The pelvic floor is composed of muscle and connective tissue; damage to either has implications on its function. Damage to the musculature and sphincters of the pelvic floor may be caused by stretching, cutting or tearing during delivery or by instruments used in an assisted delivery. Damaged muscle is replaced by fibrous tissue, reducing the over­all strength of the muscle and increasing the risk of stress incontinence.

Painful perineum
Pain is often felt in the perineum for some weeks following delivery. Most women should feel more comfortable within a month although some may take more than two months. Discomfort may follow an episiotomy or tear which has not repaired well either because of poor stitching leading to lumpy scar tissue, or because of infection.

What can be done to help? Pelvic floor exercises are invaluable to assist the healing process, although many women may be apprehensive about doing these exercises with a sore perineum. Pain may be more severe with the first contraction but should decrease with repetition as the swelling is reduced. Increased blood flow to the damaged tissue speeds up the healing process, removing waste products from the area and helping the edges of a cut or tear to close together. It is vital that the pelvic floor is contracted whilst coughing, sneezing or lifting to counter-brace the rise in intra-abdominal pressure.

Stress incontinence
Stress incontinence is the consequence of weak pelvic floor muscles which cannot with­stand sudden rises in intra-abdominal pres­sure. This occurs when coughing, sneezing, laughing or during exertion such as lifting, jumping or running and results in a small leak of urine. This condition has a high incidence rate - one in four women - and usually occurs after childbirth.

What can be done to help? Pelvic floor exercises should be frequently performed. The quick 'snatched' exercises will have the greatest effect on this condition although the slow exercises should still be encouraged. With regular use these muscles will, in time, be recruited reflexively to brace the pelvic floor and prevent leakage. It will not be possible to achieve more than 10 repetitions per set of the quick contractions as these fast-twitch muscle fibres will fatigue quickly. For more severe cases small weighted cones can be used to increase pelvic floor strength; these are inserted into the vagina and held in place over a period of time - for further details consult an obstetric physiotherapist.

Exercise and stress incontinence activities which cause obvious impact to the pelvic floor should be avoided as this will exacerbate the condition, e.g. jumping, horse riding, trampolining and running (although this is dependent on the technique). Resistance training and vigorous abdominal work should be approached with caution as the rise in intra-abdominal pressure may also stress the pelvic floor. Pelvic floor exercises should be an integral part of the exercise regime and should be performed in sets of repetitions as with any other muscle group.