What’s the pelvic floor?
The Pelvic floor (PF) is made up of complex layers of muscles that sit like a hammock at the base of the pelvis. They connect the tailbone at the back to the public bone at the front, and they also connect across the sitting bones.
The Pelvic floor muscles support all your organs (without them everything would fall out!), but they also control the passage of urine, gas and faeces. The also play an important role in sexual function, and the birth process of course.
They are a pretty important group of muscles, that unfortunately still today gets completely left out of biology classes at school, doesn’t EVER get mentioned or trained in fitness and sports classes, and that most of us thus know nothing about…. until we get pregnant!
In my opinion, the PF should be exercised like any other muscles group: often, regularly, according to its function and to each person’s level of fitness and comfort.
All my Pilates classes – yes all of them, including the non-pregnancy/postnatal classes – include exercises that increase awareness of the pelvic floor, and promote suppleness and tonicity in this group of muscles.
The pelvic floor during pregnancy
During pregnancy, the PF has to support more weight – the weight of the uterus that has expanded + amnotic fluid + baby – and is therefore asked to work somewhat harder than it usually does.
That’s the reason why some women will start feeling heaviness in their PF, experiencing leakages or just feeling general discomfort in that area. Which is completely normal, seen the changes happening in the body at that time.
That’s where education in the function and functioning of the PF is needed. And that’s something that all my Pilates classes, and my Prenatal classes in particular, provide.
If you know what your PF is meant to do, what your PF is meant to feel like, and what your PF is capable of doing, you then have the tools you need to keep your pelvic floor healthy and move and exercise safely during pregnancy and forever after.
However, if the sensations of heaviness or discomfort in the PF or pelvic area become extremely disruptive to everyday life and unbearable, it is highly recommended to see a specialised pelvic floor physio, who should be able to diagnose and treat the issue. Noone should have to go through pregnancy in discomfort and pain!
I can help you identify whether what you are experiencing is normal or should be assessed by a professional. Together we can work on your breath and pelvic floor release and activation to see if that improves your symptoms.
The pelvic floor during birth
During birth, the PF will undergo a lot of stress, as the pelvis opens and the birth canal gets stretched and the PF muscles are recruited for the bearing down process.
In addition, organs can get out of alignment during the birth, which will leave women who have just given birth feeling like a bulldozer drove through their insides. Which, again, is completely normal, considering the trauma birth actually is for the PF and the body.
On top of that, if an episiotomy is carried out during birth, a cut will be made in the perineum, which adds to the trauma and disruption of function of the PF. The perineum is the central part of the PF, it is a thick layer of muscles where many of the PF muscles are superimposed and meet.
An episiotomy is no small intervention, and will greatly affect the function of many different muscles of the PF and result in great loss of integrity.
All this will leave people who’ve just given birth wondering what’s happened to their PF and whether all they are feeling down there is normal.
What to do if your pelvic floor feels weird after birth
Immediately after birth, it is considered normal to feel a certain amount of tenderness in the PF, to feel some heaviness, to have the impression than peeing/passing faeces isn’t as natural/easy/ comfortable as before. These sensations can go on for a few weeks, sometimes a couple of months. After a while, things should start going back to normal and the sensations disappear.
If you still feel heaviness in your PF, still leak urine when coughing/sneezing/jumping, still have pain during sex, or experience any other weird symptoms 4-6 months after birth, then this might mean that your PF needs a little bit of help getting back into a normal functioning mode.
What I recommend then is signing up for a couple of private sessions with me, so that we can start working on releasing your pelvic floor and working on your breath, and assess whether that makes any difference to your symptoms. At the same time as you start classes with me, you will start the process of booking sessions with a specialised PF physio: I will give you names of specialised physios to get in touch with in Berlin, but you might need a referral from your Gyno for reimbursement from your health insurance. It might take a while before you get an appointment with a physio, but be patient. This will get the healing process started, and once you have been assessed by the physio I will work together with them to decide on the best exercise programme for you.
All classes with me can be done online or in my studio, but I always recommend coming to the studio for the first private sessions, so that I can carry out a proper assessment.
Don’t worry, if you are later than 6 months into your postpartum phase, even if it’s been years since you have given birth and still experience symptoms: it is never too late to get treatment and get your PF (and whole body) back into shape!
What does pelvic floor rehab consist of?
To regain a healthy pelvic floor, it is crucial to learn how to feel this group of muscles, but also to learn how to contract it and relax it, which is something I teach in my Pilates classes.
A lot of women have a really hard time feeling their pelvic floor – that’s normal, we’re never taught that in normal exercise classes. So the first step in restoring your pelvic floor will be to learn how to feel it, and to differentiate the different layers of of the PF: the most external layer that connects the sitting bones, and the deeper layer, the pelvic diaphragm, that connects the back of the pelvis (tailbone) to the front (pubic bone).
A healthy pelvic floor can be contracted and then relaxed, just like any other muscle group. For a lot of women, especially if they are quite fit, tense, stressed, releasing and relaxing is what’s the hardest and that is the cause of their symptoms and the source of their problems. A tense, hyperactive pelvic floor is a weak pelvic floor, unable to do its normal job supporting our organs.
To support the pelvic floor it is also crucial to breathe properly with no restrictions and no tensions. Using movement and fascial release in my classes we work a lot on giving the body the ability to breathe fully and properly.
And of course for the PF to regain its function it is essential that the whole body is aligned, flexible and strong – which is also something we work on in Pilates in general and in my classes a lot.