poor pelvic floor

After DS birth I had really bad issues with my pelvic floor. It's all so much better now after almost a year of physio. I still have problems sometimes when I cough, sneeze or at the gym. I've modified how I do aerobics to limit the jumping and pressure on my pelvic floor.

I'm not sure what I should do. Should I go for more physio or given I've had a year of it already do I have a poor prognosis? I'm kind of thinking I might need an operation, but I can't do that until we have decided that we have finished with having children. There is a history in my dad's side of the family of poor pelvic floor after childbirth. My aunt had to have an operation to rectify things for her.

I kind of feel a bit alone on this one. I know around 1/3 or something of women have these issues but because it's embarrassing no one talks about it. Does anyone feel comfortable sharing what type of action they took when they had issues post-12 months and if it led to further improvement?

I was going to suggest physio but it sounds lioke you have we;; and truly done that. Do you see a specialist pelvic floor physio? Have you had a second opinion from another physio or urologist?

After having DD1 I had some prolapse issues although no incontinence. After seeing a physio for approx 6 months I had no symptoms except the first 1-2 days of AF. Her reccommendations were pelvic ffloor exercises, not lifting heavy loads,weight loss, avoiding constipation and she said once I stopped breastfeeding things would also improve (she didn't say to stop, just told me that when I chose to stop the change in hormones would improve my pelvic floor. For me this all helped and I while Ihad an uncomfertable prolapse after dd3's birth with excerises it was aback to normal (for me) within a month. She said things that you can't change were family history/genetics (Im in a similar boat to you) and that statitically the first and fourth child do most damage, and that a significant amount of perlvic floor damage is attributed to pregnancy not birth, so a c/section birth can still leave the mother with significant pelvic floor damage. She also said instrumental deleviries have a slightly higher risk of pelvic floor damage too.

Do you have any prolapse? Surgical repair is not advised until you have finished having children as subsequent birhs can undo the surgicla repair, but seeing a specialist can help as in some cases topical application of estrogen or a pessary can improve symptoms. Unfortunately being overweight can also worsen pelvic floor issues so weight loss helps

Good luck, its hard when people don't talk about these things. Oh and I can't do star jumps or skipping anyomre as it seems to worsen things but thats about all I can't do now (well things I cant do because of my pelvic floor, my lack of co-ordination on the other hand.......)

Ds was engaged for 5 weeks and resting on my pelvic floor so I had no control after his birth. I used a magnetic chair to help and am now pretty much back to normal only have issues after a big sneeze.

Speaking as a physio who has worked in women's health, I would suggest the first step is having a frank and honest chat to the physio you've been seeing and ask the same questions you've asked here. Make it clear that you appreciate the improvement so far, but that you still want to get even better, and if you feel like the improvement has plateaued, tell her that, too.

You didn't say what format the physio has been taking over the last year, so no-one could say that you have a poor prognosis. I bet you haven't tried everything that a really good specialised women's health physio has to offer! It may be that you need to change your exercise type or parameters, (increasing reps or intensity, or doing exercises in more functional, upright positions instead of lying down, for example) or if treatment has mainly been passive (ie, the physio uses the machine on you to make the muscles work) then you may need to be moving towards a more active approach, (ie, you make the muscles work on their own without the machine's help.) If treatment hasn't changed and progressed over the course of the year, it's definitely time to progress! Feel free to pm me with more details of what kind of treatment you've been having, and I might be able to make further suggestions.

Depending on the physio's response, you might then decide to continue with the same physio, or to get a referral from your GP to have a chat with a gynaecologist about further investigations/diagnostics/treatments, or find a different women's health physio to take things further. Note that seeing a gynae doesn't mean committing to having surgery straight away. It can be very helpful to have a specialist talk through your options, some of which may well be applicable now, even if you're planning on having more children.

Pholi - it's been several months since I had physio. I was having it through my public hospital which I gave birth at. It kind of ran out at the 12 month mark. I was doing exercises of various descriptions including squats, attempting to do jumps (couldn't really hold though), doing steps and marching. I never had a machine. I feel like the treatment plateaued at about 6 months. Initially I had big improvements as things were really bad so I have come a long way.

Blackrose - what's a magnetic chair?

Sararose - I don't have prolapse, but similar to you I can't do star jumps and skipping.

Thanks for your responses.

Lisa, I presume all of that was done with you consciously tightening your pelvic floor? Did they actually assess your pelvic floor strength and endurance (ie, physio uses a finger inside your vagina and you squeeze on the finger? This gives a really good baseline measurement of function, and it might be that you have great strength but poor endurance, or vice versa, and this determines what kind of exercise you'll still benefit from. I would recheck this every few weeks/every few months with my ladies, to measure the improvement and make sure they are still getting things right.

I've treated ladies who believe 100% that they're doing the right thing when they try to contract their pelvic floor, but when I actually have a feel, they're not getting it right still! That means that as many exercises as you do, you're wasting your time because you're not using the right muscles. (I'm not saying this IS the case for you, but it might be if you haven't been checked!) There might have been nerve damage which repaired to some extent over that first 6 months that things did improve, and it's plateaued because the nerve recovery is complete, but you're still not exercising the muscles to make them strong enough to jump, run, etc.

There are also little gadgets which you can use to exercise - vaginal cones are out of 'fashion' at present, but are still appropriate for some people, and there are several other mechanical 'exercisers' which variously increase the resistance to build strength, or give visual feedback so you can see how strongly you're contracting - and if you're getting it right or not. If you have a fairly good pelvic floor awareness and the ability to contract correctly, the electrical machines are less likely to be of benefit to you at this stage.

If the hospital wound up treatment according to protocol, as opposed to because they felt you were as good as you would get, you might be able to get re-referred by your GP back to the hospital, or find a private physio in your area who specialises in women's health, for a second opinion.

I second seeing a private physio who specialises in pelvic floor physiotherapy and getting assessed

Glad to know that we're not alone with these issues!

I had seen a gynecologist at the public hospital for my stress incontinence where I had given birth to DS and was referred to the physio there at the hospital, but I was told that it would be a 3 month wait through the public system just to get the first appointment! I didn't want to waste any more time (as it's been 2 years since DS was born) so I decided to see a private physio and I had my first session today.

They used an ultrasound to asses my pelvic floor muscles as I was doing the exercises to make sure that I had the technique right. I had no idea that I previously didn't have the correct technique to do the exercises efficiently to make a significant improvement. Although this is only my first appointment, I am much more optimistic about this approach and definitely recommend seeing a physio!