The role of the pelvic floor in childbirth

What is the pelvic floor?

Before I explain something about the pelvic floor and the role it plays during childbirth, I think it is good to first tell you something about the pelvic floor itself.

The pelvic floor is, in short, a huge muscle located in the small pelvis. Both women and men have a pelvic floor. This muscle is made up of multiple muscle parts and layers. The function of these muscles includes keeping the organs located in the small pelvis in place and ensuring our continence.
Since we as humans started walking on two legs, the burden on the pelvic floor has increased. In general, people are no longer as aware of the pelvic floor muscles. After we became toilet trained as a child, they have usually been forgotten.
However, this muscle plays a very important role in normal functioning and in complaints.

What happens to the pelvic floor during pregnancy:

During pregnancy, the load on the pelvic floor increases enormously. This is due to the pressure of the growing uterus. The supporting tissue also changes under the influence of the hormonal changes during pregnancy. This causes the connective tissue to relax. This relaxation is really necessary in preparation for pregnancy. Connective tissue is everywhere, including in the muscle, at its attachment points, the ligaments and of course also in the supporting tissue of the vagina.

During the first pregnancy, a woman will generally experience little discomfort from this sagging.
Complaints that can occur are having to urinate more often: this is due to the increasing pressure, but also due to the increase in the so-called diuretic hormone, which increases urine production. Due to the increasing pressure of the uterus, the bladder will also give the signal more quickly that you have to urinate, despite the fact that the bladder is not yet that full. This complaint often disappears after delivery.

Too much tension on the pelvic floor:

In addition, there may also be too much tension on the muscles. This may have occurred unconsciously or due to excessive training. If the resting muscle tension is too high, it is no longer possible to control the muscles, i.e. tense and release them. Everything is, as it were, locked up. The complaints that go with this are difficult bowel movements, having to urinate even more often or, on the contrary, very difficult and in pieces to urinate and pain during sex.

The intestines become somewhat lazy during pregnancy due to hormonal changes, the passage is slower. If the muscles at the exit also have difficulty relaxing, constipation occurs. As a result of prolonged pushing, you can also get complaints of hemorrhoids, something you already have a greater chance of during pregnancy. It is important to pay close attention to your diet: eat fiber-rich food and drink enough fluids. Also pay close attention to your posture on the toilet. Sit as if you are sitting on a chair and not hunched over.

Urinating more often during pregnancy:

Having to urinate more often is part of pregnancy, but can increase due to an overly tense pelvic floor muscle. The bladder is even more stuck. The bladder is a kind of balloon, which normally at a certain filling, 300cc, sends the first signal to the brain that it may be necessary to urinate. Normally we can easily ignore this signal. As it fills further, the signal increases in strength, until it becomes so strong that you give in to it. Even with a very strong signal, we still have it under control and the urine does not start to flow spontaneously.

If the bladder is now stuck, partly due to high muscle tension, it sends the signal to the brain much faster when it is less full. This signal is often much stronger and difficult to suppress. A vicious circle often arises: the stronger signal is responded to sooner, the bladder sends the signal even sooner and this can often no longer be ignored or can be so strong that the urine starts to flow before looking at the toilet. These complaints fall under a so-called overactive bladder with urge (strong urge) and frequency (frequent urge).

Outside of pregnancy, these complaints can be treated with medication combined with pelvic floor physiotherapy, with a focus on letting go and coordination. We cannot use the medication in question during pregnancy, but physiotherapy can help reduce the complaint and help with recovery after delivery. Women who experience this complaint strongly often recognize it from before pregnancy. The high muscle tension was usually already present before pregnancy.

The birth:

During childbirth, the pelvic floor has a hard time. During pushing, the pelvic floor does not have much involvement in the first half of the birth canal. However, with good pelvic floor coordination, this will benefit your pushing technique. Only when the baby's head is past the halfway point, by which we mean through the narrowest part of the bony pelvis, does the pelvic floor play a role in the speed of expulsion. With too much resting tension, the pelvic floor will give a lot of resistance. With a slack pelvic floor, this does not happen. This should not be a license to let the pelvic floor slacken; you will also benefit from a good pelvic floor after childbirth.

Due to the pressure and the passage of the baby through the birth canal, small tears can occur in the muscle and the supporting tissue. These tears will never fully heal and can contribute to reduced support. As a result, a so-called prolapse can occur. Prolapse can occur at different levels: of the uterus, which moves down more and the cervix hangs lower in the vagina. Prolapses of the vaginal walls can occur on the side of the bladder and/or on the side of the intestine. The supporting tissue of the vagina is then slackened, causing the organ behind it to excrete more fluid into the vagina. A prolapse is not a life-threatening condition, but it can be annoying. Complaints such as the feeling of having a ball in the vagina or as if the vagina is constantly open can be experienced.

In the first months after delivery, the strength of the supporting tissue will increase again significantly. Count on at least 9 months. But here too, exercises to strengthen can be of great value. If the complaints are of such a severe degree and there is insufficient recovery, surgical correction can be chosen. However, as long as you still want to have children, surgery is not an option. Every pregnancy will cause new damage. In that case, a supporting pessary can be chosen. In a subsequent pregnancy, the complaints of the prolapse can certainly increase in the first half due to the slackening of the connective tissue. Due to the growth of the uterus, the prolapse will relatively decrease in the second half of the pregnancy, because the uterus pulls upwards. A prolapse is not an obstacle before delivery. However, the complaints will return after delivery. Outside of pregnancy, complaints can be treated with medication combined with pelvic floor physiotherapy.

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