Pelvic Floor Self Assessment (ePAQ)
In Norfolk and Waveney every birthing person will be asked to complete a pelvic floor self-assessment questionnaire called ePAQ pelvic floor.
We are aware that symptoms related to your bladder, bowel and sexual health can be private and sometimes difficult to discuss with health professionals. However we know they can impact your quality of life.
The questionnaire will help screen for any problems and help get you any support you need.
You will be invited to complete your ePAQ once during pregnancy, and once after you have birthed your baby.
Pelvic Floor Exercises
It is recommended to do daily pelvic floor exercises during pregnancy and after birth. This will help prevent symptoms of Pelvic Floor Dysfunction such as bladder and bowel leakage or prolapse.
Your pelvic floor exercises or ‘Kegels’ can be performed in any position. Find one which is comfortable for you. You may find lying or sitting easier if your muscles feel weak and try standing when they are stronger.
Imagine that you are trying to stop yourself passing wind and urine at the same time. You can also think of squeezing tight in the vagina. You should feel your pelvic floor muscles ‘squeeze and lift’ inside. Don't hold your breath or clench your buttocks. You may feel a gentle tightening in your tummy, which are your deep tummy muscles working to help the pelvic floor.
Pelvic Floor Exercise Programme
Your pelvic floor exercises should include long squeezes and short quick squeezes.
How Often Should I do Pelvic Floor Exercises?
Try and repeat this programme 3 times a day. Build up to do 10 long squeezes for 10 seconds, then 10 short squeezes. You may need to start with little and often until the muscles get stronger
Build up your exercise programme over the following weeks and months. You should notice the exercises getting easier in around 3-5 months.
Once improved continue to practice them once a day to maintain the improvement. You may find the NHS squeezy app useful to support you with your daily pelvic floor exercises.
Healthy Bladder & Bowel
Having a healthy bladder and bowel can help you avoid Pelvic Floor Disfunction (PFD).
Eating & Drinking
Try and drink 6-8 glasses of water a day. Other drinks such as milk, herbal (caffeine free) teas, diluted squash and juices are also OK sometimes. This helps you to stay hydrated. If you don’t drink enough, your poo can become hard and difficult to pass.
During pregnancy it is recommend to avoid caffeine (including tea, coffee, coke) because it can increase your blood pressure and heart rate, and also increase the urgency and frequency that you will need to wee. This can lead to you becoming dehydrated.
Eating a balanced nutritional diet will help your poo to be soft and formed.
When using the toilet, sit down to wee, don’t hover! Sit in a relaxed position and lean forward with your feet apart. This will help your bladder to empty fully. Remember to give your bladder time to empty. When you have a newborn baby or small children you may often hurry off the toilet before you have completely finished. This can lead to you needing to go back again or leaking after.
Cut out ‘just in case wees’. During pregnancy you may feel you are going very often to the toilet due to the pressure of your growing baby. After birth, over the following weeks and months, teach your bladder to hold again, aiming for going every 2-3 hours. Try to avoid going just because you are going out the door! This can cause bad habits.
Check your urine. If it is dark, cloudy, smelly or blood stained make sure to tell your midwife or GP. During pregnancy you are more likely to get urinary infections and a health professional can check this for you, but also rule out other causes.
Use a footstool to poo. Placing a stool or toddler step under your feet can ensure you are in a more relaxed squat position. This will help pass your poo more comfortably.
Listen to your bowel. It is important to make time to poo when your body tells you it needs to go. If you miss the ‘call for stool’ it can then be harder to open your bowels.
Don’t strain, this can weaken the pelvic floor muscles further. If you are finding your poo is too hard and difficult to pass, discuss treatment options with your health professional.
Pregnancy Perineal Massage
The perineum is the area between your vagina and back passage. Tearing the perineal muscles during childbirth can place you at higher risk of pelvic floor dysfunction (PFD) symptoms, including difficulty controlling your bowels (wind and poo).
If you are pregnant and planning to have a vaginal delivery it is recommended that you practice perineum massage because it can reduce the risk of tearing the muscles in the back passage (anus) during your delivery.
It is recommended to massage from 35 weeks, 3-4 times a week. If you would like more information you can speak to your midwife about this during any of your appointments.
Download Squeezy App
Squeezy is a smartphone and tablet app that helps people with their pelvic floor muscle or 'kegel' exercises.
How do I access the App for free?
If you live in Norfolk and Waveney you will receive an invite to download the App after your dating scan. This will be a combination of an email and text message with a verification code to access your App. You can download the app from your mobile app store.
What does the Squeezy App do?
Squeezy helps by reminding you when it’s time to do your pelvic floor exercises, and guides you through completing them. It also has handy diaries to help keep track of any bladder or bowel symptoms, as well as other pelvic health information.
Squeezy comes preset with a clinically recommended exercise plan. If you are experiencing symptoms and working with a pelvic health specialist, Squeezy can also be tailored with a personalised plan to fit your needs.
It is important to note that the Squeezy App is not a replacement or an alternative to supervised pelvic floor physiotherapy but can be used as a tool to support this.
Getting More Help
If you have downloaded and trialled the Squeezy App and are still finding it difficult to squeeze and relax your pelvic floor muscles, please self refer for further support.
If you are experiencing symptoms, or need help practising pelvic floor exercises correctly contact your pelvic health professional who can help.
Pelvic floor dysfunction (PFD) is a term for a group of related conditions caused by the pelvic floor not working correctly.
Click the titles below for more information on PFD conditions and the treatments available if you need help.
In Norfolk and Waveney we have launched a pelvic health project to provide a pelvic floor health care system for everyone who is having a baby. You will be provided with the following to support your pregnancy and birthing journey.
For a referral to physiotherapy services please follow the routes below:
James Paget Hospital - referral via your GP, Midwife or Consultant.
Norfolk & Norwich University Hospital - self-referral via 24 hour answer phone on 01603 287 130. Please leave your name, hospital number, contact number and a brief description of the problem. You will receive a call back to speak about the problem. This service is for those who are planning to have their baby at NNUH, during pregnancy or up to three months after birth. From three months postnatal a referral is via GP, or consultant.
Queen Elizabeth Hospital - referral via your GP, Midwife or Consultant.
If you feel worried and would like more advice you can speak to your midwife throughout your pregnancy and up to 28 days after the birth of your baby.
If you live in Norfolk
If you live in Suffolk
These pelvic health advice sessions are recommended for all to attend during and after pregnancy. The sessions are led by Norfolk & Waveney NHS Perinatal Pelvic Health Service who aim to support all women and birthing people by increasing awareness of pelvic health topics such as exercise in pregnancy and the birthing year, bladder control, constipation and pelvic floor exercises!
These sessions are held virtually or face to face. Click below to find out about more details and book a spot.