When a woman gets pregnant, what we see is the changes in her body externally. But, there are several other changes that happen internally in her body that are not visible. The physical changes that happen in a woman’s body during pregnancy are detrimental to the muscles, nerves, connecting tissues in her pelvis region. Weakening of muscles in the pelvis region can result in Pelvic Floor Dysfunction that can include Stress Urinary Incontinence, Faecal Incontinence, prolapse of the organs in the pelvis region etc.
Symptoms of Pelvic Floor Dysfunction
- Urinary Tract Problems
- Urinary Incontinence
- Urgent and Frequent Urination problem
- Inability to empty the bladder
- Problems with Bowel movements
- Faecal Incontinence
- Obstructed defecation, constipation
- Rectal/Anal Prolapse
- Prolapse of the Uterus / Uterine Prolapse
- Painful Sexual Intercourse / Dyspareunia
- Orgasmic Dysfunction
What happens to the organs in the pelvis during pregnancy?
Stress Urinary Incontinence is the most common problem suffered by women during pregnancy. The condition gets better and becomes normal after delivery of the child. Studies involving ultrasound imagining of the bladder and urethra revealed that as the child in the uterus grows, the angle of the bladder opening at the bladder neck (where the urethra joins the bladder) increases resulting in urinary incontinence. Also, due to the hormonal changes in the body the mobility of the bladder increases during pregnancy which adds to pelvis related problems.
In a study done in 2003, it was noted that the method of delivery of the child, whether caesarean or vaginal, didn’t make any difference in the symptoms post delivery. This indicated that pregnancy was the reason for pelvic floor dysfunction. However, it was also noted that more percentage of women reported stress urinary incontinence who delivered the baby vaginally. In women whose connecting tissues were damaged during pregnancy, faecal incontinence condition was observed.
Does that mean, caesarean delivery can be preferred over vaginal delivery? NO. Vaginal delivery can increase the chances of Stress Urinary Incontinence in some women but there are other problems that can occur in caesarean delivery cases such as haemorrhage, infection, pulmonary embolism etc. The chance of hemorrhage was 10 times higher in women who underwent caesarean for delivering the baby.
Apart from pregnancy, what other factors contribute to pelvic floor dysfunction in women?
- Obesity – In a study conducted in 2008, it was evident that women who are obese are at higher risk of developing stress urinary incontinence.
- Previous Child birth – Women who delivered a child previously vaginally are also at higher risk of developing SUI when they are pregnant with next child.
- Chronic (long term) cough during pregnancy increases the risk of Incontinence.
- Actual Strength of Pelvic Muscles – The initial strength of pelvic muscles before becoming pregnant also play a significant role in determining the chances of developing SUI.
Pelvic floor dysfunction due to child birth
Vaginal delivery of the baby starts with ‘crowning’, a stage when the largest part of the baby’s body, the head comes out from the vagina. At this stage, tremendous stress will be laid on the pelvic floor muscles, connecting tissues and the nerves in the region. In many women, several muscles and connecting tissues (fascia) are torn resulting in pelvic floor dysfunction. Tearing of the connecting tissues resulted in Urinary Incontinence in several women up to 3 months after delivery. Though these muscles and tissues have the property of healing, they cannot get back to the exact state before pregnancy in terms of strength. After child’s delivery, incontinence issues or pelvic floor dysfunction symptoms may subside but they can return once the woman starts ageing (at around menopause age) and as the muscles in her pelvis region start losing strength. Women with weak pelvic muscles develop pelvic floor dysfunction or incontinence issues much before menopause.
Injury or tearing of the perineal muscles and the anal sphincter results in faecal incontinence. It is not possible to determine the extent of the injury to the perineal muscles or the anal sphincter because of the swelling of tissues that happens during delivery.
Along with muscles and tissues, nerves also get stretched during labour. However, the elasticity of the nerves is very less (maximum of 22%) compared to that of muscles (200%). This over stretching of nerves can result in loss of nerve supply (called denervation) in peripheral nerves. Nerve damage during labour also causes Stress Urinary Incontinence. If pelvic muscle dysfunction occurs at the same time in such women, the condition becomes worse with time.
Self test for pelvic muscle action
To test for pelvic muscle action, women can try ‘Stop mid-stream test’. In this test, the woman should stop peeing half way. By doing this, she can know if she is able to control the muscles like she should.
Another test is to palpate the skin in the perineum area (The area between the anal opening and vagina) and feel for movement in upward and forward directions as the muscles contract. Alternatively, the woman can insert her finger or thumb in her vagina and feel the contraction of muscles as she moves her finger upward and forward towards her bladder.
Every woman is advised to maintain healthy weight at all times and work on her pelvis region to strengthen the muscles in the area. Whether before pregnancy or after delivery, it is important to keep the pelvic muscles strong to avoid several problems arising out of pelvic floor dysfunction.