 --> 00:21:48.400
And is there any recommendation as to the interval between pregnancies that we talk about?
00:21:49.119 --> 00:21:51.839
Yes, well, all of these things can affect your pelvic floor.
00:21:51.920 --> 00:21:52.480
You're right.
00:21:52.720 --> 00:21:58.960
I think would you recommend two years, or is the World Health Organization recommendation two approximately two years?
00:22:00.160 --> 00:22:06.880
Roughly the recommendation, but that is a holistic, I think, recommendation for multiple factors, not just the pelvic tool.
00:22:06.960 --> 00:22:16.000
That's certainly a factor, but also in terms of optimizing time for breastfeeding, if that's something that that you're choosing to do, emotional and mental well-being.
00:22:16.079 --> 00:22:26.240
It's certainly for many people who have, you know, two under two years, they know how demanding that can be on individuals and families and other children.
00:22:26.400 --> 00:22:29.519
So I think in general, that's a general recommendation.
00:22:29.680 --> 00:22:29.920
Yes.
00:22:30.160 --> 00:22:32.720
Which incorporates the pelvic floor for sure.
00:22:33.119 --> 00:22:33.519
That's right.
00:22:33.920 --> 00:22:36.000
And a good idea for all of those reasons.
00:22:36.319 --> 00:22:44.880
In terms of the pelvic floor, we do see that the risk of developing incontinence is highest with your first pregnancy.
00:22:45.119 --> 00:22:46.000
So interesting.
00:22:46.319 --> 00:22:51.839
Yes, it's not that it just gets worse and worse with every pregnancy or a higher risk.
00:22:52.079 --> 00:22:57.599
So in fact, the first is the biggest risk to the pelvic floor muscles for incontinence.
00:22:58.640 --> 00:23:01.680
However, prolapse has a different pattern.
00:23:02.079 --> 00:23:14.640
So the repeated stretching, loading and stretching and birth process tends to increase prolapse with each subsequent birth, but not necessarily incontinence.
00:23:14.880 --> 00:23:15.119
Okay.
00:23:15.599 --> 00:23:21.200
Again, if nothing we can do about that if that's your life choice and your birth choices.
00:23:21.359 --> 00:23:28.960
However, we know that pelvic floor muscle training has high level of evidence for treating both incontinence and prolapse.
00:23:29.200 --> 00:23:42.880
So whether you have three pregnancies or four, and you have some incontinence after each, by doing pelvic floor muscle training, that's the best evidence for reducing the incontinence between and after.
00:23:43.039 --> 00:23:44.240
And the same for prolapse.
00:23:44.640 --> 00:23:44.960
Yeah.
00:23:45.119 --> 00:23:45.279
Okay.
00:23:45.599 --> 00:23:46.240
That's good to know.
00:23:46.559 --> 00:23:50.240
For mild to moderate prolapse, severe prolapse may require surgery.
00:23:50.799 --> 00:23:59.200
But for mild to moderate, which is the majority, and for incontinence, pelvic floor muscle training would be your go-to treatment in the first instance.
00:23:59.680 --> 00:24:00.559
Well that's encouraging.
00:24:00.799 --> 00:24:00.960
Yes.
00:24:01.119 --> 00:24:01.279
Yeah.
00:24:01.519 --> 00:24:02.559
Again, something you can do.
00:24:02.880 --> 00:24:05.920
And something that's relatively low risk and easy to do.
00:24:06.240 --> 00:24:06.400
Yes.
00:24:07.200 --> 00:24:16.400
And in terms of prolapse, I think, as you mentioned, it can be severe, but again, we're really guided by people's symptoms and how much it's bothering them, aren't we?
00:24:16.559 --> 00:24:21.839
Trevor Burrus That is the number one factor that determines what treatment, if any, you you choose to have.
00:24:22.400 --> 00:24:27.440
So you can actually have evidence of prolapse when you're examined, but feel nothing.
00:24:27.920 --> 00:24:32.240
So if the prolapse is mild, you may not be aware that you have a prolapse.
