Prepare

Pelvic Floor Resilience: Building Strength for a Healthy Pregnancy and Beyond: Part 2

• Mercy Perinatal • Season 2 • Episode 21

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In this episode, Dr Rangi is joined again by pelvic floor physiotherapist and researcher Professor Helena Frawley to explore the pelvic floor, why it matters, and how to keep it healthy before, during, and after pregnancy.

This is the first of a two-part series. In this episode Rangi and Helena discuss:

  • How the Pelvic Floor changes in Birth and Postpartum
  • What is common and normal after birth
  • How we can improve symptoms at home
  • When and how to seek help if you're experiencing issues

As mentioned in the podcast - here are some resources recommended by Prof Frawley:

SPEAKER_01

Welcome to Prepare, the Mimisi Prenatable podcast dedicated to helping parents prepare for the journey of pregnancy, childbirth, and early parenthood. 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. 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.

SPEAKER_00

Hi everyone, welcome back to another episode of Prepare. My name's Dr. Rangi DeSilva, and I'm your host. 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. 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.

SPEAKER_02

So thank you again, Professor Helena Frawley, for joining us. Thank you, Rangi, for inviting me back, and it's a pleasure to be here discussing this topic with you.

SPEAKER_00

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?

SPEAKER_02

Yes. So during pregnancy there are changed levels of hormones which will help the pelvic floor muscle relax for birth and stretch. So we have increased elasticity in the muscle. During birth, the muscle will undergo quite a significant stretch, up to two and a half times its normal length. 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. But our body is built to do that. However, it may not always bounce straight back postnatally. So there may be a period of weakness and laxity, as we say, so a loss of support. And the best way to help that is through exercise. And we can talk about what to do postnatally in a few minutes in terms of how to build up that program of recovery. But yes, during birth, the muscle is under load and stretch. But we do have good blood vessels in the area, so they will help bring healing to the muscle. It's completely something that we can work on and support. Yes, it's a normal process we need it to happen to allow birth, and then we can work on the recovery. Not everybody has any consequences or long-lasting effects of birth, but up to a third of women do postnatally. 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. 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. But they may also compromise the pelvic floor muscles.

SPEAKER_00

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. But that's something that we would discuss with you in terms of potential risk factors or risks of that happening. What are some of the other risk factors for pelvic floor compromise or damage during labour? You kind of mentioned a couple of them briefly, but maybe things like the size of the baby.

SPEAKER_02

Yeah, so the pelvic floor muscles are perhaps one player in the game, and they're not the only player in the game. So there are other factors outside of the pelvic floor muscles that will play a role in how easily or how difficult birth is. So it could be the size of the baby, the position of the baby, other maternal factors, size of the pelvis, the maternal pelvis. So if you're a very petite person and with a very large baby, that's going to be more difficult. We can't do anything about those factors though.

SPEAKER_00

It's difficult because those factors are beyond our control. That's right. But that's why we need our good obstetric caregivers. Yeah. And it's all about trying to make sure we're talking together with our patients about those factors and considering them. What about things like ethnic background? Does that play any role in the risk of perineal injury or pelvic floor trauma in birth? Do you know?

SPEAKER_02

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. Yeah. So a different makeup of collagen. 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.

SPEAKER_00

Yeah.

SPEAKER_02

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.

SPEAKER_00

So those pelvic floor exercises that we talked about in part one and also perineal massage. That's right.

SPEAKER_02

From 34 weeks onwards and also during labour. 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. Mm-hmm.

SPEAKER_00

Great. 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? Because it's been through a huge load, a huge stretch. An upheaval. An upheaval in the biggest possible way. Yes. 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? And when should we be concerned?

SPEAKER_02

It's not uncommon to feel some discomfort. 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. So it's not unusual to feel some degree of discomfort. 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. So that we're making sure that there's nothing that's been missed and that does need medical attention. But it's quite common, as you say, from the upheaval you've been through, to have some degree of discomfort, swelling. And for some women, there's a degree of numbness initially, that they have no sensation because the there's been such a stretch. And the nerves are part of the stretch. So while the muscle stretches, so does everything else in that area. So nerves, ligaments, muscles, blood vessels will all undergo some degree of stretch and compression. So that can affect their function as well. And that's why there is a recovery period. So those tissues don't bounce back within 24 hours. And that period of recovery depends on many factors and is different for most women. But up to six weeks and up to three months for some women if there's been more difficulty with the birth. So there are some symptoms that women or sensations that women may feel after birth that are quite expected and normal. And they would include a feeling of swelling because of the process of childbirth and the stretching, there will be some inflammation and swelling. Like if you strain your knee or your ankle ligaments, there's always swelling. So it's not unusual to have some swelling. Discomfort, most women will have some degree of discomfort because they have been through an enormous upheaval. So we just want to make sure that that discomfort does settle and doesn't escalate with increasing pain. So a degree of swelling that should go down, a degree of discomfort that should go down, sensation should return. There may be some numbness or altered feeling initially that should return to normal within six to twelve weeks. And control, bladder and bowel control, that they're important too. 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.

