The body goes through an awful lot during pregnancy. As well as the hormonal changes, the abdominal muscles stretch to capacity and the pelvic floor muscles are pushed to their limits. Add in a complicated delivery, perhaps, and having a child is no doddle.
While there is great emphasis on the woman’s health during the pregnancy, mothers often take a back seat when the baby arrives. Many are too busy caring for the baby to care for themselves properly, which can lead to health problems years later.
Chartered physiotherapist Audrey O’Leary of the Pelvic Floor Clinic in Co Wexford sees this a lot.
“A lot of women are finished with their family and their youngest child is often in school by the time they seek help for issues like incontinence,” she says. “Women often put themselves at the bottom of the priority list, unfortunately.”
When it comes to looking after mothers, the HSE, she believes, is very good with antenatal information but not about the mother caring for herself after the birth. “Your whole pregnancy is about ‘how are you doing, how are you feeling’, then the minute the baby is born, mothers and how they are is often neglected, even though they’ve been through so much,” she says.
Because of this, Audrey would like to see much more emphasis on the mother’s health after childbirth.
“In France, new mothers are offered 10 free physiotherapy sessions after the birth, for example,” she says.
“There needs to be a massive push on that here, with women’s health after birth being recognised more. If problems like weak pelvic floor muscles are identified early and you’re shown how to do the exercises correctly, you can prevent problems in the future. Looking after yourself in this way is important. We call it ‘Mummy Maintenance’.”
The good news is that younger women are now more aware of looking after themselves after childbirth.
“A lot has changed since I graduated in 2008,” says Audrey. “It’s a slow cultural change. Instagram is a big thing, with influencers talking about things like incontinence and prolapse. Younger women are coming in, knowing that incontinence isn’t something that just happens with ageing. They’re saying, ‘I don’t want to be wearing pads and worrying about smell’. They want a check-up to make sure they know how to do their pelvic floor exercises correctly.”
What the check-up involves
Having a post-natal physio check takes about an hour and involves assessment and treatment as well as a bit of “homework”– a programme of exercises to treat whatever issues have come up.
The first 30 minutes of the consultation involve taking a patient’s history, including asking how pregnancy and delivery went.
Audrey would also ask what exercise they’re doing currently and what their goals are around that.
“Women often feel pressure to ‘snap back’ into shape so we would have a conversation around managing their expectations,” she says. “Sometimes they are not realistic. It takes 10 months for your pregnancy hormones to leave the body and longer if you’re breastfeeding.”
Women can’t forget about looking after their pelvic floor if they’ve had a Caesarean section rather than a vaginal delivery either.
“We know from recent research that women who’ve had a C-section are as much at risk of urinary urgency problems as women who’ve had vaginal births. During the pregnancy, the pelvic floor muscles are like a sling of muscle underneath. After carrying a baby for nine months, the pelvic floor muscles are wrecked. They are only small muscles but they are keeping a baby up, fluid and pelvic organs.”
The lead-up to the C-section may have had consequences for the pelvic floor also.
“A lot of times with a C-section, it’s an emergency section. A woman could have been induced, may have been fully dilated, instruments may have been tried but then they end up having an emergency C-section so the pelvic floor has been through quite a bit.”
Pain may have had an impact on the muscles too.
“A lot of women who have a C-section have a high level of pain afterwards so they go into what’s called ‘guarding response’. That’s where their pelvic floor muscles are clenched a lot so they need to be trained to release that.”
Physical examinations are part of the consultation.
“We do a spinal screen, looking at the person standing and walking, at how the body is moving. We’d do some hands-on examination, too, to see how the spine is moving with the pelvis. If there are any restrictions or blocks we would focus our treatment on that.”
The majority of women Audrey sees have some sort of lower back issue.
“Women develop a ‘waddle’ at the end of their pregnancy so the majority who come in are going to have some sort of stiffness in their lower back/pelvic region.”
