Hello, and congratulations on giving birth to your baby.
This video is about how pregnancy and childbirth can affect your pelvic floor.
We will talk about your recovery and healing, as well as possible pelvic floor issues you may have.
[NURSE] My name is Jana, and I am a Registered nurse.
I am part of the team at the Pelvic Floor Clinic in Calgary, Alberta, where we specialize in pelvic floor issues, such as bladder and bowel control and pelvic organ prolapse.
There are many factors that can contribute to problems with your pelvic floor.
And one of the biggest factors is having a baby.
When you are young and healthy, your body tends to cope well with giving birth.
But later in life, the effects of having a baby and lifestyle issues can cause changes to your pelvic floor, and you might start having symptoms.
It is important to learn what you can do now to prevent smaller issues from becoming big problems, and what you can do now if you are already having problems.
It’s a great idea to watch the first 4 videos in the Understanding Your Pelvic Floor series on the MyHealth.Alberta.ca website.
They go into more detail about the pelvic floor issues you may be having.
 Your pelvic floor is at the base of your pelvis between your legs.
You can think of it as the bottom of a canister.
Your muscles and bones in your abdomen and back are the sides of the canister.
The top is your diaphragm muscle, which moves your lungs up and down to help you breathe.
Your pelvic organs sit on the base of this canister, that is, the pelvic floor.
There are no bones underneath your pelvic floor, only muscles circling around it, so the pelvic floor muscles here act as a sling or trampoline to support your pelvic organs.
 This group of muscles contains 3 openings: the urethra from the bladder, the vagina in the middle, and the anus at the back.
The muscles encircle these openings and affect how they work.
Your pelvic floor helps support these organs in their normal positions.
You need a healthy pelvic floor to control your bladder and bowels.
It is also important for sex, and it helps you to lift and carry things by controlling the pressure inside your abdomen.
 During a vaginal delivery, the baby's head and body come through the birth canal.
The birth canal is a passage that goes from the uterus through the cervical opening, through the vagina and out through the vaginal opening.
Childbirth can cause tears inside the vagina or in the vaginal opening. Usually these tears go backwards towards the anus.
 Tears are classified by how far they go.
A first-degree tear involves only the skin and generally heals quickly.
A second-degree tear is deeper and involves the muscle as well as the skin.
A third-degree tear goes into the anal sphincter muscle, and a fourth-degree tear is a complete tear from the vaginal opening to the anus through the anal sphincter.
Delivering a baby by cesarean section is different, without the stretching, pressure, and possible tearing of a vaginal birth.
But just being pregnant puts stress on your pelvic floor.
Pregnancy hormones and the weight of your baby loosen and stretch your pelvic floor.
Even with a cesarean section or C-section (when your baby is born through a cut in your tummy), you will still have pregnancy hormones, your blood volume will double, and your urethra (the tube from the bladder) dilates and loses some of its tone.
Your uterus gets much bigger and heavier as your baby grows and pushes down on your pelvic floor and on your bladder.
 Your labour and delivery can affect your pelvic floor.
In the first few days after giving birth, you will start to lose the extra fluid you gained during pregnancy, so you will need to pee a lot.
You may have a lot of swelling, pain, and even loss of feeling or tone in your pelvic floor after a vaginal delivery.
You may find it difficult to have bowel movements, pee, or empty your bladder completely when you go pee.
You might also pee a little by accident.
You may have pain and spasms and need to use medicines.
Your body will heal, but it takes time.
 [PHYSIO] Hello, my name is Kristen, and I am a physiotherapist with the Pelvic Floor Clinic in Calgary.
Let’s talk about problems you may have with your pelvic floor after having a baby and ways to manage these problems, such as with exercise and lifestyle.
Pelvic floor muscles support your pelvic organs and allow you to control pee, stool, and gas.
They also work with your deep abdominal muscles, deep low-back muscles, and diaphragm to give you stable posture.
 You may have heard of this group of muscles called your core muscles. The name of the pelvic floor muscle group is the Levator ani, which suggests there is a lifting action.
Circular-shaped muscles called sphincters are around your urethra and anus. These pinch the urethra and anus closed as you do pelvic floor exercises, sometimes called Kegels.
 After you've had a baby, you may find it harder to find and use these muscles.
Try to squeeze your anus in a pinching motion, and then lift it up into your body.
Imagine your anus is a bucket at the bottom of a well, and you are lifting the bucket up the well.
Then completely relax your anus.
Think of letting the bucket drop all the way back down the well.
 Or you could try to imagine squeezing to stop pee from coming out.
Feel the squeeze lifting your pelvic floor.
This is a small group of muscles, so it won’t feel like a big movement.
Don't hold your breath or tense up your thighs, bum, or rib cage.
 Do the exercises in a position where it’s easiest for you to feel the squeezing.
At first, this will likely be lying down or sitting.
You can start your exercises right after you have delivered your baby, as long as you do not have pain when you do them.
Try doing them 3 times a day.
To improve your body awareness, squeeze, lift, and hold the squeeze for up to 10 seconds.
Relax completely for the same length of time that you held your squeeze. Repeat this up to 10 times in a row.
If you cannot hold for a full 10 seconds, practise holding for as many seconds as you can, and relax when you no longer feel the squeeze.
