Myth: caesareans prevent pelvic floor dysfunction

It is estimated around 10% of women will benefit from a Caesarian Section (CS) delivery to avoid prolonged obstruction during labour and major pelvic floor damage.. In the US in 2006, 31.1% of women gave birth by CS,1 in Australia it is around 30%.2 Older mothers (over 40 years) have a higher rate of CS.3 
Your pelvic floor is the hammock of muscles ‘down under’ which spreads from your front pubic bone, to your coccyx at the base of your spine and out to your sitting bones.

  • Your urethra, vagina and bowel are closed by your pelvic floor muscles (PFM’s) to prevent loss of fluid, wind and solids
  • Your PFM’s contract to hold up your bladder, uterus and bowel when you run, cough and lift (preventing prolapse)
  • Your PFM’s contract with your Core muscles to form a cylinder to support your spine with activity
  • Your enjoyment of sex (sensation, vaginal wall and orgasm strength) is related to PFM strength

It’s commonly believed a Vaginal Delivery (VD) is the cause of Pelvic Floor Dysfunction (PFD).
Hold On……
Researchers show the same rate of Urge Incontinence at age 50 in both VD and CS mums.4
Other researchers found a 50% rate of Stress and/or Urge Incontinence in a large cohort of post menopausal nuns.5 (No babies)
So what else contributes to PFD?

  • During pregnancy – hormonal, postural changes, the pressure of the baby, fluid and placenta down onto the Pelvic Floor can cause incontinence and some women experience tears in their supporting connective tissues (e.g. when your abdominals separate)
  • Large studies show the unnecessary use of episiotomies and poor birthing positions (lying on your back) leads to more Pelvic Floor damage.6 The use of forceps and vacuum extraction cause more damage
  • Heavy women are more likely to be incontinent than average weight women7
  • Regularly straining to empty your bowel is a sure fire way to weaken PFM’s and promote prolapse8 (particularly in the 3 months after delivery)
  • Women who smoke and those with prolonged coughing due to chest disease have a higher rate of PFD9
  • Researchers have recently shown the timing of your PFM contraction is important for continence. In their study, the Continent Women automatically tightened their PFM’s first with any movement. The group of Incontinent Women tightened their waist and chest wall muscles first, and then their PFM’s had to contract harder to keep up.10 Some women have learned to incorrectly pull in their waist constantly so their brain learns to switch on these muscles first when they move, instead of their PFM’s.
  • Women whose work requires them to constantly lift heavy weights (eg. Assistant nurses), have a high rate of vaginal and lumbar disc prolapse11
  • Habitually poor posture will weaken your Pelvic Floor and Core muscles Slumping shuts them down.12 Why? These muscles switch on when you sit or stand tall and are designed to stay switched on when we are up against gravity ( they get a rest when you lie down)
  • Incorrect exercise – if you have a weak, uncoordinated Pelvic Floor, starting sit ups and doing exercise which is too challenging for your body, can promote Incontinence and prolapse.13 Your Fitness Instructor needs to know if you have PFD, BEFORE you start an exercise programme.
  • Women should train their Pelvic floor and Core muscles and postural control first, before adding a heavy exercise programme
  • Menopause brings changes in hormonal levels so women who have never exercised their Pelvic Floor may notice they develop Stress or Urge Incontinence14

During pregnancy, after childbirth and around menopause are crucial times for PFM’s to be correctly exercised.
Ideally you should learn the correct PFM action and exercise them every day the same way you make a habit of cleaning your teeth.
It’s time to stop blaming childbirth and be pro active. Visiting a Women’s Health Physiotherapist to learn the correct exercises is a great investment in your Pelvic Floor throughout life.
Mary O’Dwyer
Women’s Health Physiotherapist
Senior Teaching Fellow. Bond University. Gold Coast
Author ‘My Pelvic Flaw’ Available from all book stores and RedSok Publishing

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