00:24:32.400 --> 00:24:41.839
So there'd be no indication for any major treatment, but pelvic floor muscle training would be a good idea to prevent that mild prolapse from becoming more bothersome.
00:24:42.000 --> 00:24:44.480
Whereas any degree of incontinence, you're aware of it.
00:24:44.880 --> 00:24:44.960
Yes.
00:24:45.200 --> 00:24:45.599
That's the difference.
00:24:46.400 --> 00:24:47.279
It's hard not to be aware of it.
00:24:47.680 --> 00:24:52.640
That's right, because it's it's obvious and you feel it, whereas with a mild prolapse you may not.
00:24:52.720 --> 00:24:58.960
So any degree of incontinence means there is incontinence and pelvic floor muscle training is the first go-to.
00:24:59.519 --> 00:25:04.000
We'll do a separate topic on on this specifically, but just to touch on it.
00:25:04.400 --> 00:25:09.279
Sexual dysfunction in regards to the pelvic floor after birth.
00:25:09.599 --> 00:25:18.480
What would you recommend in terms of time for rest of the pelvic floor from that point of view after a birth vaginally?
00:25:18.640 --> 00:25:19.039
Yes.
00:25:19.279 --> 00:25:25.279
And how would you guide people to know when might be the right time to resume sexual activity?
00:25:25.519 --> 00:25:25.839
Yes.
00:25:26.079 --> 00:25:30.319
What are the normal things that people might feel the first time they're trying to have intercourse after the phone?
00:25:30.640 --> 00:25:39.920
Yeah, sexual dysfunction is quite a complex problem, unlike incontinence or prolapse, which are more single-dimension and anatomical and mechanistic.
00:25:40.079 --> 00:25:40.160
Yes.
00:25:40.400 --> 00:25:48.079
Whereas sexual dysfunction or a problem with sexual function, if you like, can be caused by a multitude of factors, not just the tissues.
00:25:48.319 --> 00:25:48.559
That's right.
00:25:48.799 --> 00:25:51.119
Which is the difference then with incontinence and prolapse.
00:25:51.359 --> 00:26:04.079
So if it's caused by other factors, obviously you need to address those, whether it's your emotional health, well-being, relationship, hormonal factors which affect your degree of lubrication.
00:26:04.240 --> 00:26:13.599
So there are many factors that are not related to the pelvic floor muscles, but some are because of the effect of childbirth on the pelvic floor muscle, as we've discussed.
00:26:13.759 --> 00:26:20.720
That muscle will have stretched, may have sustained some degree of injury, and be in the process of recovery.
00:26:20.960 --> 00:26:28.960
So, like any muscle, if it's had an injury, it's going to be uncomfortable if you press it, stretch it, attempt to use it too much.
00:26:29.359 --> 00:26:38.319
So discomfort the first time you resume vaginal sexual activity is not uncommon postnatally.
00:26:38.480 --> 00:26:42.559
So you want to wait until you've got some degree of healing.
00:26:42.799 --> 00:26:49.359
So that will depend on the birth, but for many women it'll be several weeks, if not six or more.
00:26:49.839 --> 00:26:57.200
So not to be alarmed, if it's six weeks, any touch around the vaginal area is still very uncomfortable.
00:26:57.440 --> 00:27:01.119
It might mean that you're you're needing more time and recovery.
00:27:01.359 --> 00:27:05.119
But some things can help, such as using adequate lubrication.
00:27:05.279 --> 00:27:19.599
So if your natural lubrication is compromised for any reason, whether that's fatigue and crying baby and emotional well-being, etc., then that might lower your usual arousal mechanisms to help your lubrication.
00:27:20.079 --> 00:27:21.279
Also adding hormonally.
00:27:22.079 --> 00:27:24.480
That is actually what happens, isn't it, with breastfeeding?
00:27:24.720 --> 00:27:25.039
Very true.
00:27:26.319 --> 00:27:27.359
It's going to be suppressed.
00:27:28.160 --> 00:27:28.319
Yes.
00:27:29.039 --> 00:27:31.759
So adding some lubrication is a very good idea.
