Your all life, your perineum, which is a hammock composed of muscles holding your visceral organs, had to go through a great deal (pregnancy, delivery, sport, menopause, cancer treatment). You may have perceived this sensation of heaviness standing.
Hormonal changes occurring 
during pregnancy and menopause but also due to disease (thyroid or cancer) play a big part in this perineum weakening.
Your abdominal muscles also suffer during these events, sometimes leaving sequels such as diastasis, which is a gap in you rectus abdomini, the 6 pack muscles or a chronic weakness in your transverse muscle.
Consequently, it is essential to be aware of perineum and transverse muscles and of their changes. Weakening of these tissues is the main cause of urinary and anal incontinences (coughing, laughing or even walking). It is common after giving birth due to the baby weight and the push to have a minor prolapse (lowering of bladder, uterus or rectum through the perineum hammock). Perineal rehabilitation allows a complete recovery and suppress completely ay prolapse. However, without any specific treatment there is a major risk of gradual worsening of this prolapse leading to permanent incontinence and requiring surgery.
Do not hesitate to have a look at our blog which contain different articles on the topic. It provides further information on specific problematic and more details information on the perineum and transverse muscles.
While it is never too late to start perineum rehabilitation, be aware the sooner you start the quicker and better would be the outcomes. First session always starts with a history taking to help the women health physiotherapist to understand the problems you are presenting with (pain urinary issues, sexual dysfunction, constipation or difficulty to hold gas…) but also who you are and how it affects your life. In a second time, the women health physiotherapist will examine both your hip bones and abdomen to evaluate the position of your pelvis and detect potential diastasis. Then, the women health physiotherapist will perform a vaginal touch to evaluate perineal tonicity, bladder static and, correct position of uterus and rectum.
Following the history taking and examination, in accordance with you a tailored rehabilitation will be defined. It may include:
Passive mobilisation and stretching techniques aim at you pelvic bones and muscles- Manual perineal rehabilitation techniques
- Probe rehabilitation techniques, either electro stimulation or biofeedback techniques which allow to pursuit rehabilitation in functional positions (standing, walking)
- Anal rehabilitation either manual or with probe
- Abdominal rehabilitation internal following Abdo MG method
- Hypopressive abdominal rehabilitation
Pelvic floor rehabilitation is a global approach including various techniques selected in function of the new mom needs.
Urine leakage occurring rarely in sitting position, it is essential to perform an active rehabilitation, which means standing up, walking, standing on one leg… Consequently, manual techniques are not enough and it is necessary to use a machine called biofeedback. This tool allow to engage your pelvis muscle and to visualized on a screen the contraction and relaxation, and this either lying on your back, sitting, standing, walking or even jumping. Biofeedback also brings a didactic approach as you can see on the screen what you are doing. It is very helpful to develop better awareness, sensation and control of the perineum. However, it is only useful if associated with manual, abdominal and postural rehabilitation as all these aspects need to be addressed at the same time.
None of these techniques are painful. Commonly, 5 to 10 sessions are generally needed and will be associated with exercise sessions to do on your own. Obviously, the women health physiotherapist will adapt this exercises sessions in function of your need and teach it to you. She will also be able to provide advice concerning when and how to go back to sport internal link).
If you already start exercises after your pregnancy, good! However, stop “stop pee” exercises! All the exercises need to be done with an empty bladder. “Stop pee” exercises create neurological dysfunction modifying the need to urinate and lead to urinary infections. Additionally, be extra careful with all the exercises increasing abdominal pressure (Pilate, keggel, crunches…).
At My French Physio, our woman’s health (obstetric) physiotherapist offer home visit session because we think it is more convenient for mummies and allow you to rest at the end of the session. But consultation are also provided in our practice located in North london between Kentish town and Camden town.
