If you are like many other people, the first you will have heard about the pelvic floor (Beckenboden in German) is during pregnancy, perhaps at an appointment with your gynecologist, midwife or at a prenatal yoga class.
But where is it? What is it? Why is it important in the context of having a baby? Here is everything you need to know about the pelvic floor and how it fits into the pre- and postnatal care system in Germany.
The answers were provided by our expert Guide Stephanie Bielenstein, who is a physical therapist specialized in the pelvic floor. She has a practice in Berlin, where she specializes in treating women during pregnancy and after childbirth.
What is the pelvic floor and where is it?
The pelvic floor is the connective tissue-muscular floor of the human pelvic cavity. It is a muscle plate that seals off the organs in the abdominal cavity and pelvic area.
To provide the necessary support, the pelvic floor attaches between the pubic bone and the tailbone and laterally to the two sit bones. You can feel these bony points on your body to get a better feel for its position.
In this position, the pelvic floor has several important tasks to fulfill, including:
A healthy, well-trained pelvic floor ensures continence and supports the internal organs.
The movements of the pelvic floor are also very important for aspects of sexuality.
Together with the diaphragm, a healthy pelvic floor also supports breathing during various activities such as speaking and singing.
The pelvic floor also regularly plays a major role in coughing and laughing.
Why is the pelvic floor important in pregnancy ?
The pelvic floor changes during pregnancy in three main ways:
1. Due to hormonal changes, the network of muscles, ligaments and connective tissue becomes looser and looser – even though it has to support more and more weight.
2. Slightly more urine is produced, while at the same time the tension in the urethra decreases. All this together can lead to involuntary loss of urine.
3. The growing baby stretches the abdominal muscles, the diaphragm is no longer as flexible and the lumbar spine becomes hollow, which can cause severe back pain.
All these changes have an effect on the pelvic floor
And what role does the pelvic floor play during labor and birth?
The conscious relaxation of the pelvic floor is particularly important for a positive birth experience. If the pelvic floor muscles are well relaxed, the birth is easier because the pelvic floor can stretch better. But this also needs to be learned.
A good way to stretch the pelvic floor is the so-called perineal massage. From the 35th week of pregnancy, you can do this regularly yourself or have your partner do it to make your pelvic floor more elastic and flexible for the birth.
If you learn to tense and perceive your pelvic floor during pregnancy, you will not only find it easier to relax it during the birth. You will also benefit after the birth and be able to perceive and activate your pelvic floor more easily. This knowledge and suitable exercises are usually taught in a birth preparation course.
What can new mothers do for their pelvic floor after giving birth?
Even if the mother feels fit again after the birth, I can only emphasize again and again how important it is to take it easy in the first few weeks and to relieve the pelvic floor.
Less is more now, and if there have been injuries to the pelvic floor during the birth, special and quick help is needed (e.g. pessaries, special physiotherapy).
In any case, new mothers should feel assured that help is available.
If needed, the first port of call is of course the gynecologist.
I also always recommend a pelvic floor check with ultrasound and of course a postnatal recovery course.
What are some of the physical symptoms a new or expecting mother can experience in relationship to the pelvic floor?
If you have problems with your pelvic floor after giving birth and feel uncomfortable, don't accept it as unchangeable, seek help, it is out there!
Some of the warning signs may be incontinence (loss of bladder control) or pain.
After giving birth, the main reason is usually that the pelvic floor is too weak after pregnancy and birth. But you may be incontinent if your pelvic floor is tight or too weak. Pain can also have different causes.
After birth, a tense pelvic floor is rarer, but not impossible, as an example from my practice shows: a client came to me with severe pain when sitting, she was sent to me by an attentive instructor from a postnatal course, and during the vaginal examination we found out that it was a tense pelvic floor (she had previously been advised by others to do lots of Kegel exercises), I then gave her relaxation and breathing techniques and gentle mobilization techniques. The very next day she was able to sit again and was soon pain-free. That was my little AHA- experience.
I use a vaginal examination to determine whether a pelvic floor is tight or too weak; the symptoms can be similar in both cases and a good diagnosis ensures the right treatment.
Thanks Stephanie!