Wait 10 seconds before you try again.
You can add 1 second to your hold time per week until you can hold for 10 seconds and relax for 10 seconds after each repetition.
 You can also do this exercise by squeezing and lifting your pelvic floor quickly and then relaxing quickly.
Repeat up to 10 times and make sure you relax between each repetition.
 If it’s hard for you to do these exercises properly, speak with your doctor, nurse, or pelvic health physiotherapist.
Pelvic health physiotherapists can help you find these muscles and start a program.
In Alberta, you can contact the Rehabilitation Advice Line. You’ll see the information at the end of this video.
 Next, let’s talk about bladder and bowel habits.
When you pee or have a bowel movement, pushing down hard or straining on the toilet can lead to incontinence (when you can’t control your bladder or bowels) and prolapse (when pelvic organs sag down).
Take your time on the toilet, and don’t push or strain.
Try to pee every 3 or 4 hours.
Drink enough fluids to stay hydrated and keep your pee a light-yellow colour.
 When you’re on the toilet, put a small footstool under your feet so your knees are slightly higher than your hips.
Then bring your knees together and relax your pelvic floor to open your anus and urethra.
Sit tall and lean forward slightly to bring yourself into a squat-like position.
Try to breathe normally and don't hold your breath to push.
Try blowing out gently against a closed fist or breathing through pursed lips.
 If you often feel that your bladder isn’t fully empty after you go pee, or you notice some dribbling after you get up off the toilet, try double voiding.
To do this, relax and let your bladder empty as much as it will.
Then lean forward at the hips or go side to side on your sit bones and relax your pelvic floor again.
See if you are able to empty any more urine.
Keep your pelvic floor relaxed the whole time you’re emptying your bowel or bladder.
It helps to have a soft, formed bowel movement so you don’t push or strain.
 Eat healthy food and get enough fibre.
Eating well and being at a healthy weight helps put less pressure on your pelvic floor.
It can help to see a dietitian who specializes in nutrition after giving birth.
 Everyone returns to exercise at a different time after giving birth.
You can try to do some gentle movement, such as walking, soon after.
This helps your body get rid of the extra fluid you held during pregnancy.
It’s a good idea to return to exercise gradually and increase your activity over time.
Talk to your healthcare provider if you have questions about exercising after having a baby.
 Smoking irritates the bladder and the rectum.
And smoking often causes coughing, which is hard on your pelvic floor.
If you smoke, there are many programs that can help you to quit or smoke less.
Go to AlbertaQuits.ca or scan the QR code to take you to MyHealth.Alberta.ca to learn more.
 Having a tear or an episiotomy can cause some pain after childbirth.
An episiotomy is a cut the doctor or midwife makes to help deliver your baby.
A tear is when the tissues give way during the pressure of the birth.
The cut or tear can go from near your vaginal opening to your anus.
After about 6 weeks, your episiotomy site should heal.
Have your healthcare provider check the area, and if it’s safe to do so, you can do scar massage.
Scar massage will help your tissues become more flexible and less painful.
To massage your scar, use your fingers and gradually press on the scar.
You may feel discomfort when you press.
Hold the pressure until you feel less discomfort.
If you feel pain, use less pressure. Do not keep pushing if you still have pain.
When you feel less discomfort and no pain, you can add a bit of back and forth movement with your finger, but don't slide over the skin.
Then move to another spot on the scar.
Massage your scar every other day until the scar is no longer sensitive.
Next, we’ll talk about vaginal dryness, which is common after having a baby.
 [DOCTOR] Hello, I am Dr. Shunaha Kim-Fine from the Calgary Pelvic Floor Clinic.
The opening to your vagina may be sensitive and tender for some weeks after a vaginal delivery.
Vaginal dryness is quite common during this time.
It can make having sex difficult and uncomfortable.
How long vaginal dryness lasts is different for everyone.
It may depend on whether and how long you choose to breastfeed.
To help with vaginal dryness, you can use a vaginal lubricant before and during sex.
A lubricant will make the vagina slippery for a short time.
Vaginal moisturizers can help to make the vagina moist, but you might still need to use a lubricant for sex.
When your hormones return to normal, the dryness will go away.
 You can get lubricants and moisturizers without a prescription at all pharmacies. They have no medicines or hormones.
If you need more to help dryness, your doctor can prescribe vaginal estrogen to use while you are breastfeeding.
This comes in a vaginal cream, a pill, or a ring.
You can start having sex again when you feel comfortable.
Everyone is different.
Go slowly and carefully.
By 12 weeks, you should be healed.
If, after that time, you are still sore when you wipe or wash the vaginal area and if sex is painful, talk to a pelvic health physiotherapist.
[NURSE] We hope this video has answered some of your questions about your pelvic floor after giving birth and helped you understand the common issues.
We want you to think about how your lifestyle can affect your pelvic floor in the years to come.
Remember that even if you're not having any symptoms now, you could have them in the future.
You can do a lot to prevent problems if you understand how the little things make a big difference.
If you’re having symptoms, contact your healthcare provider.
If you are not having any symptoms or concerns, please remember that what you do now makes a big difference to your pelvic floor health later.
Go to the following websites for more helpful information.
Thank you for watching and enjoy your baby!