It’s a question many of care providers who work with pregnant women are asked: How do I prevent: pelvic floor trauma, urinary incontinence, pelvic organ prolapse and diastasis rectus abdominis?
By Dr. Sinead Dufour
Navigating the clinical and scientific landscape to answer these questions is not straight forward, however there is mounting data that has garnered some important insights. Bia is here to help! First we need to understand the relationship of the structures and associated tissues of the abdomino-pelvic region of the body. Then we need to understand other powerful physiological factors the characterize the perinatal care period – endocrine and immune factors are highly relevant. We also need to understand how to assess the various systems and associated outcomes to both guide our intervention and track progress.
So what are some key clues to guide us? Well we know that pelvic floor status is important. A fit pelvic floor translates to a shorter second stage (the part of the birth where the baby is actually pushed out!), less post-partum incontinence and a more satisfying birth. We also know that women who exercise regularly have a stronger pelvic floor than those who do not. Thus, women need to exercises when they are pregnant – women should not fear exercises. That said lots of other variables come into play so individualizing is key.
What about after baby is born? We now have some consensus-based guidelines related to exercise principles to prevent and correct DRA as well as safe return to higher impact activities such as running. It seems as the though 4th trimester is an important time for restorative movement – even for those who have been avid runners prior to and during their pregnancy. The abdominal wall tissue is actually not fully restored at 6-months post-partum. We need to consider this when prescribing or counselling post-partum exercise programing. Again, there are many contributing factors that need to be explored and applied. How and when movement is executed appears to possibly be more important that what exercises are done.
As for screening, assessing and tracking progress, one thing we do know is that we need to assess a variety of parameters – not just pelvic floor strength or inter-recti distance. A multi-component assessment strategy will assist in developing an appropriate individually tailored management plan.
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