pelvic floor health - province of manitoba · – they are the muscles that are used to stop urine...
TRANSCRIPT
Pelvic Floor Health
The Pelvic Floor Health Teaching Kit includes:
• Pelvic Floor Health presentation
• Pelvic Model
• Pelvic Health resources and handouts for participants
Note: Do not share with participants that the topic is pelvic
health initially as the opening questions in the topic opener
help to build toward the topic.
Prenatal
Postnatal
Topic Opener Note to facilitator: This topic opener is not meant for every participant to answer but
more to allow time for a few answers from those willing to share. The questions tend to
get answers that are related to the topic, but not necessarily. These questions get
women thinking about their body and how it has changed throughout pregnancy and in
the postpartum period after delivery. The questions help build comfort talking about this in
the group and set the stage for the topic.
Prenatal:
• How has your body changed since becoming pregnant. Are there areas of your body
that feel stronger or weaker?
• What is one thing that surprised you about pregnancy?
• Has pregnancy changed the way you feel about your body?
Postpartum:
• How has your body changed since giving birth?
• What is one thing that has surprised you since giving birth?
• Have you changed the way you feel about your body since having a baby?
Oops! I Peed My Pants
Ask participants the following questions and allow an opportunity to answer. If participants don’t
have a story you can use the following story to help break the ice and for participants to understand
the expression.
• Have you ever heard the expression “I laughed so hard I peed my pants?”
• Have you ever said it yourself?
• Does anyone have a story they want to share with the group about one of those funny moments?
A story option if there are no other stories:
• A woman I know told me about attending a birthday party not that long after having her first baby.
A child at the birthday party wanted her to join him on the trampoline. She got up to jump with the
child and a couple of the other mothers told her that she’d better use the bathroom first …She said
she was fine, but after a couple of jumps she found she VERY URGENTLY needed to use the
bathroom.
What are some of the other times when you noticed that you had a strong urge to pee or were
scared of having an accident?
Allow participants to give examples. Here are a few to add to the group’s list if they are not
mentioned.
• Has anyone had a cough or cold?
• What about a fall where after falling you peed your pants?
• Did anyone feel like they might pee in their pants while playing sports?
Pelvic Floor
Pelvic Floor Health
Today’s session is about your pelvic floor health.
Ask Participants: What is your pelvic floor muscle?
• The pelvic floor muscle provides support for your bladder, uterus
and rectum.
• Life changes such as pregnancy, birth and breastfeeding along with
age can cause this muscle not to work like before.
• Taking care of your pelvic floor health is important throughout our
lives, but particularly during pregnancy, birth and in the postpartum
period.
What Does Your Pelvic Floor Muscle Do?
What Does Your Pelvic Floor Muscle Do?
Ask participants: What does your pelvic floor muscle do?
Answer: Pelvic floor muscle is like a hammock that supports the
bladder, uterus and rectum. The pelvic floor muscle opens and closes
the tubes that release your urine and feces. The pelvic floor muscle
also makes up the walls of the vagina.
• Imagine a hammock which has one person in it. Then imagine a kid
jumps in – the hammock becomes tighter, stiffer and loses its
springiness or bounce. If the kid jumps on the hammock too much, it
might get stretched out or damaged. The pelvic floor is like that
during pregnancy – the good news is that there are simple ways you
can improve your pelvic floor health.
Why Talk About Pelvic Floor Muscle?
Why Talk About Pelvic Floor Muscle?
• Pregnancy, the type of delivery and the number of children a woman has are factors that can increase the risk of pelvic floor damage. Pelvic floor problems can happen whether you give birth by caesarean or vaginally.
• This can be from soft tissue strain or damage of muscles and connective tissue of the pelvic floor supporting the weight of baby during pregnancy.
• It also comes from damage that can occur during delivery. Pelvic nerves may be injured during a long or difficult vaginal delivery. Delivery with forceps can result in injuries to the pelvic floor muscle and anal sphincter. Prolonged pushing during a vaginal delivery also increases the likelihood of injury to the pelvic nerves.
• Some stretches, changes in habits and exercises can help reduce pelvic floor dysfunction.