Physiotherapists also check the abdominal muscles of post-partum mothers to see if the “gap” that has developed in their tummy muscle has closed. The rectus abdominis muscles have two halves that are connected by tissue and as the baby grows, this tissue stretches. This is called diastasis recti (DRAM) with the stretched tissue feeling like a “gap” in the tummy area.
It can take up to six weeks or more after the birth for this gap to reduce.
“One hundred per cent of women have that at end of pregnancy. Some women are aware of DRAM and want to make sure they don’t have it.”
A major issue, she finds, is that many women don’t do their pelvic floor muscle exercises correctly.
“We do an internal vaginal examination to assess this,” she says. “We get them to do their exercises and we assess the ‘lift’ internally to see if their technique is correct. If it’s not, we advise them on how to get it right.”
Urinary incontinence
The most common pelvic-related problems that Audrey treats are urinary incontinence and prolapse.
“Urinary incontinence occurs in one in three women, so it is very common,” she says.
“There are a few different types like stress incontinence where you leak when you laugh or urge incontinence where you feel a sudden urge to go and you may not get to a toilet in time. Incontinence is due to pelvic floor weakness, to women not strengthening the muscles after delivery.”
Education plays a big part in helping these women solve their incontinence problems, she adds.
“We get them to fill out a bladder diary, record what they’re drinking and how often they go to the toilet also. A lot of women might be drinking a lot of tea or coffee or fizzy drinks but these can aggravate the bladder so there is a big education component around that. I’d know from the examination too, if their muscles are weak or if they need to relax their pelvic floor a bit more.”
Surgical intervention for incontinence isn’t suggested easily, she says.
“If a woman is thinking of extending their family, there wouldn’t be any surgical intervention advised until their youngest baby is at least two years old.
“Also, under new guidelines, 16 weeks of supervised pelvic floor strengthening exercises need to happen before any other intervention is advised.”
Physiotherapist Audrey O'Leary at Rathnure, County Wexford. \ Patrick Browne
Pelvic organ prolapse
Pelvic organ prolapse is when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina.
It can be the womb (uterus), bowel, bladder or the top of the vagina.
“A prolapse is not life-threatening, but it can cause pain and discomfort. It can happen if a person’s delivery was really fast or if the woman in labour was pushing in an incorrect way.
“Symptoms can feel like a drag or pull in the pelvic area or a sensation of something coming down. You could have issues emptying your bladder or bowel fully, continence problems, or issues with intercourse.”
Symptoms can usually be improved with pelvic floor exercises and lifestyle changes.
“Bladder and bowel habits have a big part to play in prolapse,” she says. “Constipation can be an issue so you have to manage the bowel correctly.”
Women also have to be mindful of heavy lifting too, and of using their pelvic floor muscles correctly while doing so.
“Anything that we lift, that puts pressure down onto the pelvic floor, repeatedly over time, puts you at increased risk of pelvic organ prolapse.”
However, Audrey points out that many women live with prolapse by learning to manage it.
Education around prolapse involves exercise programmes and sometimes the use of silicon pessary rings to support the vagina internally.
“Some women might only have symptoms when they go for a run or to the gym, or are dancing at a wedding, say, so they might learn to insert a pessary when they need to, then remove it.”
Surgical solutions, if they are needed, are usually deferred until the person finishes her family, she states, although each case is different.
“While some women want the surgery, some surgeons require you to be over menopause before they operate so if you can learn to manage it, that’s brilliant.”
• Key message – prioritise yourself. Happy mum, happy baby.
• Giving yourself time to focus on your mental and physical needs after your baby’s birth is very important.
• The cost of a postpartum consultation is redeemable against health insurance, depending on your policy.
• In France, new mothers are offered 10 free physiotherapy sessions after the birth and more support is needed for Irish mothers.
• For more information and exercises, check out hse.ie/pregnancy-birth/keeping-well/pelvic-floor-exercises/exercises.
• Audrey also has a full list of exercises and services on thepelvicfloorclinic.ie.