SPEAKER_00

So be alert for those things. They should all be improving gradually over the first six to twelve weeks, right? Depending on what's happened with your birth.

SPEAKER_02

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. And they will know, given the type of birth and the difficulty of birth, what should be normal for you to expect.

SPEAKER_00

And I suppose anything that is particularly bothering you and uncomfortable is not something that you should keep to yourself.

SPEAKER_02

Absolutely not. So definitely discuss those sensations with your team. But the good thing is to remember that there are things we can do to help improve our recovery. So we have a couple of acronyms called Peace and Love. Oh, great. So PEACE stands for protection, elevation, avoid in anti-inflammatory drugs, compression and education. So they're the things that we would recommend for the first few days after birth. 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. So for them to recover, you want to have as little loading on the tissues as possible. So that's the protection. Don't overload the tissues. Elevation, if you've got a swollen ankle, you would always have your leg up on a pillow or a chair. So that will help reduce the swelling. Avoiding anti-inflammatories in those first few days, if you can, but under medical advice, if they're required, they're required. 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. It's important to try to avoid being constipated because that will push down again on your pelvic floor like childbirth.

SPEAKER_00

And many people describe how difficult that's particularly first bowel action after birth.

SPEAKER_02

Yes, absolutely. 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.

SPEAKER_00

Yeah, because everything's so sensitive at that point. Yes.

SPEAKER_02

And then the love? Yes. 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. And so that stands for load, optimism, vascularisation, and exercise. So what we want to do is still be very mindful of the load, not overloading. 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. So being mindful of lifting heavy things around the house, laundry baskets, the weight of your baby is about uh the best guard. Exactly. If it weighs more than your baby, try to get some help. 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. Vascularization, we do want good blood supply to the pelvic floor area to help the healing and the inflammatory process. And exercise is one of the ways we can achieve that. As we said earlier, as you contract a muscle, it's a muscle pump. So you are pumping the fresh blood and nutrients into the area and then they pump out. So that's why it is a good idea to start pelvic floor muscle exercises postnatally. 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. In terms of how often we're not sure. Correct. Being doing that two and eight is great.

SPEAKER_00

Okay, great.

SPEAKER_02

Three, four days a week.

SPEAKER_00

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.

SPEAKER_02

No, in fact, that will give you atrophy and further weakness is the old saying, use it or lose it. So we know that if you don't exercise a muscle for a couple of days, you start to lose strength. Just a couple of days. Just a couple of days. Wow. And that's the same with every muscle in the body. So if you've had surgery or an injury and you're resting that muscle, very quickly you'll be weak in that muscle. And then you're more at risk of injury. 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. So we do want to gradually increase the strength and get recovery back into the muscle by gradually increasing your exercise program. 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. So you will be gradually increasing your general exercise levels over six weeks. So of course you need your pelvic floor muscles to be building up as well.

SPEAKER_00

To support that.

SPEAKER_02

Correct.

SPEAKER_00

And you'd obviously be advising to be guided by your own comfort as well. So if those pelvic floor exercises are uncomfortable, then just go slow and build up.

SPEAKER_02

And moderate what you're doing. 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. But if they're not, then it's definitely time to see somebody. And doing a pelvic floor muscle exercise should not hurt. So if you're gently tightening and drawing in, you're actually bringing the tissues that have been injured or stretched or torn together. You're not stretching them apart. That's where the injury occurs and the pain. So initially you might think, oh, it's a very weird sensation. So you do it very gently, but that should improve and normalize over six weeks. Great.

SPEAKER_00

And it's really reassuring to know that we can start early with maintaining our strength and recovering with the pelvic floor. 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? Yes. That kind of thing.

