Pelvic health

During pregnancy and following birth, your body goes through many changes to help you grow, carry, and birth your baby. Pregnant people can experience a range of symptoms that are entirely explainable by normal pregnancy-related changes. Some people will manage these symptoms themselves, whereas others may need referral to other services.

Please speak to your midwife or doctor for support or referral to other services if you have any concerns which may include some of the following;

• back and pelvic pain and problems with your abdominal muscles
• urinary incontinence
• urinary tract infections (UTIs)
• constipation
• episiotomy and perineal tears
• third- or fourth-degree tears from childbirth
• bowel incontinence
• pelvic organ prolapse
• pain during or after sex (dyspaurenia)

Have a look at the sections below to find out what you can do to improve your pelvic health.

Your pelvic floor muscles surround and support all the organs in your pelvis – your womb, bowel and bladder.

If these muscles become weak, you can leak urine when you cough or sneeze. This is called stress incontinence. Exercising the pelvic floor muscles helps to prevent this.
You can start doing pelvic floor exercises before, during and after pregnancy.

Watch the videos to learn how to do pelvic floor exercises effectively.

Physical activity in pregnancy

The more active and fit you are during pregnancy, the easier it will be for you to adapt to your changing shape and weight gain. It will also help you to cope with labour.

Keep up your normal daily physical activity or exercise (sport, running, yoga, dancing, or even walking to the shops and back) for as long as you feel comfortable.

Exercise is not dangerous for your baby. There is evidence that active women are less likely to experience problems in later pregnancy and labour.

Watch the video and have a look at the infographic for more information.

Your perineum is the bit between your vaginal opening and anus. Tears tend to happen as the vagina and perineum stretch during your baby’s birth.

What are the types of perineal tear?

• First-degree tears are small and only affect the skin. They tend to heal quickly and without treatment. They are not likely to cause long-term problems.
• Second-degree tears affect the muscle of the perineum and the skin. They may well require stitches. Second-degree tears are not likely to cause long-term problems.
• Third-degree tears extend into the muscle that controls the anus (the anal sphincter).
• Fourth-degree tears extend further into the lining of the anus or rectum.

First and second degree perineal tears are most common type.

Third and fourth degree tears are less common. there is often no clear reason why this happens, and it is not possible to predict. However, it is more likely if:

• This is your first vaginal birth
• Your baby is over 4kg (9lb)
• You have a long second stage of labour (the stage during which you push your baby out)
• Your baby’s shoulder gets stuck behind the pubic bone (shoulder dystocia)
• You have an instrumental vaginal birth (forceps or vacuum assisted)

Antenatal perineal massage

Massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy and perineal trauma during birth.

The type and frequency of massage varies across research studies. Most involve inserting 1 or 2 fingers into the vagina and applying downward or sweeping pressure towards the perineum.

The most benefit was in women who repeated this every day.

Watch the video to learn how to do perineal massage effectively.

Warm compress

A warm compress is a flannel heated with warm tap water and held against your perineum during the pushing phase of labour Ask your midwife or doctor if they can provide this.

Spontaneous vaginal birth

Spontaneous vaginal birth (birth without forceps or ventouse) can be encouraged by choosing the ideal place of birth (consider a homebirth or midwifery led unit if you are low risk), avoiding induction and epidural where possible, creating a relaxing environment (consider soothing lighting, sounds, smells) and remaining active throughout labour and birth For first time mothers with an epidural, lying on your side during the pushing phase of labour is recommended.

Slow birth of the head

Choose a birth position that is most comfortable for you Listen to your midwife and they will advise a slow and guided birth of the head. The midwife or doctor will use their hands to support both your perineum and the baby’s head at the time of birth, whilst communicating with you to ensure your baby is born in a slow and controlled way. (MPP)

Sometimes a doctor or midwife may need to make a cut in the area between the vagina and anus (perineum) during childbirth. This is called an episiotomy.

An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.

Sometimes a woman’s perineum may tear as their baby comes out. In some births, an episiotomy can help to prevent a severe tear or speed up delivery if the baby needs to be born quickly.

If your doctor or midwife feels you need an episiotomy when you’re in labour, they will discuss this with you.

The National Institute for Health and Care Excellence recommends that an episiotomy might be done if:

• the baby is in distress and needs to be born quickly, or
• there is a need for forceps or vacuum (ventouse), or
• there is a risk of a tear to the anus

If you have a tear or an episiotomy, you’ll probably need stitches to repair it. Dissolvable stitches are used, so you will not need to return to hospital to have them removed.

Repairing tears and episiotomy

After birth, the midwife or doctor will offer to gently examine your vagina and anus to see if there is a tear, and what type this is. This examination will ensure you have the best chance of recovering well. If you have a tear or an episiotomy, you’ll probably need stitches to repair it. Dissolvable stitches are used, so you will not need to return to hospital to have them removed.

Pelvic organ prolapse is when 1 or more of the organs in the pelvis slip down from their normal position and bulge into the vagina.

It can be the womb (uterus), bowel, bladder or top of the vagina.

A prolapse is not life threatening, but it can cause pain and discomfort.

Symptoms can usually be improved with pelvic floor exercises and lifestyle changes, but sometimes medical treatment is needed.

Pelvic organ prolapse symptoms include:

• a feeling of heaviness around your lower tummy and genitals
• a dragging discomfort inside your vagina
• feeling like there’s something coming down into your vagina – it may feel like sitting on a small ball
• feeling or seeing a bulge or lump in or coming out of your vagina
• discomfort or numbness during sex
• problems peeing – such as feeling like your bladder is not emptying fully, needing to go to the toilet more often, or leaking a small amount of pee when you cough, sneeze or exercise (stress incontinence)

See a GP if you have any of the symptoms of a prolapse, or if you notice a lump in or around your vagina.

During pregnancy or following birth you may need a referral to a specialist pelvic health physiotherapist. This may be done by your midwife or doctor.

Pelvic health physiotherapy is based at Bradford Royal Infirmary.

The team of specialised pelvic health physiotherapists provide up-to-date evidence-based clinical interventions and treatments. The Pelvic Health Physiotherapy team provide a range of services including those with:

• Pregnancy-related conditions
• Pelvic organ prolapse
• Overactive bladder
• Urinary incontinence
• Perineal trauma during childbirth
• Voiding problems
• Bladder pain syndrome
• Faecal incontinence
• Constipation
• Functional pelvic floor disorders
• Coccydynia
• Dermatology conditions
• Primary delay in conception