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pelvic floor musclesSpeaking to women’s health physiotherapist Carolyn Sultana, we soon came to realise that our pelvic floor is figuratively on the front lines of pregnancy, childbirth… and daily life. We were surprised at how often overlooked this area is, and how little education there is available, so we’re very grateful to have had the opportunity to have this discussion with Carolyn. Check out our interview to learn more about the important role of the pelvic floor muscles in our day to day life, how it reacts to labour and delivery, and how to ensure that all’s well in that area.

What is your pelvic floor?

The pelvic floor is a group of muscles and ligaments that run from the pubic bone in the front to the tail bone at the back and form the base of the pelvis. Their job is to support the bladder, uterus and the bowel. The opening of the bladder (urethra), opening of the uterus (vagina) and the opening of the bowel (anus) pass through the pelvic floor.  

What is the importance of your pelvic floor outside of pregnancy?

The pelvic floor supports the pelvic organs to prevent problems such as incontinence and prolapse. It also helps to control bladder and bowel function, such as allowing you to “hold on” until an appropriate time and place. The pelvic floor needs to be strong and flexible. Thus, it requires the ability to contract when needed and the capacity to relax once the contraction is over. The ability of the muscle to relax allows a person to be able to fully empty the bladder and bowel. It also allows one to enjoy sexual penetration without pain. A healthy pelvic floor also ensures good sexual function and pleasure.

 pregnancyWhat is the importance of your pelvic floor during pregnancy? 

A healthy pelvic floor is needed throughout life and most especially before pregnancy, during pregnancy and postpartum. The pelvic floor supports the growing uterus and baby. The pelvic floor muscles need to be strong for labour and a functional, flexible pelvic floor makes perineal tearing less likely.  

Pregnancy, and vaginal labour even more, will most likely cause stretching and weakness to the pelvic floor. Therefore, having healthier pelvic floor muscles before and during pregnancy will allow for easier recovery after the baby is born. There will also be less symptoms of incontinence and prolapse.

What does the pelvic floor go through during labour? 

During childbirth, the pelvic floor must stretch and thin out to allow for birth to take place. Very commonly, trauma is caused to these muscles, nerves or other tissues of the pelvic floor which leads to weakness. Trauma can occur from the head of the foetus compressing, tearing and forcibly moving the muscles and connective tissue of the pelvic floor. Such injuries may also be caused by forceps when these are used during delivery. A mother can also sustain nerve injury when the main nerve supplying the pelvic floor is compressed by the baby.

A large baby, prolonged second stage of labour and/or instrumental delivery, particularly forceps, can lead to nerve damage. Sometimes during labour, the mother will require an episiotomy to allow for birth to happen. When this is performed, the pelvic floor muscles will have to be cut and sutured afterwards. Unfortunately and not very commonly, mothers can suffer from more serious perineal tears classified as third or fourth degree tears.  During these tears, the pelvic floor muscles are torn and the tear extends from the vagina to the back passage. Any mother who suffers a third or fourth degree tear should be seen by a women’s health physiotherapist. This should be done due to scar management, strengthening of the pelvic floor, and advice to reduce the risk of prolapse.

pregnancy pelvic floor muscles exercisesHow can you get your pelvic floor strength back after pregnancy? 

Pelvic floor training should start in the antenatal period. If a mother worries that she is unable to perform the exercises properly, she should seek help from a woman’s health physiotherapist. Pelvic floor exercises should include both long, sub maximal contractions and short maximal squeezes. These should be done with equal emphasis on contraction and relaxation of the muscles. These exercises can be restarted immediately postpartum (only exclusion is if there is a catheter) and continued throughout life.

Once the sutures, if any, are healed and the mother is happy to be examined, normally around 6 weeks postpartum, she should visit the women’s health physiotherapist to check the strength and function of the pelvic floor. Like this, it is ensured that exercises are done effectively. If the pelvic floor muscles are too weak and the person is unable to initiate a contraction other techniques can be used. These include electrotherapy and biofeedback.  

Thank you for sharing this helpful insight Carolyn. The pelvic floor is so important and yet so commonly overlooked. Thanks for bringing up this conversation and educating so many!

Carolyn Sultana women's physioAbout Carolyn Sultana

Carolyn Sultana is a Women’s & Men’s Health Physiotherapist. She specialises in antenatal and postnatal issues such as pelvic and low back pain, diastasis recti, exercise during pregnancy, return to exercise postpartum and management of scars, both after perineal tears or c-section scars. Pelvic floor physiotherapy is also important for people with pelvic organ prolapse, urinary or faecal incontinence, urgency or straining. Ms Sultana also specialises in the treatment of sexual pain and dysfunction related to issues with the pelvic floor muscles.

You can find her at St Anne’s BirkirkaraMyMama NaxxarWillingness Ħaż Żebbug and Abela’s pharmacy in Gozo.


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