If I ask you to describe the pelvic floor muscles after childbirth, what are you thinking about?
If I ask you to describe the pelvic floor muscles after childbirth, what are you thinking about? Most of you would call these muscles are loosened! Logic would say that this lovely human being who came out of the vagina probably stretched the muscles and perhaps, even made some damages passing through. However, despite the fact that this birth is a memorable day for the parents, it is a important trauma for the pelvic floor. When a muscle in the body gets under stress, it can react in two ways: become hypotonic or hypertonic.
Hypertonicity of the pelvic floor is a relatively unknown phenomenon. Popular belief is that after childbirth, the woman must do pelvic floor strengthening, the famous kegels exercises, in order to avoid postpartum problems (urinary incontinence, prolapse, etc.). For a woman with a hypertonic pelvic floor, kegels can interfere with postnatal rehabilitation. It should not be forgotten that a hypertonic muscle is not necessarily strong.
Think of your trapezius, if it’s tensed, it’s certainly not stronger. However, unlike trapezius muscle tension, women are not very aware of their pelvic floor tone because they can’t see or feel it as easily as their trapezius! Most women with hypertonic pelvic floor don’t feel it until the day we get them to be aware about it.
Therefore, before recommending pelvic floor strengthening to your client, ask her some questions that may suggest hypertonicity of the pelvic floor.
If your patient answers «yes» to any of these questions, it is important to refer her to perineal and pelvic rehabilitation in order to do a complete pelvic floor evaluation. Muscle release exercises, stretching, massage as well as proprioception exercises will be taught to restore normal pelvic floor tone. Once this problem is solved, strengthening exercises can be suggested.
In cases of cesarean section, the pelvic floor is not spared! Once again, most people believe that having a cesarean section saves the pelvic floor. Unfortunately, that’s not the case! It can become hypertonic just by carrying extra weight during 9 months.
So, never assume that the pelvic floor is hypotonic after childbirth, be alert for symptoms!
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