Pelvic Floor Consciousness – Where to Begin By Alyssa Tait For many of us, pregnancy is a very special time. We are tuning in to the changes going on in our body, and starting to form a relationship with the little person growing inside. Pregnancy – especially the first pregnancy – can be a very introspective time. What a contrast once our precious bundle arrives! It is hard to believe that such a tiny person can take up so much of our time, and so much of our selves. Suddenly we are almost fully focused on another individual – and this is often a new experience to first-time parents. When there is already a toddler on the scene, there is even less time to focus on our own needs. Sometimes when I am working with women to solve their health problems, they unconsciously pinpoint the birth of their baby as the start of a downhill slide. “I just haven’t felt the same since having the kids,” is the common refrain. While having the best of intentions, many of us neglect our physical health after childbirth, and start to experience problems such as extreme fatigue, back and other joint pain, and pelvic floor problems. Pelvic floor problems, including poor bladder or bowel control, prolapse and vaginal pain, are hard to live with but even harder to speak about, so they often go untreated for a long period. But neglecting these problems to focus on our children, can, ironically, adversely affect our ability to be good parents. A prolapse, where the internal organs protrude into the vagina, can limit our physical capabilities. In order to improve the heaviness or vaginal lump associated with a prolapse, we need to avoid lifting and carrying – especially toddlers. Leakage of urine makes us wary of running in the yard or jumping on the trampoline with the kids. Vaginal pain can interfere with sex, straining our relationship with our partner. And all of these problems interfere with self-esteem and a healthy body image, which we are trying to model to our children. It is essential to take care of ourselves to help us to be better parents. Even when there are no troublesome symptoms, it is important not to neglect the pelvic floor. Many aspects of our parenting – repeatedly lifting our children, carrying them in a sling, and increased housework – take their toll on a pelvic floor that is naturally vulnerable after pregnancy and childbirth. Research shows that vaginal birth and emergency Caesarean damage nerve transmission (1). This means that the pelvic floor muscles are automatically weakened in the period after the birth. If the pelvic floor is not protected, urinary leakage and vaginal prolapse can develop over time. So what is the answer? Even if things like prolonged carrying of our children may not be ideal for pelvic floor recovery after childbirth, for many of us, this is a philosophical choice. So what else can we do – endless pelvic floor exercises? Pelvic floor exercises, while important, are only part of the answer – and let’s face it, doing them as often as is recommended can be a major challenge for busy mothers. The missing piece of the puzzle is something I like to call Pelvic Floor Consciousness. Pelvic Floor Consciousness – What is it? Pelvic Floor Consciousness is about being aware of how our activities affect the pelvic floor. It is about restoring some of that intense body awareness and reverence for the amazing natural processes of our body that we had during pregnancy. It is about acknowledging the value of a special region of our body: the region that brought life into the world. Pelvic Floor Consciousness may require some practice initially, but will eventually become second nature. The first step is to become reacquainted with the parts of the pelvic floor. A Pelvic Floor Refresher The pelvic floor muscles form a sling from the pubic bone at the front to the tailbone, with three openings – the urethra, vagina and anus. A tough connective tissue called fascia provides support and fixation for the organs, and, together with the muscles, forms the so-called pelvic floor. The pelvic floor has several crucial roles: – It provides a resting tone or “springiness” throughout our daily activity and supports the pelvic organs – the bladder, uterus and bowel. – It relaxes to allow opening of the urethra (to pass urine), vagina (to give birth) and anus (to pass wind or a bowel motion). – It provides sensation and feedback to enhance the sexual experience for both partners. – It works synergistically with certain muscles of the trunk to enhance our posture and our control of movement, and prevent dysfunction such as back and pelvic pain. How do we begin? Activity 1 – Effect of Posture on the Pelvic Floor Firstly, we focus on the sensations in the pelvic floor. Start in sitting. Sit upright on the chair edge, with your spine lifted towards the ceiling. Focus on the feeling around the vagina. You may notice it feels slightly