Childbirth when difficult can be traumatic on the Pelvic Floor, leading to muscle and fascial tears and organ descent. The variations in presentation are immense and it should not be assumed that a muscle is weak because of laxity, a tear or loss of attachment of the muscle or fascia.
It is common that the Pelvic floor is weaker after childbirth and women can develop symptoms of INCONTINENCE. As a result women start to subconsciously hold the Pelvic Floor, fearing the symptoms and gradually the abdomen sets up a negative holding pattern, further feeding into the Pelvic Floor holding.
The Pelvic Floor responds well to FACILITATION to get the right muscles going again as further squeezing the ones already working frequently doesn’t do the job. The rehabilitation needs to be specifically targeted at the damaged muscles and fascia.
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Symptoms
- STRESS INCONTINENCE can follow when the Pelvic Floor muscles just don’t reach the neck of the bladder.
- URGE INCONTINENCE can happen when the muscle of the bladder becomes overactive and often this leads to even more negative holding of the Pelvic Floor.
- FAECAL INCONTINENCE occurs when the muscles of the back passage have weakened or FAECAL URGENCY which can often be associated with TRIGGER POINTS in the Pelvic Floor.
- PELVIC ORGAN PROLAPSE can happen postnatally or later as a consequence of childbirth but only become symptomatic after the menopause. When any organs come down the Pelvic Floor has to work harder to support the organs. Clinically it can be noticed that the muscles become very tense and then of course the prolapse worsens as the lift of the Pelvic Floor is decreased. The Pelvic Floor has a shelf that the organs sit on, this shelf is the upper vaginal axis and it should be horizontal, often when the organs have descended the upper axis has become more vertical and the support is lost. The approach is to first facilitate and release the Pelvic Floor muscles and then strengthen the lift. Not all prolapses respond to a level that is manageable to the patient but most will improve and some do resolve. It is always a good idea to try to mobilise and strengthen the Pelvic Floor even if surgery is ultimately indicated.
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