How Can I Prepare My Pelvic Floor, To Avoid Problems After Delivery?

As you're surrounded by the commotion over painting the nursery or planning the baby shower, it's easy to overlook, as your due date approaches, one of the most important issues: your body. But would you enter into any other major physical event without stretching, working out, and getting yourself into shape?

Start Early. The best time to start practicing prevention is your first baby, since this pregnancy and delivery appears to carry the most potential risk of injury – and it's the one during which you can probably do the most good. On the other hand, if your first pregnancy is already behind you, several pelvic floor problems do have the potential to worsen 'from baby to baby' – and you should be aware of all you can do to minimize this cumulative risk.

'Kegel exercises' can be used to strengthen the pelvic floor, and your first pregnancy is one of the best times in your life to learn about them. Not only because the need is so great – up to 70% of women will have some stress urinary incontinence during or after pregnancy – but also because the pelvic muscles are still at their greatest potential. Increasing their strength will make incontinence and pelvic floor problems less likely.

Perineal massage involves gentle stretching of the vaginal opening, using your fingers and a bit of lubrication. Two studies have suggested that perineal massage performed in late pregnancy may decrease the risk of perineal injury and pain afterwards.

Weight gain and fitness may influence the risk of pelvic floor injury, as being overweight means more stress on the pelvic floor muscles and nerves. Studies have shown that although women of all sizes may experience incontinence during pregnancy, long-term problems are more likely among women gaining a lot of weight, and those overweight before pregnancy began. Check with your obstetrician or midwife to determine your 'ideal' pregnancy weight goals, and the most appropriate diet and exercise routine. Posture and lifting habits, pelvic tilts, and 'bracing' of the pelvic floor, are among other helpful tips to learn about.

Adapted From: "Ever Since I Had My Baby: Understanding, Treating and Preventing the Most Common Physical Aftereffects of Pregnancy and Childbirth", by Roger P. Goldberg, MD MPH

(Crown Publishers, Random House, NY 2003)