• A study of women working in an office setting done by Winnipeg physiotherapist Kelli Berzuk in 2011 found that 96% of the participants reported symptoms of pelvic floor problems. Of the 96% with symptoms, only 14% knew that they had pelvic floor problems.
• Many women accept pelvic floor problems as part of life. We are talking about it today to let you know that these problems can usually be improved.
What Are Pelvic Floor Problems?
What Are Pelvic Floor Problems?
• When the pelvic floor muscle is injured or weakened, women may
get leaks of urine, lose control of gas, and have problems with bowel
movements.
• When Jumping, falling, sneezing, coughing, or laughing cause us to
release some urine it is called stress urinary incontinence.
• Getting close to a bathroom but releasing some urine is called
urgency urinary incontinence, like the urge to go has become too
strong.
• Pain or stiffness in the pelvis, or pain during sex can also be
symptoms of pelvic floor problems.
• There may be other problems that a woman experiences that are
not mentioned here. If you think you are having pelvic floor
problems you should see your health care provider for a thorough
assessment.
Physiotherapy Exercise
Surgery
Are Body Changes Just Part Of Life?
• Many pelvic floor problems that occur during or after pregnancy will disappear over time
after delivery. However, the problems that you experienced may return later in life. If
problems persist for six weeks or more after you have given birth, you should see your
health care provider to discuss your concerns and options.
• It is a good idea to keep a diary or record of what is happening and your symptoms i.e.
trips to the bathroom, how often you experience urine leakage, when it occurs, pain you
may be experiencing, etc.
• Body changes in our pelvic health can happen in a way that ranges from a minor
discomfort or annoyance to something difficult or painful that interferes with your life.
• Most people can get an improvement in their symptoms from practising simple
exercises regularly.
• Physiotherapy can help you learn exercises and some physiotherapists have special
training that focuses on pelvic floor health.
• Physiotherapy is covered by most third party insurance or employer health benefits.
Your insurance company may require a referral by your health care provider.
• There are also surgical options if you need them which your health care provider can
discuss with you.
Pelvic Floor Muscle Exercise
Pelvic Floor Muscle Exercise
Ask Participants: What can you do to improve your pelvic floor muscle during pregnancy and postpartum?
Answer: Pelvic Floor Muscle exercises are one of the things you can do to strengthen the pelvic floor muscle.
One of the Pelvic Floor Muscle exercises that is recommend is as follows:
• Sit up straight (or lie down, with knees bent and feet on the floor)
• Find pelvic floor muscles
– They are the muscles that are used to stop urine (pee) or gas (farts).
– You may feel your lower stomach muscles engaged.
– Visualize that you are sipping a milkshake using your vagina. Try to contract and lift your pelvic floor muscles up into your pelvis.
• Squeeze and lift muscles – hold 3 seconds.
• Relax 6 seconds.
• Repeat 8-10 times, and then take a break. You can do 3 sets at a time.
• Do this exercise in a rhythmic way, increasing hold times as they get easy.
Ask Participants: What could you do to remember to do this everyday? One idea is to do this at every stop sign when you are driving.
Note: Don't use pelvic floor muscle exercises to start and stop your urine stream. Doing this exercise while emptying your bladder can actually weaken the muscles you are trying to strengthen and can lead to incomplete emptying of the bladder — which increases the risk of a urinary tract infection.
IMPORTANT: Pelvic floor muscle exercises have benefits when done during pregnancy and also postpartum. If you have been doing these exercises and notice ongoing symptoms of pelvic floor problems such as persistent pain or urine leakage, seek medical attention to ensure that you get a proper diagnosis and treatment.
Mindful Toileting
Mindful Toileting Mindful contraction and relaxation:
• We can protect our pelvic floor health if we pull up or contract our pelvic
floor muscle when we are going to laugh, cough or jump.
• Another important way to protect our pelvic floor health is to pay attention
when using the toilet.
– Don’t hover over the toilet. Instead spread your knees and raise your
feet while using the toilet with your knees higher than your pelvic area.
– Consciously relax the muscles before releasing urine, let your bladder
fully empty, then contract/squeeze the muscles again.
– Sitting on the toilet after you are finished going can weaken pelvic floor
muscles.
