More than half of women between the ages of 30 and 75 have experienced urine leakage while laughing or sneezing. Urinary incontinence, also known as bladder weakness, is a widespread condition in society. Approximately 50 percent of women suffer from it, many of them between the ages of 30 and 39.
A strong pelvic floor is the best way for women to prevent urinary incontinence. However, the prevalence of bladder weakness in society is not discussed enough, and the importance of pelvic floor exercises for health is still underestimated.
To learn more about the pelvic floor, I visited the St. Joseph-Stift Pelvic Floor Center . There we spoke with Dr. Sabine Gaiser and Dr. Kerstin Volkmer, the medical directors of the Pelvic Floor Center, as well as with Annika Krüger-Tiefenbach, who works there as a physiotherapist specializing in pelvic floor therapy.
In the second part of our two-part pelvic floor series, you will learn more about the role and function of the pelvic floor after childbirth and postpartum recovery (Here you can read part 1 "How pelvic floor training gives us the chance to find our stable center").
How does the pelvic floor change after childbirth?
Dr. Sabine Gaiser:
"We often have women who come to us six weeks to three months after giving birth, desperate because their pelvic floor is weak and they have severe symptoms of prolapse. During breastfeeding and throughout the first year after delivery, there is still a good chance that the pelvic floor will strengthen again – perhaps with the support of exercises, depending on how pronounced the weakness is.".
Once breastfeeding ends, the hormonal cycle regulates itself. Hormone production then supports the function of the pelvic floor again. The postpartum recovery process is generally not complete until about a year later, and many symptoms subside by then.
This does not necessarily mean that the pelvic floor is back to how it was before childbirth – all women need to know that these changes are partly physiological – but the discomfort and the massive feeling of prolapse are gone.”
From what point after childbirth is it possible to strengthen the pelvic floor again?
Dr. Kerstin Volkmer:
"Women should wait for the natural recovery process to complete. During the postpartum period, the first six weeks after birth, the uterus shrinks back to its normal size. There are exercises many midwives recommend for this period, which are only done while lying down, but these are mostly just awareness exercises. And you shouldn't really start exercising until after the postpartum period is over, so at the earliest after six weeks.".
Our postpartum recovery classes usually don't start until three months after birth. This is mainly for practical reasons, like childcare. It's called the postpartum period because women used to be expected to rest. I've noticed that many women nowadays think they have to be fit and up and about right away. But that's absolutely not the case. No, in the beginning, you should rest, take care of your baby, get used to each other, not walk around so much, not have so many visitors, and not try so hard to be Miss Perfect.
I think postnatal exercises without children make much more sense, because how many women are truly focused when the baby is present? My advice: You don't have to start early, but when you do, you should be fully present and engaged
Dr. Sabine Gaiser:
"I would argue that some of these postpartum recovery courses are not effective for various reasons. Perhaps the woman isn't ready yet, the children are present, or the course doesn't focus sufficiently on the pelvic floor. Often, it's a good idea to take a pelvic floor course specifically after a postpartum recovery course."
What should be considered during postpartum recovery and pelvic floor training?
Annika Krüger-Tiefenbach:
"It's always good to do something for your pelvic floor. The sooner you know what to pay attention to, the better. Therefore, it makes sense to find out before giving birth how best to carry the baby or how to take care of your still weakened pelvic floor.".
Carrying a baby car seat, for example, to the side is detrimental to core stability and a weakened pelvic floor. It's better to carry the car seat in front of the midline. These are all very strenuous activities. It's also about how to avoid pressure on the pelvic floor in everyday life. This is much more protective than a lot of exercise.
It's more about taking care of yourself, being careful, and concentrating fully on what you're doing. Anything that puts strain on your back also puts strain on your pelvic floor – if you keep that in mind, you can protect yourself quite well.”
What if pelvic floor exercises no longer help?
Dr. Sabine Gaiser:
"For example, a woman who has given birth to two children tells her gynecologist: 'When I go to my exercise class and jump around, I leak urine. Otherwise, I don't have this problem in my daily life, and I don't need to go to the toilet more often. But I don't want to do any exercise anymore.' Usually, the woman does pelvic floor exercises, which help, but she says: 'If I jump really hard or jog for a long time, I still leak.'".
These are women who can effectively manage their bladder by using a special tampon, inserted into the vagina like a menstrual tampon, while exercising. The tampon then supports the urethra from within the vagina, preventing urine leakage when pressure is applied to the bladder.
This means they don't need anything in everyday life, but when they go to the gym, they insert this tampon beforehand and can jump as much as they like. Young women in particular can cope well with this; they don't need surgery and have a tool to be able to pursue sporting activities again without worry
The most important message…
Annika Krüger-Tiefenbach:
"The important thing is simply to get regular exercise, maintain balance, and incorporate pelvic floor training, whether in a suitable class at a sports club or at a pelvic floor school. Even after three children and during menopause, women should be active. There's a lot you can do yourself. Pelvic floor training is our chance to find our core stability and strengthen it – this is an opportunity you shouldn't miss!"
Sabrina Muscharski completed her practical semester at the Bremen Family Network and, as part of her Public Health studies at the University of Bremen, created a poster series on the topic of "Bladder Weakness and Pelvic Floor Training with Ben Wa Balls" together with her fellow student Sarah Bauder. She conducted extensive research for this project and carried out this interview in March 2022.
Part 1/2: How pelvic floor training gives us the chance to find our stable center.
Part 2/2: Out of postpartum recovery, into movement!