4 Ways to Get Pelvic Floor Muscles to Contract
Muscles should be able to turn on and off to contract and relax like a light switch. In the clinic, I rarely see this happen with the pelvic floor muscles after birth. Here are 4 main areas I address in my sessions to improve pelvic floor function in the postpartum period often within two sessions.
Stabilize the Pelvic Bones
When working with the pelvic floor, we often focus on the muscles, but what about the pelvic bones themselves? The bones are giving structure and stability to this space and move during birth, so we want to help the bones return to their normal position in the postpartum body.
For a vaginal birth, the sacrum needs to move into flexion for the baby to come on out. The ischial bones need to move laterally. Sometimes, one ischial tuberosity is more splayed out than the other, depending on the person’s position when they gave birth. Depending on the birth’s progression prior to a cesarean birth, these structures may be impacted as well.
Letâs think about the effect on the pelvic floor muscles when the sacrum goes into flexion or the ischial bones splay. The coccygeus muscles bilaterally will be on stretch with sacral flexion and the levator ani muscles will be more on stretch with an ischial splay. We know a lengthened muscle is not as strong. When the bones find their original position the muscles can function better, but the muscles may need to be reset into their normal, more shortened position.
Paying attention to the tension and tone in the pelvic floor muscles, identifying what pelvic bones might be impacting and creating that tension, and addressing them is a great place to start.
Address Intravaginal Organs
Once the bones are addressed, then the next area to work on is the anterior vaginal wall, or bladder as I like to say, seeing as itâs right behind the pubocervical fascia. Making sure there is no pulling on this tissue and the bladder is in midline will have a positive impact on the function of the pelvic floor muscles.
The next organ to address is the cervix. The cervix may wind up anywhere vaginally after birth. It could be off to the sides with tightened cardinal ligaments, it could be poking into the anterior vaginal wall with lengthened uterosacral ligaments, or it could be tucked way back posteriorly with tightened uterosacral ligaments making it challenging to reach. The cervix needs to be pinata-like in its intravaginal mobility. It has to be able to move 360 degrees and be able to move up and out of the way for pain-free intercourse.
Letâs think about how sacral flexion may impact the position of the cervix because of the influence of the uterosacral ligament. If the sacrum is lifted backward, this will put excessive strain on the uterosacral ligament and pull the cervix toward the sacrum and may reduce the cervixâs ability to move away from the sacrum.
I have found that the cervix’s mobility is essential to healthy pelvic floor muscle function and to preventing pain in the vaginal tissues. Offering a connection or releasing the uterosacral ligaments to tonify or lengthen them can be a big game changer in creating mobility for the cervix.
Release the EAS/IRF
Those are a lot of letters referring to the external anal sphincter, EAS, and the ischiorectal fossa, IRF. These two structures are critical for the optimal function of the pelvic floor muscles. I always find knots in the EAS after vaginal birth, sometimes leaving the sphincter muscle held open. Knots and a held-open EAS can minimize pelvic floor function. Releasing the knots and assessing and releasing the IRF can dramatically improve pelvic floor muscle function.
Consider the Trauma Response
The less obvious issue that could be causing pelvic floor muscle dysfunction is a trauma response in the tissues. I will go here when I canât get a muscle to relax or contract when all the above issues have already been addressed. When tissues donât respond to anything, consider a trauma response.
I had one client I was seeing for the third time, and I kept finding her sacrum resistant to moving into extension. It was stuck in flexion, and the left ischium was more splayed. Iâd treated it two other times, and it was still presenting with the same patterns. The left side levator ani muscle group couldnât contract and held tension in the muscles that would not let go.
I worked with the client on the trauma release statement, âWe just ask these tissues to release any shock or trauma knowing the baby is out, the labor is over, and everyone is ok.â Her body wasnât on board with knowing the baby was out and the labor was over. There was a limiting belief stuck in there that we released, and then the statement landed better, and the tissues started to soften. Afterward, the pelvic floor muscles could contract and relax more normally. The difference was amazing!
Achieving a Stronger Pelvic Floor Muscle Contraction
Keep these steps in mind when working to get a stronger pelvic floor muscle contraction, and remember the connection to ALL of the structures. If one of them is restricted, it will affect the others. Remembering the relationship between all the anatomical structures in the pelvic space can help you avoid blaming the pelvic floor muscles alone. They are at the effect of everything else! When you address these other structures you will find there is very little to do to the pelvic floor muscles themselves to get them to activate stronger.
About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com