00:27:31.839 --> 00:27:37.039
And again, we we talked about using edible oils, natural oils, for perineal massage.
00:27:37.119 --> 00:27:39.359
It's the same for sexual activity.
00:27:39.519 --> 00:27:46.240
So you can buy sexual activity lubrication from a pharmacy, but you can also use oils just as comfortably.
00:27:46.559 --> 00:27:46.799
Great.
00:27:47.119 --> 00:27:48.799
So that means you don't need to buy anything extra.
00:27:49.039 --> 00:27:49.440
Yes.
00:27:49.920 --> 00:28:01.359
And surprisingly or not surprisingly, pelvic floor muscle exercises have good evidence for improving sexual dysfunction because of those factors we talked about before, the muscle pump.
00:28:01.519 --> 00:28:06.799
So when you exercise the muscle, you contract and relax and you get more blood flow through the area.
00:28:06.960 --> 00:28:09.359
So it's generally a healthier muscle.
00:28:09.599 --> 00:28:16.559
So that has been shown in research that if you do pelvic floor muscle exercises, it has a good effect on sexual dysfunction.
00:28:17.119 --> 00:28:30.960
In terms of discomfort, it depends whether that discomfort is due to some of those other factors we discussed, the hormones, lubrication, injury, the recovery of your injury, and that that's just going to take some time.
00:28:31.200 --> 00:28:58.799
And that's where some of that, not exactly the perineal massage, but if the the problem postnatally is that the muscle has tightened with some scar tissue, then your pelvic health physiotherapist can do some gentle massage of the muscle and the vaginal tissues, like we would use elsewhere in the body after an injury or surgery where the skin and the connective tissue are tightening around the injured muscle.
00:28:59.119 --> 00:29:00.240
Like remedial massage.
00:29:00.480 --> 00:29:00.799
Correct.
00:29:01.039 --> 00:29:03.759
Some gentle stretching muscle uh massage.
00:29:04.000 --> 00:29:04.319
Mm-hmm.
00:29:04.960 --> 00:29:05.359
Great.
00:29:05.599 --> 00:29:12.400
So again, really important to know that sexual dysfunction after a birth can be normal.
00:29:12.640 --> 00:29:12.880
Correct.
00:29:13.279 --> 00:29:14.000
It's quite common.
00:29:14.240 --> 00:29:14.400
Correct.
00:29:14.720 --> 00:29:23.599
But potentially reversible and often something that will get better with time and can be benefited from pelvic fluorexis.
00:29:23.920 --> 00:29:24.240
That's right.
00:29:24.480 --> 00:29:28.480
And of course it's hard not to feel distressed about it because it is very distressing.
00:29:28.640 --> 00:29:41.279
And pain anywhere in the body is distressing, but particularly in our pelvic area and vaginal area, it's very distressing if an activity that we'd like to feel pleasure with is causing us pain.
00:29:41.519 --> 00:29:53.839
So it's very important to discuss that with your healthcare provider if you feel comfortable, so that you can receive some good advice and confidence that it will improve with time, recovery, and some good treatment.
00:29:54.079 --> 00:30:01.119
For example, you might need to see a pelvic floor physiotherapist to get some direct treatment to the tissues if that's part of the problem.
00:30:01.839 --> 00:30:09.039
We've discussed pelvic floor exercises so much, and it obviously there's so much benefit in doing them at any stage of life.
00:30:09.440 --> 00:30:19.119
Would you recommend, in general, if we have the means to, that everybody consult a pelvic floor physiotherapist in pregnancy and postpartum?
00:30:19.759 --> 00:30:26.400
Ideally, if there's any time in your life that it would be grand to have that opportunity, that would be it.
00:30:26.640 --> 00:30:32.559
A window of opportunity, we'd call it, because that's a time of high risk to the pelvic floor.
00:30:33.039 --> 00:30:40.240
So if there's only one opportunity in your life to see a pelvic floor physiotherapist, yes, that's a good idea during the childbearing year.
00:30:40.480 --> 00:30:40.640
Yeah.
