Sarah Kheirallah
Sarah Kheirallah is a midwife, osteopath and acupuncturist specialising in providing holistic care during pregnancy and beyond. She is currently based in multiple teaching hospitals in London where she holds midwifery specialist roles in Pelvic Health. Privately, she is self-employed (maternityandyou.com) and works in the City at the London Pregnancy Clinic.
She also works with an American NGO “MEET International“, helping improve maternal and neonatal outcomes in a busy region in Vietnam working collectively with different specialists (midwives, obstetricians, psychiatrists, anaesthetists, dieticians…) from around the world.
Website – maternityandyou.com
@private_midwife_london
Summary
Pelvic floor education in your postnatal care package is generally lacking and often at best consists of the midwife saying ‘Remember to do your pelvic floor squeezes daily’ and handing you a leaflet. But what does that even mean? Has anyone ever actually spent the time talking you through how to do a pelvic floor squeeze effectively? If not – you are in the perfect place. Let’s get to work.
What we know:
Many women experience pelvic health changes after pregnancy, childbirth, the years that follow or in perimenopause or menopause. 10% of all women have pelvic issues (leakage, stress incontinence, prolapse, or a too-weak or too-tight pelvic floor).
1 in 3 women will experience issues at some point in their life. Research estimates that about 1 in 3 women experience urinary leakage 3 months after pregnancy. 1 in 5 women have accidental bowel leakage 1 year after pregnancy. 1 in 12 women report symptoms of pelvic organ prolapse.
What we don’t know:
The most common problems are leaking with exercise, sneezing/coughing (also called Stress Urinary Incontinence) and/or not getting to the toilet on time (also called Urge Incontinence). Other common pelvic health issues include having the sensation of something heavy; dragging or bulging in the vagina (also called Pelvic Organ Prolapse) and painful sex (also called Dyspareunia).
The pelvic floor (or pelvic diaphragm) spans across your pelvis from the pubic bone at the front to the coccyx at the back. It is made of different types of muscle fibres, ligaments and fascia. It acts as a support for the structures above (bladder, rectum, cervix, womb, digestive system…). It helps you control wind, pee and poo. It stretches to help you deliver your baby. It also can help improve sex by increasing your sensation and orgasm. Finally, it participates in maintaining the stability of your hips and pelvis.
Pelvic floor exercises consist of exercises which can be done in a multitude of positions.
Practice time!
Practice time! In a comfortable lying down or seated position, imagine that you are trying to stop yourself from passing wind (without squeezing your buttocks together). Draw your pelvic floor muscles upwards and forward from the back passage towards the front passage, lie a “zip”. Fully relax your pelvic floor muscles.
-> Try and repeat this programme 3 times a day (if you are experiencing symptoms, otherwise once a day).
-> Start with 5-10 short squeezes and then build up to 10 long squeezes aiming to hold each squeeze for 10 seconds. You may not be able to hold for 10 seconds straight away so it is important to gradually build up to this at your pace. You may need to start with little and often until the muscles get stronger.
-> You should notice the exercises gradually getting easier and feel the benefits after a few months (3-5 months).
-> And after? Once improved, continue to practice these exercises once a day to maintain strength.
Preventing pelvic health problems occurring:
- Chronic constipation: having to strain can overstretch and weaken your pelvic floor. Hydration, walking, diet and fibre as well as responding promptly to signals to open your bowels and effective toilet position are all simple measures to prevent constipation.
- Heavy or repetitive lifting: this can cause increased abdominal pressure which would be putting strain on the pelvic floor structures. Ask your healthcare provider about safe lifting techniques.
- Overweight: this can cause a direct increase in pressure on the pelvic floor. You can get support in your community.
- Chronic Respiratory Conditions/Smoking: repetitive coughing can cause pressure on the pelvic floor. A technique called the Knack consisting of squeezing before coughing/sneezing/laughing will help your pelvic floor respond to the increasing intra-abdominal pressure. Smoking cessation experts are available in the community, so don’t hesitate to seek advice locally!
An effective toileting position (the “squatty potty” position) will help reduce pressure onto your pelvic floor and better empty your bladder/ rectum. And don’t forget to breathe and relax! It is as important to squeeze your pelvic floor as it is to relax. Mindfulness techniques and manual therapy practitioners can support you.
Links to other resources
Websites and Guidelines
Websites and GuidelinesNICE: Pelvic Floor Dysfunction: Prevention and Non-surgical Management
NHS England: Perinatal Pelvic Health Services https://www.england.nhs.uk/mat-transformation/perinatal-pelvic-health-services/
Pelvic, Obstetric and Gynaecological Physiotherapy: https://thepogp.co.uk/
Continence Foundation of Australia: https://www.continence.org.au/who-it-affects/women/female-pelvic-floor-muscles
Royal College of Obstetrics and Gynaecologists: https://www.rcog.org.uk/for-the-public/perineal-tears-and-episiotomies-in-childbirth/your-pelvic-floor
Books
BooksStrong Foundations: Why Pelvic Health Matters – an Empowering Guide to understanding your body by Clare Bourne
Film Audio, Apps and Podcasts
Film Audio, Apps and PodcastsMy health London: Maternity Pelvic Health Wellbeing
My Health London: Perineal massage, Pelvic Floor
Pelvic Health Podcast: https://thepelvichealthpodcast.podbean.com/
Grainne Donnelly Podcast: https://absolute.physio/podcasts/