SPEAKER_02

Yes, because we've got to remember the benefits of exercise, and we had a previous episode on that, and it's hugely important. So we do want to encourage women postnatally to resume exercise, and unfortunately, too few women do. Yes. So the rates of return to exercise postnatally are disappointingly low. 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. So we have fewer women who are exercising even at the minimum level required for good health. So we want to do as much as we can in that early postpartum period to encourage women to resume exercise. But it's a balancing act. We want people to do the exercise they love because they're more likely to do it. Whereas if you tell someone to do an exercise they don't enjoy, you won't have any adherence. 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. So we would need to build up the exercise program, the pelvic floor muscle training program, to withstand that load. A good test is if you're doing an exercise that involves some jumping, try a jump at home on a full bladder. And if you can't prevent leakage, that means your exercise activity, fitness activity may well cause some leakage. And that's not a good thing because it means it's overloading your pelvic floor muscles. 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. So that's another factor, of course, that women are concerned about postnatally is losing excessive weight that they've gained. And the best way to do that is exercise combined with good diet. So if you can't exercise, it's a struggle to lose weight. 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. 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. 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. 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. 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.

SPEAKER_00

Great. 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.

SPEAKER_02

That's what we want. So that we generally have good physical activity and health and fitness in our postnatal mums.

SPEAKER_00

Great. Really positive and optimistic, I think, because I think it's a common issue. As you said, you know, over half of women who have a pregnancy will have some kind of uh potential problem with their pelvic. About a third. About a third about it. Postnatally, yeah. Um so that's really important that and reassuring to know that it's you're not alone. It's really common. But there's lots of things that we can do about it.

SPEAKER_02

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. Make sure you lift with good posture so you don't strain your back. No point having a good pelvic floor muscles, but back pain and neck pain. So we want to look after our whole body. 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. So you also need your back and neck and arms and general posture to be working in your favour as well.

SPEAKER_00

Good physiotherapy principles. Yes, that's right.

SPEAKER_02

General, general body principles, yes.

SPEAKER_00

And how about subsequent pregnancy? Yes. What is the evidence for how that might impact the pelvic floor, having multiple pregnancies? And is there any recommendation as to the interval between pregnancies that we talk about?

SPEAKER_02

Yes, well, all of these things can affect your pelvic floor. You're right. I think would you recommend two years, or is the World Health Organization recommendation two approximately two years?

SPEAKER_00

Roughly the recommendation, but that is a holistic, I think, recommendation for multiple factors, not just the pelvic tool. 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. 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. So I think in general, that's a general recommendation. Yes. Which incorporates the pelvic floor for sure.

SPEAKER_02

That's right. And a good idea for all of those reasons. In terms of the pelvic floor, we do see that the risk of developing incontinence is highest with your first pregnancy. So interesting. Yes, it's not that it just gets worse and worse with every pregnancy or a higher risk. So in fact, the first is the biggest risk to the pelvic floor muscles for incontinence. However, prolapse has a different pattern. So the repeated stretching, loading and stretching and birth process tends to increase prolapse with each subsequent birth, but not necessarily incontinence. Okay. Again, if nothing we can do about that if that's your life choice and your birth choices. However, we know that pelvic floor muscle training has high level of evidence for treating both incontinence and prolapse. 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. And the same for prolapse.

SPEAKER_00

Yeah. Okay. That's good to know.

SPEAKER_02

For mild to moderate prolapse, severe prolapse may require surgery. 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.

SPEAKER_00

Well that's encouraging. Yes. Yeah. Again, something you can do. And something that's relatively low risk and easy to do. Yes. 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?

SPEAKER_02

Trevor Burrus That is the number one factor that determines what treatment, if any, you you choose to have. So you can actually have evidence of prolapse when you're examined, but feel nothing. So if the prolapse is mild, you may not be aware that you have a prolapse. 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. Whereas any degree of incontinence, you're aware of it. Yes. That's the difference. It's hard not to be aware of it. That's right, because it's it's obvious and you feel it, whereas with a mild prolapse you may not. So any degree of incontinence means there is incontinence and pelvic floor muscle training is the first go-to.

SPEAKER_00

We'll do a separate topic on on this specifically, but just to touch on it. Sexual dysfunction in regards to the pelvic floor after birth. What would you recommend in terms of time for rest of the pelvic floor from that point of view after a birth vaginally? Yes. And how would you guide people to know when might be the right time to resume sexual activity? Yes. What are the normal things that people might feel the first time they're trying to have intercourse after the phone?

SPEAKER_02

Yeah, sexual dysfunction is quite a complex problem, unlike incontinence or prolapse, which are more single-dimension and anatomical and mechanistic. Yes. Whereas sexual dysfunction or a problem with sexual function, if you like, can be caused by a multitude of factors, not just the tissues. That's right. Which is the difference then with incontinence and prolapse. 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. 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. That muscle will have stretched, may have sustained some degree of injury, and be in the process of recovery. 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. So discomfort the first time you resume vaginal sexual activity is not uncommon postnatally. So you want to wait until you've got some degree of healing. So that will depend on the birth, but for many women it'll be several weeks, if not six or more. So not to be alarmed, if it's six weeks, any touch around the vaginal area is still very uncomfortable. It might mean that you're you're needing more time and recovery. But some things can help, such as using adequate lubrication. 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.