Read more
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The body goes through an awful lot during pregnancy. As well as the hormonal changes, the abdominal muscles stretch to capacity and the pelvic floor muscles are pushed to their limits. Add in a complicated delivery, perhaps, and having a child is no doddle.
While there is great emphasis on the woman’s health during the pregnancy, mothers often take a back seat when the baby arrives. Many are too busy caring for the baby to care for themselves properly, which can lead to health problems years later.
Chartered physiotherapist Audrey O’Leary of the Pelvic Floor Clinic in Co Wexford sees this a lot.
“A lot of women are finished with their family and their youngest child is often in school by the time they seek help for issues like incontinence,” she says. “Women often put themselves at the bottom of the priority list, unfortunately.”
When it comes to looking after mothers, the HSE, she believes, is very good with antenatal information but not about the mother caring for herself after the birth. “Your whole pregnancy is about ‘how are you doing, how are you feeling’, then the minute the baby is born, mothers and how they are is often neglected, even though they’ve been through so much,” she says.
Because of this, Audrey would like to see much more emphasis on the mother’s health after childbirth.
“In France, new mothers are offered 10 free physiotherapy sessions after the birth, for example,” she says.
“There needs to be a massive push on that here, with women’s health after birth being recognised more. If problems like weak pelvic floor muscles are identified early and you’re shown how to do the exercises correctly, you can prevent problems in the future. Looking after yourself in this way is important. We call it ‘Mummy Maintenance’.”
The good news is that younger women are now more aware of looking after themselves after childbirth.
“A lot has changed since I graduated in 2008,” says Audrey. “It’s a slow cultural change. Instagram is a big thing, with influencers talking about things like incontinence and prolapse. Younger women are coming in, knowing that incontinence isn’t something that just happens with ageing. They’re saying, ‘I don’t want to be wearing pads and worrying about smell’. They want a check-up to make sure they know how to do their pelvic floor exercises correctly.”
What the check-up involves
Having a post-natal physio check takes about an hour and involves assessment and treatment as well as a bit of “homework”– a programme of exercises to treat whatever issues have come up.
The first 30 minutes of the consultation involve taking a patient’s history, including asking how pregnancy and delivery went.
Audrey would also ask what exercise they’re doing currently and what their goals are around that.
“Women often feel pressure to ‘snap back’ into shape so we would have a conversation around managing their expectations,” she says. “Sometimes they are not realistic. It takes 10 months for your pregnancy hormones to leave the body and longer if you’re breastfeeding.”
Women can’t forget about looking after their pelvic floor if they’ve had a Caesarean section rather than a vaginal delivery either.
“We know from recent research that women who’ve had a C-section are as much at risk of urinary urgency problems as women who’ve had vaginal births. During the pregnancy, the pelvic floor muscles are like a sling of muscle underneath. After carrying a baby for nine months, the pelvic floor muscles are wrecked. They are only small muscles but they are keeping a baby up, fluid and pelvic organs.”
The lead-up to the C-section may have had consequences for the pelvic floor also.
“A lot of times with a C-section, it’s an emergency section. A woman could have been induced, may have been fully dilated, instruments may have been tried but then they end up having an emergency C-section so the pelvic floor has been through quite a bit.”
Pain may have had an impact on the muscles too.
“A lot of women who have a C-section have a high level of pain afterwards so they go into what’s called ‘guarding response’. That’s where their pelvic floor muscles are clenched a lot so they need to be trained to release that.”
Physical examinations are part of the consultation.
“We do a spinal screen, looking at the person standing and walking, at how the body is moving. We’d do some hands-on examination, too, to see how the spine is moving with the pelvis. If there are any restrictions or blocks we would focus our treatment on that.”
The majority of women Audrey sees have some sort of lower back issue.
“Women develop a ‘waddle’ at the end of their pregnancy so the majority who come in are going to have some sort of stiffness in their lower back/pelvic region.”
