Short on time? Then the key things to know are:

• Your pelvic floor can take 4-6 months to heal after a vaginal delivery so it's normal to expect to do exercises to strengthen these muscles
• A third of women will experience bladder incontinence after giving birth and it’s thought 1 in 10 will experience bowel leakage
• You can start doing pelvic floor exercises straight after your first wee post-birth!
• If you are having trouble emptying your bladder or bowel, have a weak bladder or uncontrolled flatulence, or find you need to support your pelvic floor to pass a stool, you should seek expert medical help
• Bladder and bowel incontinence exercises will help to strengthen your pelvic floor and stop leakage - read on for our how to guide!

 

Are you struggling with poor pelvic floor control after giving birth?

Giving birth is an incredible feat for our bodies and the pelvic floor and bladder neck adapts to continue to support your bump through pregnancy. The pelvic floor muscles even stretch up to 3.5 times their length during a vaginal delivery!

But what happens next?

Whether you’ve had an abdominal or vaginal delivery, it may be the case that your pelvic floor requires some extra help to regain its usual function and support organs like your bladder and bowel. We know pelvic floor healing alone can take 4-6 months after a vaginal delivery (and a caesarean scar can take 6-7 months to recover!).

In this guide we share how to strengthen your bladder and bowel with pelvic floor exercises for incontinence.

What are the pelvic floor muscles?

Your pelvic floor is a group of muscles which runs from the front of your pelvis all the way to the back (touching your coccyx bone). Our pelvic floors work hard to protect us from leaking from our bladder or bowel; they relax in a controlled manner during sex and even for baby to be born (although your uterus really does the pushing!). This means that our pelvic floor can prevent us from being incontinent and kegel exercises are often the first port of call for a ‘natural’ treatment for bladder and bowel incontinence.

The pelvic floor can still tend to be a bit of a taboo subject, and research has shown us that many women aren’t told the significance of them during their pregnancy, postpartum recovery and long term health, or understand how to exercise them effectively.

It is important to know that the pelvic floor forms an important part of everyones’ core systems, (including women who haven't had children and men!) There is a misconception that our “core” only refers to our abdominals, yet it actually includes an interplay of lots of different muscles including your diaphragm, deeper abdominal muscles, pelvic floor and spinal muscles.

These muscles work together in a coordinated way with our breathing to not only remain continent, but move efficiently and without pain by managing our intra abdominal pressure. We need our pelvic floor to automatically respond to larger increases in pressure like when we cough, sneeze, lift something heavy, run or jump.

Bladder and bowel incontinence is common but not normal

It’s thought that at least 1 in 3 postpartum women will experience bladder incontinence and that 1 in 10 will have some bowel leakage. Because of its prevalence, it would be forgiven to think this is ‘normal’. But it’s not, and there are many non-invasive options to help improve or totally eliminate symptoms!

These might include pelvic floor training, bladder training, lifestyle changes, biofeedback or electrical muscle stimulation. If the non-invasive treatments aren’t as effective as expected, then a small percentage of women may consider medication or surgery.

Please know that it is not your fault if you’re struggling with incontinence after birth! We know that factors such as having a larger baby, having an assisted vaginal delivery (e.g. vacuum extraction) and a high BMI during and after pregnancy can increase the chance of incontinence. If you know this is you, it is a good idea to chat to a pelvic physiotherapist to support you.

So, how do you know if your pelvic floor might need some expert help?

As a new mum it is incredibly difficult to put yourself first and easy to brush symptoms aside. But, if you’re experiencing any of the below indicators, it may be time to contact professional medical help:

• You have trouble emptying your bladder or bowel
• You aren’t able to get to the toilet in time
• You find that you need to move or support your pelvic floor to pass a stool
• You have uncontrolled flatulence
• You are leaking from your bladder or bowel without control
• You’re not drinking or eating enough to avoid leaking

It can be very daunting to experience these symptoms and internet forums can be a mine-field of information.

For bladder or bowel incontinence treatment, it is important to seek medical help from a doctor or women’s health physiotherapist; ideally someone who is registered to the Pelvic Obstetric Gynaecological Physiotherapy (POGP) list of reputable practitioners (all Naytal experts are POGP registered).

How do I know if physiotherapy can help?

Once your doctor or physiotherapist has confirmed that your pelvic floor muscles are the cause of your symptoms (they may have sent you for further investigation to check your nerve, bladder or bowel integrity before physiotherapy, depending on your location), you can begin your rehabilitation program.

Pelvic floor rehabilitation is proven to help with bladder incontinence and has some of the best quality evidence to support this. The evidence to support pelvic floor exercises and bowel incontinence is still catching up but still advised (NICE Guidelines).

How long will it take to recover my pelvic floor?

Regular muscle rehabilitation takes at least 3 weeks to start to feel change, and can take up to 16 weeks to stop leaking symptoms.

In around 6 weeks most will notice a positive difference with their pelvic floor if your exercises are done correctly. You may need guidance from your pelvic floor physiotherapist to check you’re adequately relaxing and engaging your muscles. It’s not all about the squeeze!