00:30:40.880 --> 00:30:41.119
Yes.
00:30:41.519 --> 00:30:45.119
And you don't need many appointments with that healthcare professional, do you?
00:30:45.440 --> 00:30:45.920
It depends.
00:30:46.000 --> 00:30:51.119
If you have no symptoms but you're taking a preventative approach, one appointment might be sufficient.
00:30:51.599 --> 00:31:01.359
If you actually have symptoms and you've had them for some time and the haven't improved off your own resources and self-management, it may take several appointments.
00:31:01.759 --> 00:31:13.599
So it's important to be realistic about what is required for physiotherapy treatment, unlike medication or surgery, where you don't have to do anything yourself.
00:31:13.839 --> 00:31:17.359
The treatment is doing it for you, the surgical or the drug treatment.
00:31:17.680 --> 00:31:24.799
For any physiotherapy treatment, usually you do need to be involved in improving and doing it with the physiotherapist.
00:31:24.880 --> 00:31:30.079
So that might mean exercise, changing your lifestyle, doing things differently.
00:31:30.319 --> 00:31:32.400
And the effects take time.
00:31:32.880 --> 00:31:40.640
As we discussed before, if you wanted to get fit or lose weight, it's not going to happen with one session at the gym or with a personal trainer.
00:31:41.119 --> 00:31:46.640
So any change to our tissues that we need to make ourselves is going to take time.
00:31:46.799 --> 00:32:02.559
So most of the research that has tested physiotherapy to do pelvic floor muscle training to treat incontinence or prolapse or pelvic pain or sexual dysfunction usually requires a course of treatment, six to eight weeks, maybe three months.
00:32:02.960 --> 00:32:03.119
Okay.
00:32:03.519 --> 00:32:19.759
So if you can factor that in, and you may then need occasional follow-ups during other periods of your life when you're at high risk other changes or you get the flu, and you're coughing and sneezing, and your pelvic fore muscles have suffered a bit under that load again.
00:32:20.400 --> 00:32:23.599
So there might be top-ups throughout your life.
00:32:23.680 --> 00:32:26.799
But think of it as like an exercise or a fitness program.
00:32:26.960 --> 00:32:28.240
You need to do something yourself.
00:32:28.319 --> 00:32:33.599
The physiotherapist needs time to help you, so it may take six to eight weeks.
00:32:34.079 --> 00:32:35.759
Which is a relatively short space.
00:32:36.160 --> 00:32:36.720
In scheme of things.
00:32:38.160 --> 00:32:45.839
And as you said, thinking beyond this childbearing window of time, the pelvic floor can be under stress for many other reasons.
00:32:46.079 --> 00:32:46.400
That's right.
00:32:46.720 --> 00:32:49.680
Such as infection where we might have chronic coughing.
00:32:50.000 --> 00:33:06.160
But certainly as we get older and we go through hormonal changes, perimenopause, menopause, postmenopausal, these issues that we've talked about with the pelvic floor can become more apparent as well.
00:33:06.720 --> 00:33:06.960
That's it.
00:33:07.279 --> 00:33:10.240
So we think of it as a compounding situation.
00:33:10.480 --> 00:33:26.799
So while you might have got through your childbearing years without too many symptoms of pelvic floor dysfunction or problems, you might notice that with aging and the effects of menopausal changes, you then become aware of pelvic floor problems where you might not have had them before.
00:33:27.279 --> 00:33:30.400
So it's a bit like overloading.
00:33:30.640 --> 00:33:31.759
There's a threshold.
00:33:31.920 --> 00:33:33.920
We call it the pelvic floor threshold.
00:33:34.319 --> 00:33:44.240
And below that threshold, you may have had activities or events that have compromised your pelvic floor, but you're managing and you don't feel any symptoms.
00:33:44.480 --> 00:33:52.880
But as life events build up and start overloading, you cross over your threshold of becoming aware of symptoms.
00:33:53.119 --> 00:33:56.319
It doesn't mean that anything dramatic has happened.
00:33:56.720 --> 00:34:00.640
It's just that accumulation of several things that are working against you.