Physiotherapists also check the abdominal muscles of post-partum mothers to see if the “gap” that has developed in their tummy muscle has closed. The rectus abdominis muscles have two halves that are connected by tissue and as the baby grows, this tissue stretches. This is called diastasis recti (DRAM) with the stretched tissue feeling like a “gap” in the tummy area.
It can take up to six weeks or more after the birth for this gap to reduce.
“One hundred per cent of women have that at end of pregnancy. Some women are aware of DRAM and want to make sure they don’t have it.”
A major issue, she finds, is that many women don’t do their pelvic floor muscle exercises correctly.
“We do an internal vaginal examination to assess this,” she says. “We get them to do their exercises and we assess the ‘lift’ internally to see if their technique is correct. If it’s not, we advise them on how to get it right.”
Urinary incontinence
The most common pelvic-related problems that Audrey treats are urinary incontinence and prolapse.
“Urinary incontinence occurs in one in three women, so it is very common,” she says.
“There are a few different types like stress incontinence where you leak when you laugh or urge incontinence where you feel a sudden urge to go and you may not get to a toilet in time. Incontinence is due to pelvic floor weakness, to women not strengthening the muscles after delivery.”
Education plays a big part in helping these women solve their incontinence problems, she adds.
“We get them to fill out a bladder diary, record what they’re drinking and how often they go to the toilet also. A lot of women might be drinking a lot of tea or coffee or fizzy drinks but these can aggravate the bladder so there is a big education component around that. I’d know from the examination too, if their muscles are weak or if they need to relax their pelvic floor a bit more.”
Surgical intervention for incontinence isn’t suggested easily, she says.
“If a woman is thinking of extending their family, there wouldn’t be any surgical intervention advised until their youngest baby is at least two years old.
“Also, under new guidelines, 16 weeks of supervised pelvic floor strengthening exercises need to happen before any other intervention is advised.”
Physiotherapist Audrey O'Leary at Rathnure, County Wexford. \ Patrick Browne
Pelvic organ prolapse
Pelvic organ prolapse is when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina.
It can be the womb (uterus), bowel, bladder or the top of the vagina.
“A prolapse is not life-threatening, but it can cause pain and discomfort. It can happen if a person’s delivery was really fast or if the woman in labour was pushing in an incorrect way.
“Symptoms can feel like a drag or pull in the pelvic area or a sensation of something coming down. You could have issues emptying your bladder or bowel fully, continence problems, or issues with intercourse.”
Symptoms can usually be improved with pelvic floor exercises and lifestyle changes.
“Bladder and bowel habits have a big part to play in prolapse,” she says. “Constipation can be an issue so you have to manage the bowel correctly.”
Women also have to be mindful of heavy lifting too, and of using their pelvic floor muscles correctly while doing so.
“Anything that we lift, that puts pressure down onto the pelvic floor, repeatedly over time, puts you at increased risk of pelvic organ prolapse.”
However, Audrey points out that many women live with prolapse by learning to manage it.
Education around prolapse involves exercise programmes and sometimes the use of silicon pessary rings to support the vagina internally.
“Some women might only have symptoms when they go for a run or to the gym, or are dancing at a wedding, say, so they might learn to insert a pessary when they need to, then remove it.”
Surgical solutions, if they are needed, are usually deferred until the person finishes her family, she states, although each case is different.
“While some women want the surgery, some surgeons require you to be over menopause before they operate so if you can learn to manage it, that’s brilliant.”
• Key message – prioritise yourself. Happy mum, happy baby.
• Giving yourself time to focus on your mental and physical needs after your baby’s birth is very important.
• The cost of a postpartum consultation is redeemable against health insurance, depending on your policy.
• In France, new mothers are offered 10 free physiotherapy sessions after the birth and more support is needed for Irish mothers.
• For more information and exercises, check out hse.ie/pregnancy-birth/keeping-well/pelvic-floor-exercises/exercises.
• Audrey also has a full list of exercises and services on thepelvicfloorclinic.ie.
Read more
Maura Canning: ‘a routine blood pressure check saved my life’
Health: with change in weather, farmers need to be more aware of lyme disease
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