Everyone will recover at different rates, and you are not exempt from pelvic floor issues if you had a caesarean, as your pelvic floor still had increasing pressures through it for 9 months as well as the trauma to your abdominals.

How to strengthen your pelvic floor muscles

Unless you have been told otherwise or have a catheter in place, you can start doing your pelvic floor exercises straight away.

How to do pelvic floor exercises:

• Breathe - first of all, try to practice diaphragmatic breathing by inhaling to expand your ribs and belly, then exhaling to bring your belly gently back in. A hand on your belly may help you.
• Get comfy - lay on your back with your knees bent and a pillow under your head so you can relax.
• Find your pelvic floor - your pelvic floor is a group of muscles which runs from the front of your pelvis all the way to the back. See if you can relax in your back passage as you inhale and lift from your back passage as you exhale.
• Long & short holds - it is advised to do both long and shorter pelvic floor holds to train both your long endurance and quick power muscle fibre types. You may be able to hold up to 10 seconds during your longer holds and repeat this 5 to 10 times, and you may be able to do between 5 and 10 repetitions of the faster 1 second lifts.
• Try different positions - if you’re able to complete your pelvic floor exercises easily on your back, then try them sitting and standing. It is expected that these holds will be more challenging since you’ll be working against gravity.
• Cough & squeeze - can you lift your pelvic floor before you cough? This is called ‘The Knack’ and can be used to help protect you from leaks when you laugh, sneeze or jump!

Seek guidance for an individualised program - depending on your symptoms, you may be asked to repeat your exercise program up to 3 times a day to achieve positive changes in your pelvic floor muscles. Your physiotherapist can guide you on what your main focus will be according to your symptoms. You may be asked to concentrate most on nutrition, relaxing, longer holds or quick holds when working on your pelvic floor.

Top tips for strengthening your pelvic floor

• The NHS Squeezy App is a really useful resource to help guide and remind you to do your pelvic floor exercises.
• Think about tightening your back passage when you do the exercises then draw that contraction forward and up. Other useful cues can be imagining trying to pick up something small (marble/blueberry) at your vaginal entrance, then lift it up and inside with a strong lift.
• When we exhale, our pelvic floor is naturally recruited so try and do your contractions then, rather than holding your breath which can raise your intra abdominal pressure. Also think about exhaling when you lift the buggy and car seat recruiting your pelvic floor as well.
• Progress from lying up to standing. We know these don't necessarily set the world alight in terms of being the most exciting exercise, but the reality is they work!

The next stage is to challenge your pelvic floor strength and endurance more with movement or weight before returning to running or jumping too soon. Examples include integrating the pelvic floor contraction with a squat (inhale down, exhale as you come up and lift pelvic floor).

As long as you don't have symptoms you can add some dumbells or a barbell when you feel ready if returning to the gym. The same applies for bringing it in with a jump. The stronger your glutes and other surrounding muscles, the less your pelvic floor will try and do the work.

How soon after giving birth can I start my pelvic floor exercises?

Straight away after your first wee! Depending on how your baby’s birth went may affect how soon you feel you can start your kegels. If you have any tears requiring stitches or wounds which require healing, this may affect how comfortable it is to begin right away.

Need support with your pelvic health?

It is always beneficial to have a women's health physiotherapy assessment to give you a more thorough idea of how your pelvic floor muscles are working and a bespoke rehabilitation plan for you.

Feeling lost with what you should and shouldn’t be doing when it comes to after birth recovery is extremely common. And that’s where we come in - your pelvic health physiotherapists!

We’ll help teach and guide you towards the correct exercises to help optimise your recovery. Whether you are suffering with incontinence, abdominal separation, lower back aches or other postnatal related musculoskeletal pains. Book a private online consultation with one of our women’s health physio experts and get specialist help today.

If you find you are struggling with low mood due to your symptoms please contact one of the mental health counsellors for support.

NB: This article contains generalised medical advice and may not be suitable for all pelvic floor symptoms; if in doubt please seek professional guidance.

Other resources for support: Bladder and Bowel Community UK.

References

Abrams P et al. (2016) Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence: recommendations of the International Scientific Committee, 6th International Consultation on Incontinence. In: Abrams P et al editor(s). Incontinence: 6th International Consultation on Incontinence, Tokyo,

September 2016. 6th Edition. Vol. 1, Bristol (UK): International Continence Society (ICS) and International Consultation on Urological Diseases (ICUD), 2017:2549‐619.

Hay-Smith J, et al (2008) Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2008. p. CD007471.

Jundt, K et al. (2010) Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women. European journal of medical research vol. 15,6: 246-52. doi:10.1186/2047-783x-15-6-246 Norton C, Cody JD. (2012) Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database of Systematic Reviews 2012, Issue 7. [DOI: 10.1002/14651858.CD002111.pub3]

Woodley, Stephanie J et al. (2017) Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. The Cochrane database of systematic reviews vol. 12,12 CD007471 doi:10.1002/14651858.CD007471.pub3

Wijma J, et al (2007) Displacement and recovery of the vesical neck position during pregnancy and after childbirth. Neurourol Urodyn. 26(3):372-6.