00:34:00.960 --> 00:34:04.000
And that's when you might need a good course of treatment.
00:34:04.400 --> 00:34:04.559
Yeah.
00:34:04.640 --> 00:34:06.079
And to up those pelvic fluoride.
00:34:06.480 --> 00:34:08.800
Correct, and just to get your threshold higher.
00:34:09.119 --> 00:34:13.039
But it's really important to know, I think, that it's very common.
00:34:13.440 --> 00:34:14.079
Very common.
00:34:14.320 --> 00:34:16.159
But that something can be done about it.
00:34:16.480 --> 00:34:16.719
Absolutely.
00:34:17.360 --> 00:34:31.760
I think I often find that it's a symptom, whether it's pre-pregnancy, in-pregnancy, postpartum, or beyond, or any of these symptoms are things that people often dismiss, may feel ashamed about, embarrassed about.
00:34:32.239 --> 00:34:41.920
But it is certainly something that we should be talking more about with our close friends or health professionals so that we can do something about it.
00:34:42.239 --> 00:34:48.400
That's it, because information and knowledge is power and gives you the opportunity to choose what you'd like to do.
00:34:48.559 --> 00:35:04.719
But you're right, we do have low self-disclosure, meaning women don't volunteer this information because it is embarrassing, they feel there's some shame or stigma, or there could be cultural reasons for not disclosing their symptoms.
00:35:04.800 --> 00:35:18.719
And that's very sad because we have no uh barriers to disclosing other symptoms from other health problems, but anything to do with the pelvic floor, unfortunately, has historically been shrouded.
00:35:18.800 --> 00:35:18.960
Yeah.
00:35:19.199 --> 00:35:28.159
And we really need to encourage women to discuss these symptoms with somebody they trust who can give good advice because there is lots of help available.
00:35:28.480 --> 00:35:32.079
Yeah, and that's the important message I think is that we shouldn't be ashamed.
00:35:32.320 --> 00:35:32.639
That's right.
00:35:32.960 --> 00:35:39.760
It's something that we can be very proactive about and do something about, and it can significantly improve people's quality of life.
00:35:40.079 --> 00:35:40.559
It does.
00:35:40.719 --> 00:35:43.840
It absolutely does, which affects your physical health and your mental health.
00:35:44.400 --> 00:35:47.599
And to remind women that it's their choice.
00:35:47.760 --> 00:35:51.280
So whatever treatment option they choose, that is their choice.
00:35:51.440 --> 00:35:55.440
And some women will choose an option that another woman would not choose.
00:35:55.519 --> 00:36:00.480
But that's okay, you've got to weigh all the things up: access, time, all of those things.
00:36:01.760 --> 00:36:02.079
Correct.
00:36:02.559 --> 00:36:03.039
Yeah.
00:36:03.360 --> 00:36:06.239
That's a really great note, I think, to finish on.
00:36:06.400 --> 00:36:07.840
Thank you so much, Alina.
00:36:07.920 --> 00:36:23.840
I think we've covered a lot about, again, about the pelvic floor, how it changes in birth and postpartum, what can be common and normal, and how reassuring it is that we can actually do a lot about those common symptoms that we feel postpartum and beyond.
00:36:24.000 --> 00:36:24.239
Absolutely.
00:36:24.639 --> 00:36:26.159
A lot of it is within our control.
00:36:26.239 --> 00:36:28.159
So thank you so much, Alina.
00:36:28.559 --> 00:36:31.280
Thanks very much, Rangy, for inviting me to participate.
00:36:31.599 --> 00:36:32.239
Thank you.
00:36:32.480 --> 00:36:34.159
Every pregnancy is unique.
00:36:34.320 --> 00:36:39.599
The information provided in today's podcast is for educational and general purposes only.
00:36:39.760 --> 00:36:43.519
It is not intended to be substitute for professional medical advice.
00:36:43.760 --> 00:36:54.159
It is important that you always seek the guidance of qualified health professionals with any questions you may have regarding your health, pregnancy, or any medical conditions.
