A Pelvic Floor Checklist for your next Pregnancy

Are you ready to have another baby?

Is your pelvic floor ready for your next baby?

Can you answer the following questions with a positive, yes. The reasons why each area is important is discussed after each question, with tips on what to do if you need to do more work in a particular area to prepare your body for another pregnancy.

These questions can also be used as a simple postnatal check, to ensure your body has recovered after your last pregnancy and birth.

Find out more about your pelvic floor muscle exercises here

Your pelvic floor muscles are strong and you feel confident that you know how to do your exercises correctly.

What does a strong pelvic floor mean?

It can be hard for you to clarify this by yourself, as there are a number of things to consider. Ideally it means that your pelvic floor muscles are close to ‘back to normal’ after the effects of your last pregnancy and childbirth, but how do know what your normal was before the birth last time, or before pregnancy?

Check through each of these points:

• that you don’t feel that you have any weakness in your pelvic floor muscles

• you can feel your pelvic floor muscles working when you do your exercises

• You feel your muscles relax when you let go from a pelvic floor lift and hold

• you can stop your flow of urine midstream when checking this as a test  
  (this is just a check, not an exercise, that can be done for example once a week)

• you have no problems with leakage of urine, bladder or bowel control.

Remember that with another pregnancy it is again likely that there is more strain on your pelvic floor muscles and that they can further weaken. Often there is a slow decline of pelvic floor muscle strength, which may even be subtle, from one pregnancy to the next. It is not until later on that this becomes apparent and those problems can commence. Sometimes even as late as at menopause women will notice problems that can be attributed back to pregnancy and childbirth from either not doing the exercises then, or feeling that they never quite got back to normal after they had their children.

If you are still not confident that you are doing your exercises correctly, or never were quite sure that you were doing them right, don’t wait until you are pregnant again to check this. Start now, and clarify as much as possible that you are doing your exercises the right way.

Read How NOT to do your pelvic floor exercises in the Pregnancy Exercise section of The Pregnancy Centre.

Start your exercises again now, and work to improve your pelvic floor muscle control as much as possible before becoming pregnant again. It doesn’t matter if you are not planning to become pregnant just yet. The extra time taken will only benefit your pelvic floor while you are planning or waiting.

Be diligent with your exercises during your pregnancy. In the first few months you may continue to gain some improvement in your pelvic floor muscle strength and control, but later in pregnancy you are aiming either to maintain what you have got, and reduce the weakening effect of pregnancy on your pelvic floor muscles.

If you didn’t do your exercises last time, be more diligent this time around. It will pay off in the long term, rather than waiting to have a problem appear before doing your exercises or paying attention to this area.

You experience no leakage of urine and can hold on when you need to go to the toilet.

If you do experience any leakage of urine, for example if you cough, sneeze, laugh, run, lift or exert yourself, this is an indication that your pelvic floor muscles are not working the way that they should. This will only become worse with another pregnancy and with time. Many people think that it will go away by itself. In the early post natal period, while your body is recovering it should improve, as you do your exercises. If you get to the point where you plateau and this problem persists, you should seek further advice and treatment, even if you have been doing your exercises, as there is extra help that is available particularly for this problem.

Experiencing any urgency to go to the toilet (with bladder or bowels), or loss of control on the way, is again likely to get worse with another pregnancy as the weight of the growing baby combined with the effects of the relaxin hormone can further weaken your pelvic floor muscles and therefore further reduce your control. Again strengthening your pelvic floor muscles can help with this, so start again if you haven’t done them for a while. Also seek help from a Physiotherapist working in the area of Women’s Health as treatment is available for this problem. It is better to seek treatment before you become pregnant again if possible, as you are likely to get more results then, rather than waiting until the problem becomes worse while you are pregnant.
For more information watch the video 'For 5 proven bladder control training tips', by Pelvic Floor   Physiotherapist, and author of 'Inside Out - the essential women's guide to pelvic support'.

You can empty your bladder easily, completely and without straining

There are some women who find it hard to empty their bladder and do not realise that they area actually straining to empty when they are ‘doing a wee’ or when they are finishing emptying their bladder. When these habits have developed, it means that you may be straining downwards also on your pelvic floor muscles, to empty the bladder. This is not good practice to continue this, as it can stretch and weaken your pelvic floor muscles.

Pelvic Floor Physiotherapist Michelle Kenway explains how to overcome this at http://www.pelvicexercises.com.au/empty-your-bladder/


You do not have heaviness, pain or bulging in your pelvic floor or perineal area

This indicates a prolapse (See What is a prolapse? ) or that your pelvic floor muscles may still be quite weak or not working well. Another pregnancy on top of this means that these symptoms could become worse; so work on your pelvic floor muscles diligently before and during your next pregnancy. The article above gives you advice about what to do to help reduce the symptoms of a prolapse. Seeking professional advice for further assistance if you are planning another pregnancy is highly recommended. A Physiotherapist working in the area of Women’s Health can help you to improve your pelvic floor muscle strength in preparation for the load of another pregnancy.

You do not strain to use your bowels

If you strain regularly to use your bowels, this will continue to weaken your pelvic floor muscles over time. Straining over years has been shown to increase the risk of stress incontinence (leakage of urine when you cough, sneeze, laugh, lift, run or exert yourself) and of a prolapse.

Aim to sort out the reason for straining, and address this with the help of your doctor or other health professional. If you have to continue straining all through another pregnancy, it will only add to the weakening effect of pregnancy and increase your risk of problems either now or in the future.

Consider the F.E.W principle when looking at preventing and overcoming the need to strain to use your bowels.

F = Fibre is what helps your bowel motions to be softly formed. There are different types of fibre, and the amount in food varies. Find a ‘fibre chart’ and check with your health professional for more advice on good sources of fibre that suit you.

E = Exercise stimulates the activity of your bowel and can help it to become easier ‘to go’

W = Water helps to keep your bowel motions soft, working with the fibre to produce a soft ‘stool’ or bowel motion. The amount of water that you drink depends on the climate, your body size, and your level of activity, but if you find that it is ‘hard to go’ then check on your water and fluid intake.

You can also look at your ‘toilet position’ which can be seen on pages 39 & 40 of As Your Shape Changes
Check too, that you are ‘not missing the signals’ to go to the toilet. Our bowel motion often gives us the signals to go either first thing in the morning, after a meal or a hot drink. If you delay the urge to go, the bowel motion can ‘sit’ and the signal will go away, making it harder to go. This can occur after having a baby or children, when it is harder to go when you need to, but pay attention and aim to not ignore the urge to use your bowels.

Pelvic Floor Physiotherapist Michelle Kenway, author of Inside Out – the essential women’s guide to pelvic support, further explains toilet positioning and using your abdominal muscles in a way to help you empty your bowels more easily. To find out more watch the video http://www.pelvicexercises.com.au/bowel-movement/


If you are in Australia to find out where to seek help if you have a pelvic floor problem visit The Continence Foundation of Australia - Continence health professionals and click on The National Continence Helpline.

or The Australian Physiotherapy Association Find a Physio area at  Find A Physio. Click on Continence and Women's Health and your area or state to find a physiotherapist working in this area of women's health.

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