SPEAKER_00

Also adding hormonally. That is actually what happens, isn't it, with breastfeeding? Very true. It's going to be suppressed.

SPEAKER_02

Yes. So adding some lubrication is a very good idea. And again, we we talked about using edible oils, natural oils, for perineal massage. It's the same for sexual activity. So you can buy sexual activity lubrication from a pharmacy, but you can also use oils just as comfortably. Great. So that means you don't need to buy anything extra. Yes. 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. So when you exercise the muscle, you contract and relax and you get more blood flow through the area. So it's generally a healthier muscle. So that has been shown in research that if you do pelvic floor muscle exercises, it has a good effect on sexual dysfunction. 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. 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. Like remedial massage. Correct. Some gentle stretching muscle uh massage. Mm-hmm.

SPEAKER_00

Great. So again, really important to know that sexual dysfunction after a birth can be normal. Correct. It's quite common. Correct. But potentially reversible and often something that will get better with time and can be benefited from pelvic fluorexis.

SPEAKER_02

That's right. And of course it's hard not to feel distressed about it because it is very distressing. 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. 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. 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.

SPEAKER_00

We've discussed pelvic floor exercises so much, and it obviously there's so much benefit in doing them at any stage of life. Would you recommend, in general, if we have the means to, that everybody consult a pelvic floor physiotherapist in pregnancy and postpartum?

SPEAKER_02

Ideally, if there's any time in your life that it would be grand to have that opportunity, that would be it. A window of opportunity, we'd call it, because that's a time of high risk to the pelvic floor. 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.

SPEAKER_00

Yeah. Yes. And you don't need many appointments with that healthcare professional, do you?

SPEAKER_02

It depends. If you have no symptoms but you're taking a preventative approach, one appointment might be sufficient. 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. 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. The treatment is doing it for you, the surgical or the drug treatment. For any physiotherapy treatment, usually you do need to be involved in improving and doing it with the physiotherapist. So that might mean exercise, changing your lifestyle, doing things differently. And the effects take time. 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. So any change to our tissues that we need to make ourselves is going to take time. 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. Okay. 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. So there might be top-ups throughout your life. But think of it as like an exercise or a fitness program. You need to do something yourself. The physiotherapist needs time to help you, so it may take six to eight weeks.

SPEAKER_00

Which is a relatively short space. In scheme of things. And as you said, thinking beyond this childbearing window of time, the pelvic floor can be under stress for many other reasons. That's right. Such as infection where we might have chronic coughing. 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.

SPEAKER_02

That's it. So we think of it as a compounding situation. 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. So it's a bit like overloading. There's a threshold. We call it the pelvic floor threshold. 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. But as life events build up and start overloading, you cross over your threshold of becoming aware of symptoms. It doesn't mean that anything dramatic has happened. It's just that accumulation of several things that are working against you. And that's when you might need a good course of treatment. Yeah.

SPEAKER_00

And to up those pelvic fluoride.

SPEAKER_02

Correct, and just to get your threshold higher.

SPEAKER_00

But it's really important to know, I think, that it's very common. Very common. But that something can be done about it. Absolutely. 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. 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.

SPEAKER_02

That's it, because information and knowledge is power and gives you the opportunity to choose what you'd like to do. 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. 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. Yeah. 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.

SPEAKER_00

Yeah, and that's the important message I think is that we shouldn't be ashamed. That's right. It's something that we can be very proactive about and do something about, and it can significantly improve people's quality of life.

SPEAKER_02

It does. It absolutely does, which affects your physical health and your mental health. And to remind women that it's their choice. So whatever treatment option they choose, that is their choice. And some women will choose an option that another woman would not choose. But that's okay, you've got to weigh all the things up: access, time, all of those things. Correct.

SPEAKER_00

Yeah. That's a really great note, I think, to finish on. Thank you so much, Alina. 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. Absolutely. A lot of it is within our control. So thank you so much, Alina.

SPEAKER_02

Thanks very much, Rangy, for inviting me to participate. Thank you.

SPEAKER_01

Every pregnancy is unique. The information provided in today's podcast is for educational and general purposes only. It is not intended to be substitute for professional medical advice. 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.