Today I want to write about a topic which is always surrounded by much intrigue in our English Speaking Mums in Paris facebook group: Perineal re-education. Not a week goes by where I don't see a question about this mysterious therapy asked by a mum who's been prescribed it after giving birth. I asked the lovely mums in our group what they'd like to know about re-education and got some fantastic responses. It seems that there's a lot of mystery and myth surrounding re-education, what to expect and why it's practiced so widely here (hint; it's not, as the myths might suggest merely to make monsieur feel a little more snug!)
I've enlisted the help of three experts in their fields to explain to you all the what, why and how of Perineal re-education.
- Vicki is a UK based physiotherapist specialised in female health care and she'll be telling us all about the amazing muscle, or group of muscles that make up the pelvic floor and why it's considered so important to re-educate them.
- Sharon Bales is a wonderful yoga teacher whom I'm sure many of you know personally. She specialises in fertility, pre and post natal yoga and is also now teaching hypnobirthing classes here in Paris. She'll be talking about how we can care for our perineal muscles in our daily movements and how to keep them healthy.
- Diana Powell-Bodrone is a midwife and lactation consultant who works here in Paris under the French healthcare system and is going to tell us all about how to get your free re-education sessions.
- What is my pelvic floor and why might it need to be "re-educated"?
The pelvic floor is a layer of muscles within the pelvis. Its functions include support of internal organs (bladder, bowels and womb), maintaining continence of both the bladder and the bowel, assisting in bladder emptying and sexual function.
It can be weakened by both pregnancy and childbirth, menopause, recurrent coughing, constipation/straining, lack of general fitness and neurological damage and the common conditions associated with pelvic floor weakness include incontinence, prolapses of bladder, bowel and womb and faecal incontinence.
- Why do I need to worry about this if I've given birth, either vaginally or by c-section?
When you're pregnant with the growing foetus inside your womb, the muscles are stretched significantly over a long period of time. Without muscle retraining, they will not necessarily spring back into place following childbirth (whether you gave birth vaginally or via c-section). Therefore exercise is needed to shorten and tighten the muscles again, reducing your risk of the above conditions associated with a weakened pelvic floor.
- Why have I never heard of this reeducation where I am from?
Unfortunately, lack of education. This country (The UK) is particularly poor at education in the ante natal period. People are handed leaflets within a pack of information regarding childbirth and pregnancy by their midwife but are not specifically trained or educated regarding the importance of this muscle.
- Why is this so important?
Leakage of urine is a common and well known problem for women following childbirth. It is known to affect 1 in 3 women.
The incidence of 3rd degree tears is as high as 1-9% of all vaginal deliveries, as recognised by the Royal College of Obstetrics and Gynaecology (RCOG). This could have a huge impact on a women’s continence, both bladder and bowel in the short and long term. It can also affect sexual relations due to pain. The incidence of faecal incontinence as a result of these tears is as high as 50%, but is not discussed as openly as urinary incontinence. Failure to manage these conditions at the time of injury could be detrimental to a women’s quality of life and many become socially isolated as a result.
The menopause can highlight problems with discomfort, leakage, pain and prolapse as a result of hormonal and vascular changes. These symptoms can be minimalized in the future with regular pelvic floor training immediately following childbirth and for life. Up to 30% of women who attend physiotherapy on their first session are not correctly performing a pelvic floor muscle contraction. It is vital that you know how to do this correctly for long term protection.
- How common are these problems?
1 in 3 women suffer with Stress urinary incontinence
50% of women have some degree of prolapse
1 in 10 people suffer with some form of bowel problem
21.8% of women complain of pain with intercourse
The first step in maintaining a healthy pelvic floor is to establish a healthy connection to it. There is so much bad and old information out there about the pelvic floor. Many women never even consider their pelvic floor until pregnancy or post-birth recovery, and many, many women honestly have no idea what the pelvic floor is. Understanding that these muscle bundles, which should operate in harmony with the respiratory diaphragm are in fact an integral part of your core strength is key.
Another great myth of the pelvic floor is that every woman needs to tighten and strengthen and do kegel exercises to achieve this. Oh dear, this is such an oversimplification that it is simply worthless information. It's important for the pelvic floor to not only be able to contract and be strong, it is just as essential to be able to relax these muscles. In fact, a "too-tight" pelvic floor, or what is called a "hyper-tonic" pelvic floor, is often the culprit in pelvic pain and other pelvic issues.
Once you can connect with your pelvic floor and it's clear which muscles we're talking about, learning to engage these muscles in movement will make you feel stronger... because you are stronger when using these muscles correctly! We have so many movement habits in our lives, it's important to start thinking about the way we move, sit, stand, and carry things and how this impacts the balance of those muscles.
Connecting with and maintaining the health of your pelvic floor will not only strengthen your core power, but will also do much to prevent prolapse of pelvic organs, allow you to breathe more deeply and efficiently, prevent and resolve some pelvic pain issues including pain during sex. Training those muscles to engage and release properly will usually resolve problems with leaking pee when you laugh, cough, jump, etc.
- How can I obtain my free re-education sessions in France?
Usually you will be given a prescription when leaving the maternity. This is however, changing a little and is not always prescribed upon discharge to mothers who've had "normal" complication free births. This does not mean that you're not qualified for it. Ask your midwife or gynaecologist at your six week check up for a prescription and they'll be able to give it to you. You can also ask your general practitioner or gynaecologist at any point for a prescription and they will give you one for ten, or more sessions.
- What are the methods of re-education?
On the prescription there is usually three things:
Sondre (this is a wand used for internal muscle stimulation when there is no feeling)
Manual (this is the part when the practitioner goes through various exercises using their fingers to work the internal perineal muscles)
Abdominals (It's really important that this is included in the re-education programme as these are the support of the pelvic muscle)
Both sage-femmes (midwives) and kinéstherapistes (physiotherapists) can perform just one, or a combination of these techniques to achieve results. You should ask, upon meeting your practitioner, which techniques they practise and make a choice based off of your preference.
Ladies I just cannot over-state the importance of these re-education sessions, if only if as a tool to get to know your pelvic floor. If a medical environment is not your thing, get yourself to one of Sharon's classes, take a beginners pilates class (lots of pelvic floor connection!) do some reading about your muscles and learn about how your amazing bodies work! Putting some good work in now can truly make a difference in the fight against some of the above listed conditions and, as women we need to take the time to take care of ourselves and do some preventative healthcare!
If you need any help or advice about pelvic pain, incontinence, pain during or after sex or any other problems, do ask your gynaecologist, midwife or general practitioner what can be done to help. There are options out there!
You can find all of Sharon's details here.
And all of Diana's details here.
And finally, these gorgeous designs are by Duvet Days and you can get them here. Designs by Duvet Days Is a subsidiary of DuvetDays.org – An organization that uses design to create awareness, self discovery, and a space for self-love while supporting those affected by rape and domestic abuse.