lifted/tense/closed. Then slump, and notice how the feeling around the vagina changes to lowered/slack/open. Doing this repetitively will enhance your awareness of this change in sensation. This is not a way of exercising the pelvic floor muscles, but it does show how the activity of these muscles is influenced by posture. Let’s call this the first revelation of Pelvic Floor Consciousness! By sitting and standing tall, and maintaining this posture with movement, you can “switch on” the pelvic floor muscles at a low level to help protect the area through light activity during the day. Activity 2 – Optimal Activation of the Pelvic Floor Fine-tuning the pattern of pelvic floor muscle contraction is the second step. In the same upright sitting position, focus on the urethra, where the urine stream comes from. Pretend you are passing urine, and you are trying to slow down the flow. (Don’t pretend to stop it, which can result in too rapid and jerky a contraction, and interfere with the muscle’s holding ability). Feel a drawing-up sensation inside. Hold it at its highest point while continuing to breathe normally – say, 3 natural breaths in and out. Then slowly lower the muscles by pretending to allow the stream to slowly start again. A slow and full release is just as important as the contraction. It may help some people to visualize the red of the root chakra, located at the perineum and connecting to the base of the tailbone. Draw the energy upwards from here towards the second chakra (at the level of the sacrum) said to be responsible for urogenital health. Activity Three – The Resting Position of the Pelvic Floor in Standing Stand still and focus on the pelvic floor. Then, consciously relax or lower the pelvic floor muscles, allowing the vagina to open slightly. If you cannot feel anything, the pelvic floor is probably already completely relaxed, which means it is not automatically “buzzing” with low-level activity as it should be. Try lifting the crown of your head towards the ceiling and try again. You may feel that correcting your posture allowed the pelvic floor to gently “switch on”. Activity Four – Activating the Pelvic Floor with Movement. Sit upright on the edge of a chair, gently lifting the pelvic floor muscles. Come up into standing, and once you are standing still, release or lower the pelvic floor muscles. If you feel this, you can be confident that the pelvic floor muscles held through the change in position – wonderful news, as this is often a very difficult skill after having children. If you feel nothing when you try to consciously let go, it may mean that the muscles have let go by themselves during the movement. This means that they are not effectively protecting the area, and that problems are more likely to arise or worsen over time. Activity Five – May the Force Be With You Forceful activities like coughing, sneezing, vomiting, lifting, jumping and nose-blowing are common triggers of urine leakage in women. This is due to one or both of the following: weakening or poor activation pattern of pelvic floor muscles, and disruption of the normal unconscious sequence of events involved in a cough (2). In the standing position, focus on the pelvic floor. Then cough. If you feel opening, lowering or pressure in the vaginal area, the automatic contraction of the pelvic floor muscles may no longer be present. Try contracting the muscles beforehand, and notice whether this feeling changes. Do the same before lifting (especially toddlers), blowing your nose, or exerting effort through your day-to-day activities. Activity Six – Consciousness Through Daily Activity Put some stickers up around your living areas (out of the reach of inquisitive fingers!). Whenever you see one during the day, freeze and focus on your pelvic floor. To check if it is “switched on”, try releasing the muscles. If you feel a lowering or relaxing in the area, grin broadly! Your muscles are starting to work without you trying. Draw them back in gently and carry on. If not, smile encouragingly to yourself and gently draw the muscles in! You have taken a step towards a higher Pelvic Floor Consciousness! NOTE: Pelvic Floor Consciousness is about being mindful of the muscles, at least initially, until it comes naturally during day-to-day life. However, if you have any bladder or bowel weakness or prolapse, a specific, individualised program will also be necessary, which will depend on the type and extent of the problem. This can be provided by a physiotherapist with special qualifications and experience in the area. 1 Sultan AH, Kamm MA and Hudson CN (1994): Pudendal nerve damage during labour: prospective study before and after childbirth. British Journal of Obstetrics and Gynaecology 101: 22-28. 2 DeLancey JOL (1996): Stress urinary incontinence: where are we now, where should we go? American Journal of Obstetrics and Gynaecology 175: 311-319.