– Some of us don’t get breaks very often, so it might be tempting to sit an
extra minute and relax or check your phone. We encourage you to
stand up instead, stretch, or sit down on the closed lid and give yourself
permission to take a breath and take a break. Try to take a break
somewhere other than the bathroom – even better!
Don’t Just Wish For
A Great Birth
Prepare For One
Don’t Just Wish For A Great Birth
Prepare For One
• In late pregnancy, starting at about 34 weeks, massaging the perineum (the area of tissue between the vagina and anus – use pelvic model as visual) can help prevent injury to the pelvic floor muscle by increasing circulation to the area and stretching the tissue to make it more elastic and better able to stretch around the emerging baby.
• How to massage the perineum:
– Using clean hands and lubricant or olive oil, insert your thumb or thumbs into the vagina, and stretch the vagina out and down.
– This can be done until you feel a slight stinging sensation, but do not give yourself pain. You can also massage the perineum directly, using circular motions.
– These are basic instructions. For more detailed instructions see handouts or video below.
• A visual demonstration using a pelvic model is available here: https://www.youtube.com/watch?v=DK2P8Ziqc6Y
Things That Can Irritate Your Bladder
Ask participants: Pelvic floor muscle exercises are used to strengthen or retrain the
nerves and muscles of the pelvic floor helping to improve some bladder problems.
However did you know that some foods, drinks, drugs or scented soaps can irritate your
bladder?
The irritation may make bladder control more difficult. If you are having bladder trouble,
you might want to try avoiding some of these possible irritants to see if there is an
improvement.
– Food and drinks that contain caffeine (example: coffee, cola, chocolate, energy
drinks or tea) often irritate the bladder
– Alcohol
– Smoking
– Scented soaps/body washes/bubble bath on the genitals (especially in a
bathtub)
There are other foods that could be possible bladder irritants and if you are having
bladder issues, include your diet as part of your discussion with your health care provider.
Taking Care Of Yourself
Is A Lifelong Commitment
• Women need to take action in the prevention and correction of
pelvic floor dysfunction through healthy living and diet, good toileting
habits and commitment to proper pelvic floor muscle exercises.
• Get help for any ongoing pelvic health symptoms. Most pelvic floor
dysfunction can be improved and good pelvic health will increase
your quality of life. You are worth it!
• See your health care provider for a full assessment and referral to
someone who has education and experience with pelvic health. This
can include gynecologists and physiotherapists with education and
experience in pelvic health.
“Pelvic Floor Health”
has been developed and produced in partnership by
Healthy Child Manitoba and Women’s Health Clinic
If you have questions about your pelvic floor health please contact your health
care provider for an assessment. Some health care providers may not have
experience with pelvic health disorders and you can request a referral to
someone who has education and experience with pelvic health.
. College of Physiotherapists of Manitoba
204-287-8502
www.manitobaphysio.com/directory
The information in this presentation kit is not meant to replace health care advice
Where Can I Get Help?
This kit was developed in January 2015
It is not intended as a handout for program participants
“Pelvic Floor Health”
has been developed and produced in partnership by
Healthy Child Manitoba and Women’s Health Clinic
If you have questions about your pelvic floor health please contact your health
care provider for an assessment. Some health care providers may not have
experience with pelvic health disorders and you can request a referral to
someone who has education and experience with pelvic health.
. College of Physiotherapists of Manitoba
204-287-8502
www.manitobaphysio.com/directory
The information in this presentation kit is not meant to replace health care advice
Where Can I Get Help?
This kit was developed in January 2015
It is not intended as a handout for program participants
Acknowledgements and References
Many thanks to:
Kelli Berzuk and Nova Physiotherapy, Incontinence and Pelvic Pain Clinic (IPPC)
Lynn Crocker-Loat, WHC Pelvic Pain Nurse
Christine Nykiforuk, Physiotherapist
Katy Bowman, katysays.com; restorativeexercise.com
“I Laughed So Hard I Peed My Pants! A Woman's Essential Guide for Improved
Bladder Control” by Kelli Berzuk
“Alignment Matters: The First Five Years of Katy Says” by Katy Bowman
