Pelvic floor training in pregnancy could help prevent the need for 'barbaric' vaginal mesh surgery

April 25, 2017 by Victoria Salmon And Rachel Jarvie, The Conversation
Exercises can help women’s pelvic floor health during pregnancy and after birth. Credit: COLLATERAL/

For millions of women, childbirth is a somewhat daunting yet thoroughly rewarding process. In the western world, many years of medical research and professional experience mean that women have access to expert care before, during and after birth. However, there is still one matter that is not being addressed enough during pregnancy: pelvic floor health. Women often do not realise, and are not properly informed, that something can be done to reduce the risks of pelvic floor problems in pregnancy and after childbirth.

The muscles lie across the base of the pelvis, supporting and holding the bladder, uterus and bowel in position. They also help to control the bladder and bowel. Pregnancy and childbirth can cause problems such as weakness, overstretching and tears in the , due to increased pressure.

Weakening or damage may result in inability to control bladder or bowel movements, resulting in incontinence. Muscle weakness can also contribute to pelvic organ prolapse, which is the bulging of one or more of the , such as the uterus, bowel and bladder, into the vagina.

Urinary incontinence is a common problem, affecting over 5m women in the UK alone. Between 30-50% of women will experience some leaking of urine during or after . And, according to one study, up to three out of four still experience symptoms 12 years after giving birth.

Incontinence can make women feel shame and embarrassment, which stops them from seeking help. It is normalised in UK society, with many women believing that incontinence is an unavoidable consequence of having children, further stopping them from accessing treatment. They are exposed to media images of female incontinence as normal and inevitable: young women are portrayed as accepting the condition in adverts for absorbent products, accompanied by tag lines such as "Oops moments happen. C'est la vie."

Prevention rather than treatment

When women do seek help for pelvic floor problems they are offered treatment according to the severity of their symptoms. Pelvic floor training (PFMT) is a first line treatment. PFMT involves pulling up the pelvic floor muscles by pretending to hold in wee or stopping passing wind. The muscles can be strengthened by regularly doing a series of long and short holds. For example, squeezing these muscles slowly ten times in a row, then doing ten fast squeezes and repeating this three times per day.

In more severe cases, surgery may be offered, which can include insertion of mesh through the vagina, to provide extra support when repairing weakened or damaged tissue.

However, vaginal mesh surgery has more problems than benefits. It has been called "barbaric" and recently led to more than 800 women suing the NHS over complications with it such as permanent pain, and an inability to walk, work or have sex.

So why aren't we focusing more on women's pelvic floor health in pregnancy, to try to avoid these conditions developing?

Evidence shows that PFMT can help prevent and treat incontinence in pregnant women or women who have recently given birth. In fact, research has found that women having their first baby who performed PFMT were about 30% less likely to experience incontinence up to six months after delivery. There is also increasing evidence that PFMT may prevent symptoms of and could reduce the uptake of further treatment.

UK guidelines for antenatal care recommend midwives offer information about pelvic floor exercises at a pregnant woman's first appointment. However, for PFMT to be effective it needs to be delivered through a structured, supervised training programme. Simply giving out information on its own is rarely enough to support people to carry on exercising long term.

Women have reported that the information they received about PFMT in pregnancy was insufficient, and they weren't told about the importance of pelvic floor health. They did not understand why they had to do the exercises or how to do them correctly. The information was not clearly linked to the role of the muscles in reducing the risk of or pelvic organ prolapse so many women did not think PFMT was worth doing.

Evidently, more could and should be done to improve the quality and delivery of PFMT information during the antenatal period. Incontinence and prolapse do not need to be taboo, but nor should they be normalised as part of the consequences of childbirth and pregnancy.

PFMT during pregnancy presents an opportunity to prevent long-term, debilitating pelvic health problems and may reduce the need for further medical or surgical intervention. But for this to happen, women need to understand the benefits, know how to do it and feel that PFMT is realistic and doable in their daily lives.

Explore further: Muscle training may help with mild pelvic organ prolapse

Related Stories

Muscle training may help with mild pelvic organ prolapse

March 29, 2016
(HealthDay)—Pelvic floor muscle training (PFMT) results in greater pelvic floor symptom improvement than watchful waiting in women with pelvic organ prolapse, according to a study published online March 21 in BJOG: An International ...

International trial shows pelvic floor exercise benefit for preventing prolapse

December 21, 2016
Researchers, including several University of Otago academics, have conducted the first trial of pelvic floor muscle training for the prevention of prolapse symptoms in women with early signs of prolapse several years after ...

New device to monitor pelvic floor

November 23, 2016
A world-first innovative device that can measure pelvic floor muscle changes in women is being developed at the University of Auckland.

Vaginal pessary beneficial in pelvic organ prolapse

June 27, 2016
(HealthDay)—For women with symptomatic pelvic organ prolapse (POP), use of vaginal pessary in addition to pelvic floor exercises is associated with improvements in prolapse symptoms and quality of life, according to a study ...

Vaginal estriol gel helps women recover after surgery for pelvic organ prolapse

March 29, 2017
Pelvic organ prolapse is estimated to affect up to one-half of all women, causing pain and interfering with sexual function. A new study demonstrates how an ultralow dose of vaginal estriol gel used before and after pelvic ...

Involuntary urinary incontinence can discourage sufferers from exercise

February 27, 2017
According to a study published in the distinguished journal PLOS ONE, urinary incontinence symptoms in middle-aged woman are linked to lower levels of exercise. Involuntary urinary incontinence symptoms can discourage sufferers ...

Recommended for you

Human Cell Atlas study reveals maternal immune system modifications in early pregnancy

November 14, 2018
The first Human Cell Atlas study of early pregnancy in humans has shown how the function of the maternal immune system is affected by cells from the developing placenta. Researchers from the Wellcome Sanger Institute, Newcastle ...

Soy formula feeding during infancy associated with severe menstrual pain in adulthood

November 9, 2018
New research suggests that infant girls fed soy formula are more likely to develop severe menstrual pain as young adults. The finding adds to the growing body of literature that suggests exposure to soy formula during early ...

A major role for a small organ in the immune response during pregnancy

November 9, 2018
The immune system of a pregnant woman is altered during pregnancy, but not in the way previously believed, according to results from a study at Linköping University, Sweden. This study, published in the Journal of Allergy ...

Mailed HPV tests can help find women at-risk for cervical cancer, study finds

November 7, 2018
University of North Carolina Lineberger Comprehensive Cancer Center researchers have found that mailing self-collection kits to test for high-risk human papillomavirus infection has the potential to boost cervical cancer ...

Women who give birth to boys much more likely to have postnatal depression

November 6, 2018
A University of Kent study into postnatal depression (PND) found the odds of developing this condition increased by 79% when mothers had baby boys compared to baby girls.

New study takes first step toward treating endometriosis

November 1, 2018
Researchers at Northwestern Medicine have taken the first step in bioengineering the human uterus to treat endometriosis, uterine-factor infertility and endometrial cancer.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.