Articles

Key takeaways

• Your pelvic floor muscles support your bladder, womb, and bowel.
• Leaking urine after birth is common but usually improves over time, or is treatable
• Pelvic floor exercises are key for recovery and strengthening.
• Talk to your GP or midwife if symptoms continue after 6 weeks.

Understanding pelvic floor symptoms

Your pelvic floor is a group of muscles. It stretches like a hammock from the front of your pelvis to the bottom of your backbone. These muscles surround and support the organs in your pelvis- including your womb, bowel, and bladder. These muscles are also important for sexual function.

Common pelvic floor symptoms

Weaker pelvic floor muscles can cause several issues, including:

• Leaking urine when coughing, sneezing, or laughing (stress incontinence)
• Changes to how sex feels
• A bulge in or around the vagina (prolapse)
• Bowel control problems (faecal incontinence)

It is common to leak urine after having a baby (urinary incontinence). About 1 in 3 women experience bladder control issues after birth. It is more likely after a vaginal birth, but can also happen after a caesarean birth. Less commonly, you may have problems controlling your bowels.

When to seek help for symptoms

It is very common to feel you have little or no control over your bladder for days or weeks after birth. Many women feel this way and don't always ask for help, but support is available.

If you are still leaking urine when you cough or sneeze after 6 weeks, it is worth speaking to your GP, family nurse, or health visitor. Although it can feel embarrassing to discuss bladder or bowel control problems, healthcare professionals are used to talking about these symptoms and can help you access the right care and support.

If you had a third- or fourth-degree tear, you should have a follow-up appointment at the hospital. This is usually 6 to 12 weeks after birth. If you have problems with controlling your bowels, you may be referred to a specialist for further assessment and support.

What to expect from professional help

Your GP or health visitor can advise you and refer you to a specialist if necessary. They can help you get the right care. This may include:

• Physiotherapy – This can help treat leaking urine and improve a prolapse.
• Bladder and bowel training – These are specific exercises and techniques.
• Surgery – Sometimes considered if other treatments haven't helped, a specialist might discuss surgery.

At-home management and physical recovery

There are many ways to manage symptoms and support your recovery at home.

Perineal care

Tell your midwife or health visitor if you feel pain in or around your vagina, or if you notice any offensive-smelling discharge. This can be a sign of infection, along with increasing pain, redness, and swelling.

When wiping after using the toilet, always wipe gently from front to back. This helps protect your wound, if you have one, from bacteria.

Gentle movement and avoiding strain

Gentle exercise like walking will help you recover. It also reduces your risk of a blood clot in a deep vein (DVT). This can sometimes happen if you are not moving around as much after birth.

Avoid lifting or carrying heavy things, including older children or shopping bags. Also avoid activities like hoovering.

If you had a third- or fourth-degree tear, avoid strenuous activity or heavy lifting for 4 to 6 weeks. After this time, you can gradually increase your general activity.

You may also need to avoid high-impact exercise, such as jogging. Avoid having sex until you feel comfortable, which may not be for about 6 weeks.

Your GP might also talk about healthy weight. If you're carrying some extra weight, losing it slowly and safely can sometimes help your recovery.

Diet and hydration

Aim to eat a healthy, balanced diet. Include plenty of fruit and vegetables, along with cereals and wholemeal bread. Drink at least 2 litres of water every day. Try to avoid constipation and straining.

Keeping your bowels healthy

If you had a third- or fourth-degree tear, you should be given laxatives. These are medicines that help loosen your stools. This means you should not need to strain when you open your bowels.

Here are some tips to help you open your bowels:

• Put your feet on a footstool to raise your knees above your hips. This helps straighten out your bowels.
• Relax and rest your elbows on your knees.
• Take deep breaths to avoid straining. Bulge out your abdomen by taking big breaths.
• Gently push down from your bottom. Do not hold your breath.
• Take your time and do not rush.
• Do not delay if you need to go to the toilet.

Pelvic floor exercises

Pelvic floor muscle exercises strengthen the muscles around your bladder, vagina, and back passage (anus).

This can help prevent leaking and can help improve a vaginal prolapse. It can also improve sensation during sex and make it more comfortable. You can do these exercises lying down, sitting, or standing. With practice, you can do them anywhere.

How to do pelvic floor exercises

To do a pelvic floor muscle contraction:

• Make yourself comfortable, sitting or lying down with your knees bent.
• Squeeze and draw in your back passage, as if you are trying to stop yourself passing wind.
• Squeeze around your vagina and urethra (the tube you pass urine through), as if you are stopping the flow of urine or holding in a tampon.
• Do not clench your buttocks, hold your breath, or squeeze your legs together.
• Keep your abdomen relaxed and avoid tightening it.
• Breathe normally throughout.

You should do both quick and slow contractions:

• Slow contractions – Squeeze and lift your pelvic floor muscles as strongly as you can, holding for up to 10 seconds. Then relax fully, before repeating up to 10 times.
• Quick contractions – Quickly tighten your pelvic floor muscles for 1 second, then fully relax. Repeat up to 10 times.

Aim to do 3 sets of 8 to 10 squeezes of each exercise every day. To help you remember, link them to a daily activity such as waiting for the bus or preparing a meal. You may also find it helpful to tighten your pelvic floor before you sneeze or cough.